Francesco Ferragina’s research while affiliated with Magna Graecia University and other places

Background: Malignant tumors of minor salivary glands (MGSTs) are rare and exhibit significant heterogeneity in terms of etiology, histology and prognosis. Methods: This retrospective analysis of 48 resected MGSTs employed Receiver Operating Characteristic (ROC) curves and logistic regression models to evaluate the association between the systemic inflammatory response index (SIRI), the systemic immuno-inflammation index (SII), the neutrophil/lymphocyte ratio (NLR), and the platelet/lymphocyte ratio (PLR) with overall survival (OS). Although these biomarkers showed some correlation with OS, none were statistically significant when considered individually. Results: Significant correlation was observed between the SIRI, SII, and NLR with overall survival (OS). Among these, SIRI was the most reliable predictor, with an area under the curve (AUC) of 0.713, 80% sensitivity, and 70% specificity. Conclusions: While these inflammatory biomarkers correlate with the prognosis and risk stratification of MGSTs, there is currently no clinical utility in decision making due to the lack of standardization and their limited application in clinical practice.

Background: Ameloblastic carcinoma (AC) is a rare malignant odontogenic tumor with limited knowledge surrounding its pathogenesis, molecular pathways, clinical behavior, treatment, and prognosis. This 40-year literature scoping review aims to enhance the comprehension of this complex condition, looking closely at how AC works at molecular and pathophysiological levels and what causes it to develop. Methods: The PUBMED, Medline, Scopus, and Cochrane central databases were searched, including articles from 1984 to date. Articles reporting epidemiological, clinical, instrumental, and histopathological data were included. Results: Out of the 375 articles examined, 52 met the inclusion criteria, yielding a total of 80 cases of AC. All cases before 1984 were excluded from the analysis, as were all that did not provide information on patient survival. Several molecular mechanisms associated with its development and progression were identified; these help in early diagnosis. Moreover, AC can spread locally, making a radical surgical approach necessary. There is still no agreement on how to manage neck dissection. Surgical removal followed by monitoring is an important part of managing AC. Conclusions: Advancements in biological and molecular insights have the potential to facilitate earlier diagnosis and treatment. These could lead to improvements in patients’ quality of life and long-term survival.

Background: Intraoperative facial nerve monitoring (IFNM) is becoming increasingly prevalent as an established intraoperative aid in parotid gland surgery. To date, however, there are few scientific studies on the postoperative outcomes of submandibular gland surgery, particularly on the postoperative injury of the marginalis mandibulae branch (MMB) of the facial nerve (FN). This branch represents the most frequent and feared complication of this surgery, with an incidence of 1–7% of cases. Objective: This retrospective study aims to evaluate the incidence of postoperative MMB paralysis in patients undergoing submandibular sialoadenectomy for benign conditions from 2014 to 2023, focusing on the role of IFNM. Materials and Methods: The patients were divided into two groups: the subjects of Group 1 (G1) had undergone submandibular sialoadenectomy after identification and clamped facial vessels, without the aid of IFNM (from 1 January 2014 to 31 December 2018). Conversely, subjects in Group 2 (G2) underwent IFNM procedures (from 1 January 2019 to 31 December 2023). The classification of any FN malfunctions was conducted following the House–Brackmann grading system. A descriptive analysis was performed, and univariate and multivariate logistic regressions were used to examine the impact of IFNM on surgical timing and the association between G2 deficit (vs. G1) corrected for age, sex, and smoking status. Results: The study population comprised a total of 101 patients with a mean age of 55 ± 16 years. The sample population comprised 50 subjects assigned to Group 1 (49.5%, 24 females and 26 males) and 51 subjects assigned to Group 2 (50.5%, 21 males and 30 females). Postoperative paralysis of the MMB occurred in 23 subjects (22.77%), including 12 of G1 (4 had a grade II and 8 grade III dysfunction) and 11 of G2 (8 had a grade II and 3 grade III dysfunction). A six-month evaluation revealed that only five patients in G1, previously diagnosed with grade II dysfunction, exhibited a residual deficit. The mean surgical time for the entire patient cohort was 99 ± 44 min: 110 ± 43 min for Group 1 and 92 ± 42 min for Group 2 (Beta = −19; 95% CI −37 at −0.16; p-value = 0.048). Furthermore, a longer operative time was observed in smokers than in non-smokers (p-value = 0.008), suggesting that smoking affects the length of surgery (Beta = 0.32; 95% CI −0.08 to −0.55). Discussion and Conclusions: MMB paralysis is one of the most prevalent complications that may arise in submandibular gland surgery. IFNM provides surgeons with a valuable tool for identifying MMB in submandibular sialoadenectomy. The efficacy of IFNM as an aid is contingent upon the expertise of the operating surgeon.

