Alessandro Tel | Università degli Studi di Udine / University of Udine (original) (raw)

Papers by Alessandro Tel

Annals of Surgical Oncology, Apr 18, 2023

Scientific Reports, Jul 26, 2023

Field driven design is a novel approach that allows to define through equations geometrical entit... more Field driven design is a novel approach that allows to define through equations geometrical entities known as implicit bodies. This technology does not rely upon conventional geometry subunits, such as polygons or edges, rather it represents spatial shapes through mathematical functions within a geometrical field. The advantages in terms of computational speed and automation are conspicuous, and well acknowledged in engineering, especially for lattice structures. Moreover, field-driven design amplifies the possibilities for generative design, facilitating the creation of shapes generated by the software on the basis of user-defined constraints. Given such potential, this paper suggests the possibility to use the software nTopology, which is currently the only software for field-driven generative design, in the context of patient-specific implant creation for maxillofacial surgery. Clinical scenarios of applicability, including trauma and orthognathic surgery, are discussed, as well as the integration of this new technology with current workflows of virtual surgical planning. This paper represents the first application of field-driven design in maxillofacial surgery and, although its results are very preliminary as it is limited in considering only the distance field elaborated from specific points of reconstructed anatomy, it introduces the importance of this new technology for the future of personalized implant design in surgery. Contemporary oral and maxillofacial surgery increasingly incorporates customized devices created using the patient's anatomy as a guiding template. Hence, customized devices provide a natural and precise fit with the bone, offering advantages in terms of easy placement, reduced surgical time, and increased surgical accuracy 1-3. The advent of additive manufacturing (AM) in the healthcare field provided a strong impulse to the immediate translation of designed shapes into 3D printed implants, extending the concept of personalization to a growing number of surgical scenarios. The design of personalized 3D-printed implants is still an open issue for maxillofacial surgery devices and represents one of the main reasons to search for newer strategies specific for AM. Moreover, progresses in computerized simulations, including finite element analysis (FEA), led to improved reliability of personalized implants, which can undergo a virtual biomechanical testing by applying defined forces, boundaries, and material properties to predict critical strain areas that might be subject to failure, allowing to improve the implant shape before it is manufactured 4-6. The design of these devices generally involves using computer-aided design (CAD) software to model the final object in an ordered sequence of 3D modeling operations, starting from an empty shape and using the underlying anatomy as a reference. This process is conventionally referred to as "explicit modeling". It resembles

International Journal of Oral and Maxillofacial Surgery, Mar 1, 2012

Tenosynovial giant cell tumour (TGCT) is a rare benign proliferative disorder of the synovium cha... more Tenosynovial giant cell tumour (TGCT) is a rare benign proliferative disorder of the synovium characterised by destructive invasion by synovial-like mononuclear cells. Two variants have been distinguished: a localized (TGCT-L) and a diffuse (TGCT-D) type. TGCT usually affects adults with a peak incidence in the fifth and sixth decades of life and is more often seen in women than in men. One of the most common soft tissue tumours of the hand (finger joints and tendon sheaths), it is exceedingly uncommon in the head or neck. Only three cases of TGCT-D have been described in the literature. This report presents a case of TGCT-D in the temporomandibular joint.

Journal of Clinical Medicine, Aug 4, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Biology

The invasive nature of glioblastoma is problematic in a radical surgery approach and can be respo... more The invasive nature of glioblastoma is problematic in a radical surgery approach and can be responsible for tumor recurrence. In order to create new therapeutic strategies, it is imperative to have a better understanding of the mechanisms behind tumor growth and invasion. The continuous cross-talk between glioma stem cells (GSCs) and the tumor microenvironment (TME) contributes to disease progression, which renders research in this field difficult and challenging. The main aim of the review was to assess the different possible mechanisms that could explain resistance to treatment promoted by TME and GSCs in glioblastoma, including the role of M2 macrophages, micro RNAs (miRNAs), and long non-coding RNAs (lncRNAs) from exosomes from the TME. A systematic review of the literature on the role of the TME in developing and promoting radioresistance and chemoresistance of GBM was performed according to PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) ...

Otolaryngology–Head and Neck Surgery

ObjectiveTo investigate the accuracy of Chat‐Based Generative Pre‐trained Transformer (ChatGPT) i... more ObjectiveTo investigate the accuracy of Chat‐Based Generative Pre‐trained Transformer (ChatGPT) in answering questions and solving clinical scenarios of head and neck surgery.Study DesignObservational and valuative study.SettingEighteen surgeons from 14 Italian head and neck surgery units.MethodsA total of 144 clinical questions encompassing different subspecialities of head and neck surgery and 15 comprehensive clinical scenarios were developed. Questions and scenarios were inputted into ChatGPT4, and the resulting answers were evaluated by the researchers using accuracy (range 1‐6), completeness (range 1‐3), and references' quality Likert scales.ResultsThe overall median score of open‐ended questions was 6 (interquartile range[IQR]: 5‐6) for accuracy and 3 (IQR: 2‐3) for completeness. Overall, the reviewers rated the answer as entirely or nearly entirely correct in 87.2% of cases and as comprehensive and covering all aspects of the question in 73% of cases. The artificial inte...

