Enrico Nastro | University of Messina (original) (raw)

Papers by Enrico Nastro

Research paper thumbnail of Altered long non-coding RNA expression profile in patients with IgA-negative mesangial proliferative glomerulonephritis

International Journal of Molecular Medicine, 2012

Mesangial proliferative glomerulonephritis (MsPGN) is one of the most common immune-mediated rena... more Mesangial proliferative glomerulonephritis (MsPGN) is one of the most common immune-mediated renal diseases. The mesangium is expanded and hypercellular, immunoglobulin deposits can be found in the mesangium, but the mechanism underlying its cause remains largely unclear. There is a large amount of evidence suggesting that long ﹥200 nucleotide) non-coding RNAs (lncRNA) have important regulatory functions in the epigenetic control of gene expression. Multiple lines of evidence increasingly link mutations and dysregulations of lncRNAs to a diverse number of human diseases. Through microarray expression analysis, tests show that thousands of lncRNAs and protein-coding genes are significantly differentially expressed in IgA-negative MsPGN. Some lncRNAs and their neighboring protein-coding genes are closely related and are cooperatively expressed. This may be part of a potential regulatory mechanism. The malfunction of regulation in the network of lncRNAs may be a possible mechanism for the development of IgA-negative MsPGN. Our observations suggest that some lncRNAs are closely related to IgA-negative MsPGN and may be playing an important role in this disease.

Research paper thumbnail of P.074 Erythropoietin and VEGF in head and neck tumors

Journal of Cranio-Maxillofacial Surgery, 2008

within the 10-year period from January 1996 to December 2005. Among them, subjects less than 40 y... more within the 10-year period from January 1996 to December 2005. Among them, subjects less than 40 years of age were included in the young group, while subjects 40 years of age or older were included in the non-young group. These two groups were compared statistically. Major items of assessment included sexual specificity, site of tumor, tumor node metastasis classification (TNM), and prognosis. Results: The young group included 30 patients (16 males and 14 females). Sites of tumor were the tongue in 27 patients, floor of the mouth in 1 patient, mandibular gingiva in 1 patient, and central maxilla in 1 patient. By site of tumor, carcinoma of the tongue was significantly more common in the young than in the non-young group. None of primary lesion (T), presence or absence of lymph node metastasis (N), and stage differed significantly between the young and non-young groups. Fiveyear commulative survival rates were 75.95% and 74.91% in the young and non-young groups, respectively, and not significantly different. However, the prognosis of elderly subjects over 80 years of age was significantly poorer than that in the young group. The prognosis of the elderly subjects with carcinoma of the tongue was not significantly different from that in the young group. Conclusions: The reason why most cases of oral carcinoma in young individuals occur in the tongue has not yet been clarified, and molecular biological approaches may be required to answer this question. As noted above, for young individuals, special consideration must be paid to QOL in addition to likelihood of survival. The prognosis of very elderly individuals was significantly poorer than that of young individuals. We will attempt to determine the reason for this in future studies.

Research paper thumbnail of Synovial Hemangioma of the Temporomandibular Joint: Case Report

Hemangiomas are benign vasoformative neoplasms or developmental conditions of endothelial origin.... more Hemangiomas are benign vasoformative neoplasms or developmental conditions of endothelial origin. Synovial hemangiomas arise from a synovial lined surface within a joint space. This report describes a case of synovial hemangioma of the left temporomandibular joint (TMJ) in a 65-year-old male patient. Histologic examination confirmed the diagnosis of synovial hemangioma. This is a rare case series, as the only case of synovial hemangioma with TMJ localization previously described was reported in 1988.

Research paper thumbnail of Immunohistochemial evaluation of sarcoglycans and integrins in gingival epithelium of multiple myeloma patients with bisphosphonate-induced osteonecrosis of the jaw

Oncology Reports, 2010

Osteonecrosis of the jaw (ONJ) is an adverse outcome associated to bisphosphonate treatment. Howe... more Osteonecrosis of the jaw (ONJ) is an adverse outcome associated to bisphosphonate treatment. However, it is not known whether the ONJ lesion originates in the bone, or whether it may initiate in the oral mucosa. The aim of our study was to evaluate the pattern of basal lamina of oral mucosa after bisphosphonate administration and to analyze the structural damage of the mucosa in ONJ patients, and in subjects treated with bisphosphonates without osteonecrosis. By immunohistochemistry, we evaluated changes in basement membrane by expression of signalling proteins, laminin, and type IV collagen. All tested proteins were almost absent in basal lamina and mucosa of subjects treated with bisphosphonates without osteonecrosis, whereas in mucosa of patients with ONJ, they showed a clearly detectable pattern of the same proteins, specifically in basal lamina, but less in comparison to control samples. Moreover, in pathological mucosa, the clearly detectable staining pattern for VEGF indicate...