Background: Oral tongue squamous cell carcinoma (OTSCC) is a common disease that can cause occult metastasis (OM). Methods: This study aims to investigate the role of the pre-treatment neutrophil-to-lymphocyte ratio (NLR) in predicting the presence of neck OM in early-stage OTSCC. We reprocessed the pre-treatment blood data to calculate the NLR and the PLR on patients treated for OTSCC. We used a logistic regression model and the ROC curve to estimate the probability of metastases in cervical lymph nodes using data from pre-surgery blood tests. Results: During the period under review, 113 patients were treated for OTSCC; however, only 74 met the inclusion criteria and were, therefore, enrolled in the study. Twenty-five patients (35.3%) had lymph node metastases, and 46 (64.7%) did not. Without the NLR influence, the probability of metastasis is less than 50% (β0 = −1.058). A higher NLR value means a higher chance of metastasis. This is shown by the positive value of the NLR level coefficient (β1 = 0.135) and the ROC curve (AUC = 0.83). Conclusions: Our study showed a statistical correlation between high pre-treatment NLR values and neck OM in patients with OTSCC. These results may help to identify which patients are at risk of developing OM and then choose the right treatment.

Background: Myomucosal cheek flaps are currently considered the main reconstructive option for small to moderate oral cavity defects. Many reconstructive techniques following the resectioning of oral tongue squamous cell carcinoma (OTSCC) have been proposed over the years. Methods: We report a case of OTSCC treated surgically and reconstructed with Bozola flap, analyzing the advantages and disadvantages of this surgical technique. The defect was classified according to the glossectomy classification proposed by Ansarin. Results: We believe that the Bozola buccinator myomucosal flap is a viable alternative to free flaps for the reconstruction of certain oral tongue defects. Conclusions: Based on our experience, the Bozola flap is an appropriate primary option for T1–T2 and certain T3 OTSCC defects (excluding the tip) for I–II and IIIa glossectomies, as recorded in the Ansarin classification.

Background: The use of intraoperative facial nerve monitoring (IFNM) is becoming more and more frequent, an established intraoperative aid in parotid gland surgery. To date, there are no scientific studies in the literature on the post-operative outcomes of submandibular gland surgery, in particular on post-operative injury of the marginalis mandibulae branch (MMB) that represents the most frequent and feared complication of this surgery, with an incidence of 1-7% of cases. Objective: In this retrospective study, the authors evaluated the incidence of postoperative paralysis of the MMB of the facial nerve (FN )in patients undergoing submandibular sialodenectomy for benign diseases, such as benign tumors and sialolithiasis, from 2014 to 2023, with particular attention to the role of IFNM in this context. Materials and Methods: The retrospective study was conducted at the Maxillo-Facial Department of Magna Graecia University of Catanzaro. The patients were divided into two groups: Group 1 (G1) consisted of subjects who underwent surgery without the use of IFNM and identification and clamping of facial vessels (1 January 2014 to 31 Dicember 2018); Group 2 (G2), consisted of subjects who underwent surgery with IFNM and without identification and clamping of facial vessels (1 January 2019 al 31 Dicember 2023). In G2 employed the Nerve Integrity Monitor (NIMR di Medtronic) and to classify the FN function we used the modified House-Brackmann classification. A descriptive analysis was performed, and univariate and multivariate logistic regression were used to examine the impact of IFNM on surgical timing and the association between deficit of G2 (vs. G1) adjusted for age, sex, smoking status for age, sex, smoking status. The level of statistical significance was set at p value<0.05. Results: A total of 101 patients were included in the study: 50 subjects were assigned to G1 (49.5%, comprising 24 female and 26 male, and 51 subjects were assigned to G2 (50.5%), comprising 21 men and 30 women, the mean age was 55 ± 16 years in the entire patient cohort. In 77% of the cases (n. 78, precisely 38 in G1 and 40 in G2), no facial nerve injury occurred. In 23% of the cases (n. 23, specifically 12 in G1 and 11 in G2), postoperative paralysis of MMB was observed. Of these subjects, nobody had permanent paralysis but only transient dysfuction (of the 12 patients of G1 four demonstrated grade I dysfunction while eight exhibited grade II dysfunction, of the 11 subjects of G2, eight exhibited grade I dysfunction, while three demonstrated grade II dysfunction). After six months the dysfuction of grade II persisted only in five patients of G1. The results of univariate and multivariable linear regression demonstrated that the surgical timing was found to be 99 ± 44 minutes considering the entire cohort of patients, 110 ± 43 minutes for G1 and 92 ± 42 minutes for G2 (Beta = -19, 95% CI -37 to -0.16 and p = 0.048). A longer surgical timing was observed compared to non-smokers (always statistically significant with a p-value of 0.008), suggesting that smoking status may influence the duration of the intervention (Beta = -0,32, 95% CI -0,08 to -0.55 and p = 0.008). Discussion and Conclusions: MMB paralysis represents one of the most frequent complications that can occur also in submandibular gland surgery and IFNM offers to the surgeon a valuable support in identifying the MMB in submandibular sialadenectomy. The use of IFNM can be a valid aid, but its effectiveness always depends on the competence but its effectiveness always depends on the competence of the surgeon.

