Summary: The CAD/CAM technology for mandibular reconstruction has improved the results in terms of outcomes in restoring mandibular complex defects. Augmented reality (AR) represents an evolution of the navigation-assisted surgery. This technology merges the images of the virtual planning with the anatomy of the patient, representing in this way an enhanced scene for the surgeon’s eye. AR can also display in a single scene additional information for the surgeon. Despite of classical navigation, this scenario can be obtained with marker-less registration method, without using reference points or fiducial markers. This technologic evolution together with the large use in our experience of CAD/CAM protocol for mandibular reconstruction we developed this feasibility study to evaluate the possibility of using a marker-less image registration system. Moreover, we tried to evaluate the overlaying of the virtual planning and its reproducibility using AR. We performed a case series of 3 consecutive patients who underwent mandibular reconstruction using AR-assisted fibular free flap harvesting applying our digital workflow. Once launched, the mobile app installed on our tablet, the registration is performed according to a shape recognition system of the leg of the patient, rendering in real time a superimposition of the anatomy of the bony, vascular, and skin of the patient and also the surgical planning of the reconstruction. AR-assisted fibular free flap harvesting was performed. We believe that AR can be a prospective improving technology for mandibular complex reconstruction.

The goal of surgical treatment of mandibular cysts is their eradication. This result can be achieved by ensuring minimum risk of morbidity, while preserving the integrity of the bone structure and the functionality of the inferior alveolar nerve. The generation of bone defects after enucleation has always posed the dilemma of using filler materials or not. The aim of this study is to evaluate the degree of spontaneous bone regeneration, in terms of volume, in patients undergoing enucleation of mandibular cysts, measuring the real 3D volume of the cystic residual cavities. We included in our study 15 patients with mandibular cysts, treated from January 2018 to June 2020 at the Policlinico-Vittorio Emanuele and Policlinico-San Marco hospital of Catania and evaluated preoperatively (T0), 6 months after surgery (T1), and 12 months after surgery (T2). The results showed that after 6 months, independent of the initial volume of the cyst, around 90% of the cavity was filled with new generated bone. In conclusion, we believe that the full-3D measurement protocol can help us to understand the timing and modality of bone restoration after mandibular cyst enucleation.

Objective: The objective of this study is to investigate whether age is a significant risk factor for spinal nerve injury following selective neck dissection (SND) in patients with head and neck cancer. Methods: A retrospective cohort study was conducted on patients who had undergone SND for head and neck cancer at a tertiary hospital between 2020 and 2022. The primary outcome was the incidence of spinal nerve injury after SND. The secondary outcomes included the types and severity of spinal nerve injury and the impact of age on these outcomes. Results: A total of 78 patients were included in the study and subdivided into two groups. Two shoulder-specific questionnaires (the Shoulder Pain and Disability Index (SPADI) and the Shoulder Disability Questionnaire (SDQ)) were administered to assess shoulder morbidity postoperatively. Twelve patients showed shoulder impairment following surgery. We divided the sample into two age-based groups; the older group showed a higher rate of SAN injury and the younger group showed a lower rate of improvement over time. Conclusion: This study suggests that age is a significant risk factor for spinal nerve injury following SND in patients with head and neck cancer. Older patients are more likely to experience spinal nerve injury after SND than younger patients. The findings of this study may help in the development of strategies to prevent spinal nerve injury in older patients undergoing SND for head and neck cancer.

Osteonecrosis of the jaw (ONJ) is a disease that affects the jaw. It is mainly related to radiation or bisphosphonates therapy, and the symptoms and signs consist of pain, bone exposure, inflammation of the surrounding soft tissue swelling, and secondary infection or drainage. In the case of advanced disease of the mandibular area, the treatment of choice is mandibular resection and reconstruction. In the present study, we report a case series of patients affected by ONJ and treated with a customised bridging mandibular prosthesis-only technique. From 2016 to 2018, we treated five consecutive patients affected by ONJ: three patients were affected by biphosphonate-related osteonecrosis of the mandible (BRONJ) and two were affected by osteoradionecrosis of the mandible (ORNJ). Three patients needed a soft tissue free flap to permit optimal wound closure, intra- and/or extraorally. All reconstructive procedures were carried out successfully, with no major or minor microvascular complication. The average postoperative follow-up was 24.8 (range 10–41) months. Considering that microvascular bone transfer is a high-risk procedure in BRONJ patients, we can conclude that the positioning of a customised bridging mandibular prosthesis (CBMP), whether or not associated with a microvascular soft tissue transfer, is a safe technique in terms of surgical outcome and feasibility.

Purpose: Oral Squamous Cell Carcinoma (OSCC) is characterized by a high aggressiveness and a tendency to metastasize. The management of the neck in cT1-2N0 patients c follows three strategies: watchful waiting, elective neck dissection (END) or sentinel lymph node biopsy (SLNB). The aim was to assess the viability of intraoperative frozen sections of the nodes of cT1-2N0 to spot occult metastases as an alternative to SLNB, performing a modified radical neck dissection (MRND) in intraoperatively positive patients. Methods: The patients were treated at the Maxillo-Facial Surgery Unit of Policlinico San Marco of Catania between 2020 and 2022. END was performed in all patients, including frozen section examination of at least one clinically suspicious node per level. In case of positivity after frozen section examination, neck dissection was extended to levels IV and V. Results: All frozen sections were compared with a definitive test after paraffin inclusion. During surgery, 70 END were performed, and 210 nodes were analyzed with frozen sections. Among the 70 END, 52 were negative after frozen Sects. (156 negative nodes), and surgery was ended. Five of the 52 negative ENDs resulted in pN + after paraffin inclusion (9.6%), which underwent postoperative adjuvant treatment. The sensibility of our END + frozen section method was 75%, while the specificity of our test was 94%. The negative predictive value was 90,4%. Conclusions: Elective neck dissection + intraoperative frozen section could be an alternative to SLNB to spot occult nodal metastases in cT1-2N0 OSCC due to the opportunity to perform a one-step diagnostic/therapeutic procedure.

Ameloblastoma is a benign tumor with clinical significance due to its high incidence as well as high recurrence rate after surgical enucleation. Notably BRAF V600E pathogenic mutations have been reported in high rate of ameloblastoma. The aim of this study was investigating the association of BRAF V600E expression with clinicopathological characteristics, treatment outcomes and recurrence rates. We have analyzed 10 patients with ameloblastoma followed by a three-year evaluation, to understand the pathogenesis and molecular mechanism underlying the tumorigenic. All samples were tested for genomic DNA to identify Esone 15 mutations (codon 600) by PCR and perkiness on rotorgene Q and Pyromark Q24, by the Pathological Anatomy Department. Positive BRAF V600E mutation was detected in 4 of the 10 ameloblastoma cases. Three of the patients with BRAF V600E mutation had a recurrence within 3 years from the first surgery. The fourth patient with mutation showed no signs of relapse during followup. In only one BRAF- patient we showed recurrence of disease, 14 years after the last surgery. Another significant finding from the study is the correlation between the presence of the mutation and the initial size of the lesion. Ameloblastoma with BRAF V600E mutation has been observed with a higher recurrence rate and an increased initial volume of the lesion. The results obtained demonstrate an increased aggressiveness and invasiveness of BRAF + ameloblastomas.