Research paper thumbnail of How to Avoid and Manage Mental Nerve Injury in Transoral Thyroidectomy

Surgical technology international, Nov 10, 2019

Transoral endoscopic thyroidectomy by vestibular approach (TOETVA) represents an innovative and s... more Transoral endoscopic thyroidectomy by vestibular approach (TOETVA) represents an innovative and scarless technique for thyroid surgery. The procedure is conducted via a three-port technique at the oral vestibule using a 10mm port for the 30° endoscope and two additional 5mm ports for the dissecting and coagulating instruments. Patients meeting the following criteria can be considered as candidates for TOETVA: (a) an ultrasonographically (US) estimated thyroid diameter =10cm; (b) US-estimated gland volume =45mL; (c) nodule size =50mm; (d) presence of a benign tumor, such as a thyroid cyst or a single- or multinodular goiter; (e) Bethesda 3 and/or 4 categories, and (f) papillary microcar-cinoma without the evidence of metastasis. Beyond the classic complications of thyroid surgery, namely cervical hematoma, recurrent laryngeal nerve injury and hypoparathyroidism, novel consequences can occur as mental nerve (MN) injury. In this paper, leading experts in the field report on their curre...

Research paper thumbnail of Eagle syndrome: Lights and shadows of an underestimated condition of multidisciplinar interest

Advances in Oral and Maxillofacial Surgery

Research paper thumbnail of Osteonecrosi dei mascellari da bifosfonati: guida alla gestione clinica

Research paper thumbnail of Letter by Nastro Siniscalchi and Raffa Regarding Article, “Prevalence of Ipsilateral Nonstenotic Carotid Plaques on Computed Tomography Angiography in Embolic Stroke of Undetermined Source”

Stroke

To the Editor: We have read with interest the article titled “Prevalence of Ipsilateral Nonstenot... more To the Editor: We have read with interest the article titled “Prevalence of Ipsilateral Nonstenotic Carotid Plaques on Computed Tomography Angiography in Embolic Stroke of Undetermined Source” by Ospel et al1 published in the June 2020 issue of Stroke. The authors reported that “in patients with embolic stroke of undetermined sources, nonstenotic carotid plaques were significantly more common on the side of the ischemic stroke, suggesting that these plaques could be a potential etiological cause of the stroke.”1 Such a topic is of extreme relevance since the authors argued that the presence of nonstenotic plaques could have a determinant role for embolic events. The role of the internal carotid artery (ICA) as an embolic source has been recently stressed by many authors who reported the association between stroke caused by ICA dissection and the Eagle syndrome (ES).2,3 The ES is an underestimated disease caused by the conflict between elongated or misshapened styloid processes (SPs) and neurovascular structures of the neck, including the ICA. Several symptoms have been recently connected to ES, ranging from headache, visual disorders, dizziness, tinnitus, insomnia, up to neurological deficits caused by embolic stroke.2 Despite the wide spectrum of clinical patterns, ES still remains underestimated or misdiagnosed. That is probably because of the use of inappropriate static imaging (computed tomography, magnetic resonance imaging, and ultrasonography; neutral head position) rather than dynamic one. In fact, in an extremely dynamic region that is the neck, spatial relationships of neurovascular and bony structures can frequently change during neck movements, and a contact/conflict between these structures could be more evident during flexion/extension/rotation of the head instead of during standard neutral position.4 There is a wide agreement, in fact, on the possible relationship between elongated or misshapened SPs and its impingement on the ICA as a possible etiology of stroke.3 We appreciate the findings reported by Ospel et al and their work investigating possible causes of embolic stroke of undetermined sources. Nevertheless, in the light of reports on the association between ischemic stroke and ES, some questions arise. First of all, did the authors focus their attention on the relationship between SPs and ICA in their patients and consider the idea of ES as a possible cause of embolic stroke of undetermined sources? Indeed, could the ICA impingement by SPs be a possible pathophysiological explanation of embolic phenomena from nonstenotic plaques, as we previously suggested for pulmonary thromboembolism in jugular ES?5 Do they think that a computed tomography angiography dynamic imaging (acquired in different head position) could better identify ICA impingement by SPs in some cases of embolic stroke of undetermined sources?4 And, finally, could the styloid impingement on a carotid nonstenotic plaque explain why some patients with impingement on the ICA in the framework of an ES develop embolic events only in the elderly rather than in other periods of life when plaques are not still present?

Research paper thumbnail of Can CT scan in standard neutral head position be enough to exclude the Eagle Syndrome?

Annals of Vascular Surgery

Research paper thumbnail of Regarding Chronic Cerebrospinal Venous Insufficiency and Meniere's Disease: Interventional Versus Medical Therapy