Background: Facial nerve injury (FNI) is the most common complication of parotid surgery and manifests as FN paralysis. The use of intraoperative facial nerve monitoring (IFNM) is becoming an established intraoperative aid for surgeons, assisting in the identification of the location and dissection of the facial nerve trunk or branches. The postoperative outcomes of parotid surgery with and without monitoring have been addressed in only a limited number of studies. Objective: The objective of this study is to evaluate the incidence of postoperative paralysis in patients undergoing extracapsular dissection (ED) for benign parotid tumors concerning the use or non-use of IFNM. Materials and Methods: The retrospective study was conducted at the Maxillo-Facial Department of the Magna Graecia University of Catanzaro. The patients were divided into two groups: Group 1 consisted of patients who underwent surgery without IFNM (1 January 2015 to 31 December 2018); Group 2, on the other hand, consisted of patients who underwent surgery with IFNM (1 January 2019 to 31 December 2022). Group 2 employed the Nerve Integrity Monitor (Medtronic’s NIM®). To classify the FN function, we employed the modified House–Brackmann classification system. To evaluate the dependence between the “use of IFNM” and “postoperative paralysis”, a descriptive analysis was conducted, including applying the Chi-squared test and calculating the Pearson correlation. Subsequently, a binary logistic regression model was applied to further evaluate the correlation between the latter. The level of statistical significance was set at p < 0.05. Results: A total of 276 patients were included in the study: 120 subjects were assigned to Group 1 (43.5%, comprising 60 men and 60 women) and 156 subjects were assigned to Group 2 (56.5%, comprising 93 men and 63 women). In 91.7% of the cases (n. 253, precisely 105 in Group 1 and 148 in Group 2), no FNI occurred. In 8.33% of the cases (n. 23, specifically 15 in Group 1 and 8 in Group 2), postoperative paralysis was observed. Of these subjects, only two in Group 1 had permanent paralysis (8.69%); therefore, 91.31% had transient paralysis. As a result, 91.31% of the subjects exhibited transient paralysis. In the case of FNI, 78% of the cases involved the marginal mandibular branch (n. 18), 13% involved the temporo-zygomatic branch (n. 3), and 7% involved more than one branch (n = 2). The results of the multivariable binary logistic regression analysis demonstrated that the use of IFNM was a statistically significant influencing factor, with an estimated reduction in postoperative paralysis of approximately 62% (OR 0.378; 95% CI: 0.155–0.92). In Group 2, the occurrence of transient complications was significantly reduced (OR 0.387; 95% CI: 0.149–1.002 with p < 0.05). Discussion and Conclusions: The use of IFNM in the ED for benign parotid tumors significantly reduces the rate of FNI and, consequently, postoperative FN paralysis. On the other hand, the use of monitoring systems must not replace the experience and anatomical knowledge of the surgeon.

