Background.  Management of Medication related osteonecrosis of the jaw (MRONJ) is challenging and there is little evidence about the effectiveness of treatments. The present study aims at assessing the value of the SICMF-SIPMO MRONJ staging system as a predictor of treatment success. Patients & Methods. We performed a 10-years longitudinal cohort study at the Unit of Maxillofacial Surgery of Padova University (Italy). The study was approved by the local Ethical Committee of the University Hospital of Padova (CESC 4920/AO/20 - 24 September 2020). Patients were included in the study if they satisfied the SICMF-SIPMO clinico-radiological diagnostic criteria of MRONJ and were staged accordingly. Patients were assigned to each surgical treatment based on the SICMF-SIPMO classification. Patients were followed up at three-month intervals up to 1-year and underwent a CT scan of the jaws at three, six, and twelve months postoperatively. Results. Overall, a total of 70 patients reached the 12-month follow-up and 75 operated jaw sites were available for the analysis.The cumulative curative rate (CR) at 1-year follow-up was 85.3%. MRONJ recurred in 9 jaw sites (12%). The curative rates did not significantly differ between maxilla and mandible (87% vs. 84%). The underlying disease highly influenced the CR of MRONJ, with cancer patients more likely to develop recurrences within 1 year (CR cancer = 76% ; CR osteoporosis =100%). Bone curettage and sequestrectomy showed the highest CR in MRONJ stage 1, regardless of the underlying disease (88.2%). Marginal resection proved to be successful in MRONJ stage 2 with an overall curative rate of 81%. Nevertheless, MRONJ stage 2 patients with cancer showed high recurrence rates when treated with marginal resection. Segmental resection proved highly successful in MRONJ stage 2 (88.2%) and MRONJ stage 3 (92.9%). Of note, segmental resections in MRONJ stage 2 were mostly performed in cancer patients (12/15). Conclusion. In conclusion, the stage-related surgical algorithm proposed by SICMF-SIPMO can be safely used and it should be implemented to select the appropriate surgical treatment for MRONJ patients. Further studies are warranted before its final validation.

BACKGROUND. Assessing accuracy in CAD-CAM mandibular reconstruction poses significant challenges but is essential for ensuring reliable outcomes. Existing methods are often operator-dependent, lacking repeatability and reproducibility. PURPOSE. This study introduces the Global Positioning Layout (GPL) method, an accuracy assessment technique integrated into the reconstruction protocol based on CAD-CAM and additive printing technology. We describe the methodology and process for applying this approach in detail. METHODS. The GPL method was developed at the University of Padova, Italy. Key principles of accuracy assessment were identified and structured as Requirements, Data input, Data reference system, and Data output. The necessary 3D virtual models were defined: planned mandible, reference mandible, patient-specific implant (PSI), postoperative mandible, and postoperative PSI. A unique coordinate system (GPL-RS) was built on the reference mandible. Three Roto-Translational Matrices (RTMs) were applied to measure movements and deviations between the designed and postoperative models to assess reconstruction accuracy. RESULTS. A case study of mandibular reconstruction with a CAD-CAM titanium PSI is presented to showcase the GPL methodology. Geomagic Wrap® software is used, utilizing its Python programming tools and GEO and API libraries. CONCLUSION. The GPL method represents a significant advancement in assessing the accuracy of CAD-CAM reconstructions, providing valuable insights that can improve surgical outcomes.

Background: Currently, the standard design of the skin component of abdominal soft-tissue flaps recommended for head and neck reconstruction encompasses the upper and lower periumbilical region to include the maximum number of myocutaneous perforators. Yet, this flap design precludes the harvest of bilateral flaps and the use of the contralateral area in case of flap failure. Aim: We aimed at proving the long-term safety of infraumbilical abdominal free flaps in terms of abdominal wall integrity. Methods: Consecutive subjects who underwent reconstruction of composite cervico-facial defects with infraumbilical free flaps between 2008 - 2020 were enrolled. After surgery, patients were followed up at three-month intervals to evaluate the incidence of any complications at the donor site. Results: 25 patients underwent reconstruction with free flaps from the lower abdomen. A total of 35 abdominal flaps were performed; ten patients underwent bilateral flap harvest. Marginal abdominal skin necrosis occurred in 3 patients. Abdominal bulge occurred in one case; neither hernia nor abdominal wall weakness was encountered at a median follow-up of 12 months. Conclusions: The infraumbilical region is a safe donor area of free flaps for head and neck reconstruction that preserves abdominal wall firmness and provides a satisfactory cosmetic result at the donor site.