The Laryngoscope

We have read with great interest the article titled “Chronic Cerebrospinal Venous Insufficiency a... more We have read with great interest the article titled “Chronic Cerebrospinal Venous Insufficiency and Meniere’s Disease: Interventional Versus Medical Therapy” by Attanasio et al. and published in November 2019 in The Laryngoscope. The authors discuss a novel ethiopathogenic hypothesis of Meniére’s disease (MD) for which chronic cerebrospinal venous insufficiency (CCSVI) “may represent a predisposing factor for developing inner ear disorders such as MD.” The study deserves merit because it focuses attention on the importance of normal venous drainage in the neck region. The question of CCSVI and, above all, internal jugular vein (IJV) stenosis, recently has been evocated in another clinical condition, the jugular eagle syndrome (JES), in which elongated styloid process (SPs) can impinges the IJV, inducing signs and symptoms related to CCSVI. Bai et al. recently have described how JES can be characterized by a series of clinical manifestations, such as head and neck symptoms and visual and ear symptoms, as well as sleep disorders. The article by Attanasio et al., by highlighting the relationship between MD and CCSVI, evoked an intriguing question. Could an elongated or mishapened SP responsible for JES also be the cause of some cases of Meniere’s disease? Yet, could IJV impingement explain dizziness in MD patients because dizziness also is often reported in some eagle syndromes? Do we have the obligation to investigate the relationship between IJV and SP even in MD cases, especially using dynamic imaging tools (ultrasound, magnetic resonance angiography, computed tomography angiography) at different head orientations, as we previously described? In the light of these considerations, a question arises: to test or not to test all the MDs and ESs for potential IJV compressions. If the answer is yes, we strongly suggest the use of dynamic imaging tools in different head positions (rest, rotation, flexo-extension, and tilting) given that IJV impingement is a dynamic and not only a static phenomenon. That is because IJV patency can be influenced by head and neck movements, and imaging acquisition using the head neutral position could underestimate or misdiagnose an IJV compression occurring during head and neck movements.

Research paper thumbnail of Is Eagle jugular syndrome an underestimated potentially life-threatening disease?

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques

This version may be subject to change during the production process. Is Eagle jugular syndrome an... more This version may be subject to change during the production process. Is Eagle jugular syndrome an underestimated potentially life-threatening disease?

Research paper thumbnail of Letter to the Editor Regarding “A Staged Therapy for Internal Carotid Artery Dissection Caused by Vascular Eagle Syndrome”

Research paper thumbnail of The discomallear ligament: anatomical, microscopical, and radiologic analysis

Surgical and Radiologic Anatomy

Background Several anatomic relationships between the ear and the temporo-mandibular joint have b... more Background Several anatomic relationships between the ear and the temporo-mandibular joint have been proposed to account for the presence of tinnitus during temporo-mandibular disorders. Among the otomandibular structures, the discomallear ligament (DML) is interposed between the malleus and the retrodiscal capsular complex. The aim of present paper was to study through dissection the frequency and morphology of DML, to characterize its type of collagen, and to evaluate the DML on routine computed tomography (CT). Methods and results The study has been conducted on five un-embalmed adult cadavers, and in all cases, the DML was present (100%). It was constituted mainly by fibers of collagen I, with abundant elastic fibers. On CT exams of 40 patients with no reported pathology of the ear, on axial images, a dense structure, going from the upper end of the petrotympanic fissure to the neck of the malleus, was present in all the cases. In 90%, it showed a triangular shape, in 5% a rectangular shape, and in 5% a curved course. The mean length of the antero-medial side was 2 ± 0.6 mm and that of the antero-lateral side was 1.63 ± 0.5, and the mean area was 1.29 ± 0.83 mm 2 . Conclusion The DML could represent an anatomical structure that joining the temporo-mandibular joint and the malleus may play a role in the otologic symptoms during temporo-mandibular disorders.

Research paper thumbnail of An unusual internal carotid artery compression as a possible cause of Eagle syndrome – A novel hypothesis and an innovative surgical technique

Surgical Neurology International

Background: Eagle syndrome (ES) is a rare symptomatic condition generally caused by an elongated ... more Background: Eagle syndrome (ES) is a rare symptomatic condition generally caused by an elongated styloid process (SP) or calcification of the stylohyoid complex. On the diagnosis is made, its treatment remains subjective since the indications for surgical intervention are still not standardized. Although styloidectomy is the surgical treatment of choice, no consensus exists regarding the transcervical or/and transoral route. Here, we report our experience in a patient with bilateral internal carotid artery (ICA) dissection caused by ES, who underwent innovative surgical technique. Case Description: A 53-year-old man, with the right-sided middle cerebral artery acute stroke, underwent computed tomography angiography 3 days after a successful endovascular treatment. The study showed a bilateral ICA dissection with bilateral hypertrophic SPs and a close relationship of ICAs with both SPs anteriorly and C1 transverse process posteriorly. Considering the occurrence of ICA compression by ...

Research paper thumbnail of Diabetes: Oral Health Related Quality of Life and Oral Alterations

BioMed Research International

Background and Objectives. About 5% of the world’s population is affected by diabetes; these pati... more Background and Objectives. About 5% of the world’s population is affected by diabetes; these patients must be further treated during medical and surgical treatments. These patients, due to the glycemic conditions, realize during their life multiorgan changes, in different body districts. Moreover, this condition obliges them to undertake hypoglycemic therapies. Diabetes is a risk factor for many diseases, including those concerning the oral district with immunological implications. Materials and Methods. A comprehensive review of the literature was conducted according to PRISMA guidelines accessing the NCBI PubMed database. Authors conducted the search of articles in English language. The results of the last 10 years have been considered, which present useful information regarding the oral conditions. A total of 17 relevant studies were included in the review. The study evaluated only papers with specific inclusion criteria regarding oral health. The works initially taken into consi...