Background: Orbital floor fractures (OFFs) represent an interesting chapter in maxillofacial surgery, and one of the main challenges in orbit reconstruction is shaping and cutting the precise contour of the implants due to its complex anatomy. Objective: The aim of the retrospective study was to demonstrate, through pre- and postoperative volumetric measurements of the orbit, how the use of a preformed titanium mesh based on the stereolithographic model produced with 3D printers (“In-House” reconstruction) provides a better reconstruction volumetric compared to the intraoperatively shaped titanium mesh. Materials and Methods: The patients with OFF enrolled in this study were divided into two groups according to the inclusion criteria. In Group 1 (G1), patients surgically treated for OFF were divided into two subgroups: G1a, patients undergoing orbital floor reconstruction with an intraoperatively shaped mesh, and G1b, patients undergoing orbital floor reconstruction with a preoperative mesh shaped on a 3D-printed stereolithographic model. Group 2 (G2) consisted of patients treated for other traumatic pathologies (mandible fractures and middle face fractures not involving orbit). Pre- and postoperative orbital volumetric measurements were performed on both G1 and G2. The patients of both groups were subjected to the measurement of orbital volume using Osirix software (Pixmeo SARL, CH-1233 Bernex, Switzerland) on the new CT examination. Both descriptive (using central tendency indices such as mean and range) and regressive (using the Bravais–Pearson index, calculated using the GraphPad program) statistical analyses were performed on the recorded data. Results: From 1 January 2017 to 31 December 2021, of the 176 patients treated for OFF at the “Magna Graecia” University Hospital of Catanzaro 10 fulfilled the study’s inclusion criteria: 5 were assigned to G1a and 5 to G1b, with a total of 30 volumetric measurements. In G2, we included 10 patients, with a total of 20 volumetric measurements. From the volumetric measurements and statistical analysis carried out, it emerged that the average of the volumetric differences of the healthy orbits was ±0.6351 cm³, the standard deviation of the volumetric differences was ±0.3383, and the relationship between the treated orbit and the healthy orbit was linear; therefore, the treated orbital volumes tend to approach the healthy ones after surgical treatment. Conclusion: This study demonstrates that if the volume is restored within the range of the standardized mean, the diplopia is completely recovered already after surgery or after one month. For orbital volumes that do not fall within this range, functional recovery could occur within 6 months or be lacking. The restoration of the orbital volume using pre-modeled networks on the patient’s anatomical model, printed internally in 3D, allows for more accurate reconstructions of the orbital floor in less time, with clinical advantages also in terms of surgical timing.

Purpose Orbital fractures are common injuries and represent an interesting chapter in maxillofacial surgery. This retrospective study analyses data collected from 528 patients surgically treated at the University Hospital “Magna Graecia”, Catanzaro, Italy, from 1st January 2007 to 31st January 2021. Methods The inclusion criteria were a diagnosis of orbital bone fracture, complete clinical and radiological records, and a minimum follow-up of 12 months. We analyzed gender, age, etiology, fracture type, treatment, timing of repair, and associated complications. Results The most frequent cause of trauma was road accidents (37.88%), followed by domestic accidents (25.95%). The manifestation of diplopia (72.35%), infraorbital nerve hypoesthesia (53.41%), extrinsic eye movement limitation (51.70%), and enophthalmos (41.29%), determined the indication for surgery. Our trauma team preferred the sub-eyelid approach (79.36%). The study shows a statistical significance in the correlation between the severity of the herniation of the lower rectus muscle and the presence of preoperative diplopia (p-value = 0.00416); We found the same statistical significance for the post-postoperative diplopia (p-value = 0.00385). Patients treated two weeks after the trauma show a higher rate of diplopia and a greater limitation of long-term post-operative eye movements than those treated within two weeks (diplopia 23.08% vs. 15.56%; eye movements limitation 13.33% vs. 7.69%). Early surgical treatment (> 14 days) reduces the likelihood of functional and structural damage to the lower rectus muscle. Conclusion Our data will support future maxillofacial traumatology studies, and the education and prevention measures taken will reduce the incidence of orbital trauma.