Research paper thumbnail of Alginate Materials and Dental Impression Technique: A Current State of the Art and Application to Dental Practice

Marine Drugs

Hydrocolloids were the first elastic materials to be used in the dental field. Elastic impression... more Hydrocolloids were the first elastic materials to be used in the dental field. Elastic impression materials include reversible (agar-agar), irreversible (alginate) hydrocolloids and synthetic elastomers (polysulfides, polyethers, silicones). They reproduce an imprint faithfully, providing details of a high definition despite the presence of undercuts. With the removal of the impression, being particularly rich in water, the imprints can deform but later adapt to the original shape due to the elastic properties they possess. The advantages of using alginate include the low cost, a better tolerability on the part of the patient, the ease of manipulation, the short time needed for execution, the instrumentation and the very simple execution technique and possibility of detecting a detailed impression (even in the presence of undercuts) in a single step. A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed databas...

Research paper thumbnail of Different Embolization Approaches for the Treatment of Posttraumatic Pseudoaneurysm of the Internal Maxillary Artery

Journal of Craniofacial Surgery

Pseudoaneurysm is an abnormal dilation of an artery that could be caused either by iatrogenic or ... more Pseudoaneurysm is an abnormal dilation of an artery that could be caused either by iatrogenic or traumatic events and it is associated with high rupture risk. Pseudoaneurysm rarely involves internal maxillary artery. Computed tomography angiography and digital subtraction angiography are essential tools to perform a proper diagnosis and treatment of pseudoaneurysms. The authors described 2 different cases of internal maxillary artery pseudoaneurysm, treated by different embolization approaches. The first case was treated by a well-known arterial catheterism technique, whereas the second one was performed by an uncommon approach with a direct percutaneous puncture.

Research paper thumbnail of Microstructural investigation of masticatory muscles: a pre- and post-treatment diffusion tensor imaging study in a bruxism case

Dento maxillo facial radiology, Jan 22, 2018

We evaluated, by means of a non-invasive procedure based on Magnetic Resonance Imaging, the masti... more We evaluated, by means of a non-invasive procedure based on Magnetic Resonance Imaging, the masticatory muscular microstructure in a 55 year-old-female patient affected by bruxism. The patient underwent MR examination before and after one month of splint therapy, when she referred the complete disappearance of all symptoms. By means of Diffusion Tensor Imaging we observed changes at microstructural level of masticatory muscular complex. We conclude that DTI may be a useful instrument both to perform panoramic reconstruction of the masticatory muscle complex and to investigate microstructural modifications related to the pain relief in bruxism.

Research paper thumbnail of Spontaneous Healing of Clodronate-Related Osteonecrosis of the Jaw

Journal of Craniofacial Surgery

Cases of medication-related osteonecrosis of the jaw (MRONJ) have been more commonly associated w... more Cases of medication-related osteonecrosis of the jaw (MRONJ) have been more commonly associated with aminobiphosphonate therapy than with alkylbiphosphonate treatment. Here, we report a case of MRONJ in a subject who received an alkylbiphosphonate, clodronate, for the treatment of osteoporosis, and discuss the pathogenic mechanisms of alkylbiphosphonates and the possible reasons for the spontaneous and rapid remission of MRONJ occurring in our patient.

Research paper thumbnail of Diffusion tensor imaging reveals morphological alterations of the lateral pterygoid muscle in patients with mandibular asymmetry

Dentomaxillofacial Radiology

To evaluate non-invasively the morphological features of both lateral pterygoid muscle (LPM) and ... more To evaluate non-invasively the morphological features of both lateral pterygoid muscle (LPM) and masseter muscle by using diffusion tensor Imaging on two patients affected by mandibular asymmetry. methods: Two female patients with mandibular excess and asymmetry who underwent Le Fort I osteotomy and bilateral sagittal split osteotomy were recruited for this study. Morphological (T 1 weighted) and diffusion weighted images were acquired with a 3T scanner 1 week before (T0) and 1 month after the surgery (T1). Probabilistic tensor-based tractography reconstruction of bilateral masseters and LPMs was performed and mean fractional anisotropy (FA) values for both muscles were extracted. results: Diffusion tensor imaging was able to identify the muscle geometrical morphology and diffusion microstructural changes. Both at T0 and T1, mean FA values had no significant differences between the right and left side of masseter (at T0: p = 0.91; at T1: p = 0.54) and LPM (at T0: p = 0.92; at T1: p = 0.43), respectively. Both patients reported a significant improvement in FA mean values of the left LPM (p = 0.03) between T0 and T1, whereas no diffusion parameters' changes were observed for the bilateral masseter muscles and right LPM. Conclusions: We found that after the surgery the LPM ipsilateral to the deviation side showed a significant increase of FA compared to the baseline. Although preliminary, our findings suggest that diffusion tensor imaging may represent a promising tool to investigate noninvasively the masticatory muscles in temporomandibular joint disorders.

Research paper thumbnail of Altered long non-coding RNA expression profile in patients with IgA-negative mesangial proliferative glomerulonephritis

International Journal of Molecular Medicine, 2012

Mesangial proliferative glomerulonephritis (MsPGN) is one of the most common immune-mediated rena... more Mesangial proliferative glomerulonephritis (MsPGN) is one of the most common immune-mediated renal diseases. The mesangium is expanded and hypercellular, immunoglobulin deposits can be found in the mesangium, but the mechanism underlying its cause remains largely unclear. There is a large amount of evidence suggesting that long ﹥200 nucleotide) non-coding RNAs (lncRNA) have important regulatory functions in the epigenetic control of gene expression. Multiple lines of evidence increasingly link mutations and dysregulations of lncRNAs to a diverse number of human diseases. Through microarray expression analysis, tests show that thousands of lncRNAs and protein-coding genes are significantly differentially expressed in IgA-negative MsPGN. Some lncRNAs and their neighboring protein-coding genes are closely related and are cooperatively expressed. This may be part of a potential regulatory mechanism. The malfunction of regulation in the network of lncRNAs may be a possible mechanism for the development of IgA-negative MsPGN. Our observations suggest that some lncRNAs are closely related to IgA-negative MsPGN and may be playing an important role in this disease.

Research paper thumbnail of P.074 Erythropoietin and VEGF in head and neck tumors

Journal of Cranio-Maxillofacial Surgery, 2008

within the 10-year period from January 1996 to December 2005. Among them, subjects less than 40 y... more within the 10-year period from January 1996 to December 2005. Among them, subjects less than 40 years of age were included in the young group, while subjects 40 years of age or older were included in the non-young group. These two groups were compared statistically. Major items of assessment included sexual specificity, site of tumor, tumor node metastasis classification (TNM), and prognosis. Results: The young group included 30 patients (16 males and 14 females). Sites of tumor were the tongue in 27 patients, floor of the mouth in 1 patient, mandibular gingiva in 1 patient, and central maxilla in 1 patient. By site of tumor, carcinoma of the tongue was significantly more common in the young than in the non-young group. None of primary lesion (T), presence or absence of lymph node metastasis (N), and stage differed significantly between the young and non-young groups. Fiveyear commulative survival rates were 75.95% and 74.91% in the young and non-young groups, respectively, and not significantly different. However, the prognosis of elderly subjects over 80 years of age was significantly poorer than that in the young group. The prognosis of the elderly subjects with carcinoma of the tongue was not significantly different from that in the young group. Conclusions: The reason why most cases of oral carcinoma in young individuals occur in the tongue has not yet been clarified, and molecular biological approaches may be required to answer this question. As noted above, for young individuals, special consideration must be paid to QOL in addition to likelihood of survival. The prognosis of very elderly individuals was significantly poorer than that of young individuals. We will attempt to determine the reason for this in future studies.

Research paper thumbnail of Synovial Hemangioma of the Temporomandibular Joint: Case Report

Hemangiomas are benign vasoformative neoplasms or developmental conditions of endothelial origin.... more Hemangiomas are benign vasoformative neoplasms or developmental conditions of endothelial origin. Synovial hemangiomas arise from a synovial lined surface within a joint space. This report describes a case of synovial hemangioma of the left temporomandibular joint (TMJ) in a 65-year-old male patient. Histologic examination confirmed the diagnosis of synovial hemangioma. This is a rare case series, as the only case of synovial hemangioma with TMJ localization previously described was reported in 1988.

Research paper thumbnail of Immunohistochemial evaluation of sarcoglycans and integrins in gingival epithelium of multiple myeloma patients with bisphosphonate-induced osteonecrosis of the jaw

Oncology Reports, 2010

Osteonecrosis of the jaw (ONJ) is an adverse outcome associated to bisphosphonate treatment. Howe... more Osteonecrosis of the jaw (ONJ) is an adverse outcome associated to bisphosphonate treatment. However, it is not known whether the ONJ lesion originates in the bone, or whether it may initiate in the oral mucosa. The aim of our study was to evaluate the pattern of basal lamina of oral mucosa after bisphosphonate administration and to analyze the structural damage of the mucosa in ONJ patients, and in subjects treated with bisphosphonates without osteonecrosis. By immunohistochemistry, we evaluated changes in basement membrane by expression of signalling proteins, laminin, and type IV collagen. All tested proteins were almost absent in basal lamina and mucosa of subjects treated with bisphosphonates without osteonecrosis, whereas in mucosa of patients with ONJ, they showed a clearly detectable pattern of the same proteins, specifically in basal lamina, but less in comparison to control samples. Moreover, in pathological mucosa, the clearly detectable staining pattern for VEGF indicate...

Research paper thumbnail of How to Avoid and Manage Mental Nerve Injury in Transoral Thyroidectomy

Surgical technology international, Nov 10, 2019

Transoral endoscopic thyroidectomy by vestibular approach (TOETVA) represents an innovative and s... more Transoral endoscopic thyroidectomy by vestibular approach (TOETVA) represents an innovative and scarless technique for thyroid surgery. The procedure is conducted via a three-port technique at the oral vestibule using a 10mm port for the 30° endoscope and two additional 5mm ports for the dissecting and coagulating instruments. Patients meeting the following criteria can be considered as candidates for TOETVA: (a) an ultrasonographically (US) estimated thyroid diameter =10cm; (b) US-estimated gland volume =45mL; (c) nodule size =50mm; (d) presence of a benign tumor, such as a thyroid cyst or a single- or multinodular goiter; (e) Bethesda 3 and/or 4 categories, and (f) papillary microcar-cinoma without the evidence of metastasis. Beyond the classic complications of thyroid surgery, namely cervical hematoma, recurrent laryngeal nerve injury and hypoparathyroidism, novel consequences can occur as mental nerve (MN) injury. In this paper, leading experts in the field report on their curre...

Research paper thumbnail of Eagle syndrome: Lights and shadows of an underestimated condition of multidisciplinar interest

Advances in Oral and Maxillofacial Surgery

Research paper thumbnail of Osteonecrosi dei mascellari da bifosfonati: guida alla gestione clinica

Research paper thumbnail of Letter by Nastro Siniscalchi and Raffa Regarding Article, “Prevalence of Ipsilateral Nonstenotic Carotid Plaques on Computed Tomography Angiography in Embolic Stroke of Undetermined Source”

Stroke

To the Editor: We have read with interest the article titled “Prevalence of Ipsilateral Nonstenot... more To the Editor: We have read with interest the article titled “Prevalence of Ipsilateral Nonstenotic Carotid Plaques on Computed Tomography Angiography in Embolic Stroke of Undetermined Source” by Ospel et al1 published in the June 2020 issue of Stroke. The authors reported that “in patients with embolic stroke of undetermined sources, nonstenotic carotid plaques were significantly more common on the side of the ischemic stroke, suggesting that these plaques could be a potential etiological cause of the stroke.”1 Such a topic is of extreme relevance since the authors argued that the presence of nonstenotic plaques could have a determinant role for embolic events. The role of the internal carotid artery (ICA) as an embolic source has been recently stressed by many authors who reported the association between stroke caused by ICA dissection and the Eagle syndrome (ES).2,3 The ES is an underestimated disease caused by the conflict between elongated or misshapened styloid processes (SPs) and neurovascular structures of the neck, including the ICA. Several symptoms have been recently connected to ES, ranging from headache, visual disorders, dizziness, tinnitus, insomnia, up to neurological deficits caused by embolic stroke.2 Despite the wide spectrum of clinical patterns, ES still remains underestimated or misdiagnosed. That is probably because of the use of inappropriate static imaging (computed tomography, magnetic resonance imaging, and ultrasonography; neutral head position) rather than dynamic one. In fact, in an extremely dynamic region that is the neck, spatial relationships of neurovascular and bony structures can frequently change during neck movements, and a contact/conflict between these structures could be more evident during flexion/extension/rotation of the head instead of during standard neutral position.4 There is a wide agreement, in fact, on the possible relationship between elongated or misshapened SPs and its impingement on the ICA as a possible etiology of stroke.3 We appreciate the findings reported by Ospel et al and their work investigating possible causes of embolic stroke of undetermined sources. Nevertheless, in the light of reports on the association between ischemic stroke and ES, some questions arise. First of all, did the authors focus their attention on the relationship between SPs and ICA in their patients and consider the idea of ES as a possible cause of embolic stroke of undetermined sources? Indeed, could the ICA impingement by SPs be a possible pathophysiological explanation of embolic phenomena from nonstenotic plaques, as we previously suggested for pulmonary thromboembolism in jugular ES?5 Do they think that a computed tomography angiography dynamic imaging (acquired in different head position) could better identify ICA impingement by SPs in some cases of embolic stroke of undetermined sources?4 And, finally, could the styloid impingement on a carotid nonstenotic plaque explain why some patients with impingement on the ICA in the framework of an ES develop embolic events only in the elderly rather than in other periods of life when plaques are not still present?

Research paper thumbnail of Can CT scan in standard neutral head position be enough to exclude the Eagle Syndrome?

Annals of Vascular Surgery

Research paper thumbnail of Regarding Chronic Cerebrospinal Venous Insufficiency and Meniere's Disease: Interventional Versus Medical Therapy

The Laryngoscope

We have read with great interest the article titled “Chronic Cerebrospinal Venous Insufficiency a... more We have read with great interest the article titled “Chronic Cerebrospinal Venous Insufficiency and Meniere’s Disease: Interventional Versus Medical Therapy” by Attanasio et al. and published in November 2019 in The Laryngoscope. The authors discuss a novel ethiopathogenic hypothesis of Meniére’s disease (MD) for which chronic cerebrospinal venous insufficiency (CCSVI) “may represent a predisposing factor for developing inner ear disorders such as MD.” The study deserves merit because it focuses attention on the importance of normal venous drainage in the neck region. The question of CCSVI and, above all, internal jugular vein (IJV) stenosis, recently has been evocated in another clinical condition, the jugular eagle syndrome (JES), in which elongated styloid process (SPs) can impinges the IJV, inducing signs and symptoms related to CCSVI. Bai et al. recently have described how JES can be characterized by a series of clinical manifestations, such as head and neck symptoms and visual and ear symptoms, as well as sleep disorders. The article by Attanasio et al., by highlighting the relationship between MD and CCSVI, evoked an intriguing question. Could an elongated or mishapened SP responsible for JES also be the cause of some cases of Meniere’s disease? Yet, could IJV impingement explain dizziness in MD patients because dizziness also is often reported in some eagle syndromes? Do we have the obligation to investigate the relationship between IJV and SP even in MD cases, especially using dynamic imaging tools (ultrasound, magnetic resonance angiography, computed tomography angiography) at different head orientations, as we previously described? In the light of these considerations, a question arises: to test or not to test all the MDs and ESs for potential IJV compressions. If the answer is yes, we strongly suggest the use of dynamic imaging tools in different head positions (rest, rotation, flexo-extension, and tilting) given that IJV impingement is a dynamic and not only a static phenomenon. That is because IJV patency can be influenced by head and neck movements, and imaging acquisition using the head neutral position could underestimate or misdiagnose an IJV compression occurring during head and neck movements.

Research paper thumbnail of Is Eagle jugular syndrome an underestimated potentially life-threatening disease?

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques

This version may be subject to change during the production process. Is Eagle jugular syndrome an... more This version may be subject to change during the production process. Is Eagle jugular syndrome an underestimated potentially life-threatening disease?

Research paper thumbnail of Letter to the Editor Regarding “A Staged Therapy for Internal Carotid Artery Dissection Caused by Vascular Eagle Syndrome”

Research paper thumbnail of The discomallear ligament: anatomical, microscopical, and radiologic analysis

Surgical and Radiologic Anatomy

Background Several anatomic relationships between the ear and the temporo-mandibular joint have b... more Background Several anatomic relationships between the ear and the temporo-mandibular joint have been proposed to account for the presence of tinnitus during temporo-mandibular disorders. Among the otomandibular structures, the discomallear ligament (DML) is interposed between the malleus and the retrodiscal capsular complex. The aim of present paper was to study through dissection the frequency and morphology of DML, to characterize its type of collagen, and to evaluate the DML on routine computed tomography (CT). Methods and results The study has been conducted on five un-embalmed adult cadavers, and in all cases, the DML was present (100%). It was constituted mainly by fibers of collagen I, with abundant elastic fibers. On CT exams of 40 patients with no reported pathology of the ear, on axial images, a dense structure, going from the upper end of the petrotympanic fissure to the neck of the malleus, was present in all the cases. In 90%, it showed a triangular shape, in 5% a rectangular shape, and in 5% a curved course. The mean length of the antero-medial side was 2 ± 0.6 mm and that of the antero-lateral side was 1.63 ± 0.5, and the mean area was 1.29 ± 0.83 mm 2 . Conclusion The DML could represent an anatomical structure that joining the temporo-mandibular joint and the malleus may play a role in the otologic symptoms during temporo-mandibular disorders.

Research paper thumbnail of An unusual internal carotid artery compression as a possible cause of Eagle syndrome – A novel hypothesis and an innovative surgical technique

Surgical Neurology International

Background: Eagle syndrome (ES) is a rare symptomatic condition generally caused by an elongated ... more Background: Eagle syndrome (ES) is a rare symptomatic condition generally caused by an elongated styloid process (SP) or calcification of the stylohyoid complex. On the diagnosis is made, its treatment remains subjective since the indications for surgical intervention are still not standardized. Although styloidectomy is the surgical treatment of choice, no consensus exists regarding the transcervical or/and transoral route. Here, we report our experience in a patient with bilateral internal carotid artery (ICA) dissection caused by ES, who underwent innovative surgical technique. Case Description: A 53-year-old man, with the right-sided middle cerebral artery acute stroke, underwent computed tomography angiography 3 days after a successful endovascular treatment. The study showed a bilateral ICA dissection with bilateral hypertrophic SPs and a close relationship of ICAs with both SPs anteriorly and C1 transverse process posteriorly. Considering the occurrence of ICA compression by ...

Research paper thumbnail of Diabetes: Oral Health Related Quality of Life and Oral Alterations

BioMed Research International

Background and Objectives. About 5% of the world’s population is affected by diabetes; these pati... more Background and Objectives. About 5% of the world’s population is affected by diabetes; these patients must be further treated during medical and surgical treatments. These patients, due to the glycemic conditions, realize during their life multiorgan changes, in different body districts. Moreover, this condition obliges them to undertake hypoglycemic therapies. Diabetes is a risk factor for many diseases, including those concerning the oral district with immunological implications. Materials and Methods. A comprehensive review of the literature was conducted according to PRISMA guidelines accessing the NCBI PubMed database. Authors conducted the search of articles in English language. The results of the last 10 years have been considered, which present useful information regarding the oral conditions. A total of 17 relevant studies were included in the review. The study evaluated only papers with specific inclusion criteria regarding oral health. The works initially taken into consi...

Research paper thumbnail of Alginate Materials and Dental Impression Technique: A Current State of the Art and Application to Dental Practice

Marine Drugs

Hydrocolloids were the first elastic materials to be used in the dental field. Elastic impression... more Hydrocolloids were the first elastic materials to be used in the dental field. Elastic impression materials include reversible (agar-agar), irreversible (alginate) hydrocolloids and synthetic elastomers (polysulfides, polyethers, silicones). They reproduce an imprint faithfully, providing details of a high definition despite the presence of undercuts. With the removal of the impression, being particularly rich in water, the imprints can deform but later adapt to the original shape due to the elastic properties they possess. The advantages of using alginate include the low cost, a better tolerability on the part of the patient, the ease of manipulation, the short time needed for execution, the instrumentation and the very simple execution technique and possibility of detecting a detailed impression (even in the presence of undercuts) in a single step. A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed databas...

Research paper thumbnail of Different Embolization Approaches for the Treatment of Posttraumatic Pseudoaneurysm of the Internal Maxillary Artery

Journal of Craniofacial Surgery

Pseudoaneurysm is an abnormal dilation of an artery that could be caused either by iatrogenic or ... more Pseudoaneurysm is an abnormal dilation of an artery that could be caused either by iatrogenic or traumatic events and it is associated with high rupture risk. Pseudoaneurysm rarely involves internal maxillary artery. Computed tomography angiography and digital subtraction angiography are essential tools to perform a proper diagnosis and treatment of pseudoaneurysms. The authors described 2 different cases of internal maxillary artery pseudoaneurysm, treated by different embolization approaches. The first case was treated by a well-known arterial catheterism technique, whereas the second one was performed by an uncommon approach with a direct percutaneous puncture.

Research paper thumbnail of Microstructural investigation of masticatory muscles: a pre- and post-treatment diffusion tensor imaging study in a bruxism case

Dento maxillo facial radiology, Jan 22, 2018

We evaluated, by means of a non-invasive procedure based on Magnetic Resonance Imaging, the masti... more We evaluated, by means of a non-invasive procedure based on Magnetic Resonance Imaging, the masticatory muscular microstructure in a 55 year-old-female patient affected by bruxism. The patient underwent MR examination before and after one month of splint therapy, when she referred the complete disappearance of all symptoms. By means of Diffusion Tensor Imaging we observed changes at microstructural level of masticatory muscular complex. We conclude that DTI may be a useful instrument both to perform panoramic reconstruction of the masticatory muscle complex and to investigate microstructural modifications related to the pain relief in bruxism.

Research paper thumbnail of Spontaneous Healing of Clodronate-Related Osteonecrosis of the Jaw

Journal of Craniofacial Surgery

Cases of medication-related osteonecrosis of the jaw (MRONJ) have been more commonly associated w... more Cases of medication-related osteonecrosis of the jaw (MRONJ) have been more commonly associated with aminobiphosphonate therapy than with alkylbiphosphonate treatment. Here, we report a case of MRONJ in a subject who received an alkylbiphosphonate, clodronate, for the treatment of osteoporosis, and discuss the pathogenic mechanisms of alkylbiphosphonates and the possible reasons for the spontaneous and rapid remission of MRONJ occurring in our patient.

Research paper thumbnail of Diffusion tensor imaging reveals morphological alterations of the lateral pterygoid muscle in patients with mandibular asymmetry

Dentomaxillofacial Radiology

To evaluate non-invasively the morphological features of both lateral pterygoid muscle (LPM) and ... more To evaluate non-invasively the morphological features of both lateral pterygoid muscle (LPM) and masseter muscle by using diffusion tensor Imaging on two patients affected by mandibular asymmetry. methods: Two female patients with mandibular excess and asymmetry who underwent Le Fort I osteotomy and bilateral sagittal split osteotomy were recruited for this study. Morphological (T 1 weighted) and diffusion weighted images were acquired with a 3T scanner 1 week before (T0) and 1 month after the surgery (T1). Probabilistic tensor-based tractography reconstruction of bilateral masseters and LPMs was performed and mean fractional anisotropy (FA) values for both muscles were extracted. results: Diffusion tensor imaging was able to identify the muscle geometrical morphology and diffusion microstructural changes. Both at T0 and T1, mean FA values had no significant differences between the right and left side of masseter (at T0: p = 0.91; at T1: p = 0.54) and LPM (at T0: p = 0.92; at T1: p = 0.43), respectively. Both patients reported a significant improvement in FA mean values of the left LPM (p = 0.03) between T0 and T1, whereas no diffusion parameters' changes were observed for the bilateral masseter muscles and right LPM. Conclusions: We found that after the surgery the LPM ipsilateral to the deviation side showed a significant increase of FA compared to the baseline. Although preliminary, our findings suggest that diffusion tensor imaging may represent a promising tool to investigate noninvasively the masticatory muscles in temporomandibular joint disorders.