3D printing in medicine, May 5, 2023

This editorial presents the vision for the newly formed (2022) European 3D Special Interest Group... more This editorial presents the vision for the newly formed (2022) European 3D Special Interest Group (EU3DSIG) in the landscape of medical 3D printing. There are four areas of work identified by the EU3DSIG in the current landscape, namely: 1) creating and fostering communication channels among researches, clinicians and industry, 2) generating awareness of hospitals point-of-care 3D technologies; 3) knowledge sharing and education; 4) regulation, registry and reimbursement models.

Journal of Oral and Maxillofacial Surgery, Jul 1, 2019

PURPOSE: To present an updated protocol for proportional condylectomy in which virtual surgical p... more PURPOSE: To present an updated protocol for proportional condylectomy in which virtual surgical planning and 3D printing allow one to precisely define the osteotomy level. METHODS: 3D mirroring was performed to generate a virtual replica of the healthy hemimandible, which was subsequently aligned and overlapped with the actual mandible to estimate the level for condylectomy. A custom-fitted 3D printed surgical guide was modeled for the condylar head allowing one to reproduce virtual planning in the surgical scenario. The updated protocol for computer-guided condylectomy was applied to 7 patients. RESULTS For all patients, a follow-up period of twelve months was considered. Surface deviation color maps showed a high correspondence between the virtually calculated condylectomy and the surgical outcome achieved with the aid of the surgical guide. No cases of condylar hyperplasia recurrence were observed.

Journal of Cranio-maxillofacial Surgery, Aug 1, 2019

Single-step surgical treatment of odontogenic maxillary sinusitis: a retrospective study of 98 cases

Applied sciences, Dec 24, 2021

Annals of the Rheumatic Diseases, May 19, 2021

Frontiers in Surgery, Aug 23, 2021

In the past years, endoscopic techniques have raised an increasing interest to perform minimally ... more In the past years, endoscopic techniques have raised an increasing interest to perform minimally invasive accesses to the orbit, resulting in excellent clinical outcomes with inferior morbidities and complication rates. Among endoscopic approaches, the transantral endoscopic approach allows us to create a portal to the orbital floor, representing the most straightforward access to lesions located in the inferior orbital space. However, if endoscopic surgery provides enhanced magnified vision of the anatomy in a bloodless field, then it has several impairments compared with classic open surgery, owing to restricted operative spaces. Virtual surgical planning and anatomical computer-generated models have proved to be of great importance to plan endoscopic surgical approaches, and their role can be widened with the integration of surgical navigation, virtual endoscopy simulation, and augmented reality (AR). This study focuses on the strict conjugation between the technologies that allow the virtualization of surgery in an entirely digital environment, which can be transferred to the patient using intraoperative navigation or to a printed model using AR for pre-surgical analysis. Therefore, the interaction between different software packages and platforms offers a highly predictive preview of the surgical scenario, contributing to increasing orientation, awareness, and effectiveness of maneuvers performed under endoscopic guidance, which can be checked at any time using surgical navigation. In this paper, the authors explore the transantral approach for the excision of masses of the inferior orbital compartment through modern technology. The authors apply this technique for masses located in the inferior orbit and share their clinical results, describing why technological innovation, and, in particular, computer planning, virtual endoscopy, navigation, and AR can contribute to empowering minimally invasive orbital surgery, at the same time offering a valuable and indispensable tool for pre-surgical analysis and training.

Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology, Sep 1, 2022

The ongoing COVID-19 pandemic required a firm and prompt effort in the development of an effectiv... more The ongoing COVID-19 pandemic required a firm and prompt effort in the development of an effective vaccine. Reports of adverse reactions are increasing. Lichen planus, as well as its oral variant, is a condition that has previously been reported to be associated with vaccines. This is one of the first reports of oral lichen planus (OLP) arising after any COVID-19 vaccine. Here the authors present 2 cases of OLP that occurred after BNT162b2 mRNA COVID-19 vaccination (Comirnaty, Pfizer, New York, NY, USA; BioNTech, Mainz, Germany).

Journal of Clinical Medicine, Jan 25, 2023

Journal of Cranio-maxillofacial Surgery, Apr 1, 2021

Purpose. The worldwide pandemic caused by the COVID-19 outbreak has led to an unprecedented burde... more Purpose. The worldwide pandemic caused by the COVID-19 outbreak has led to an unprecedented burden on hospital structures, posing new challenges in terms of reshaping healthcare services. At the same time, the so-called ‘lockdown’ restrictions have decreased overall mobility, thereby challenging the traditional concept of clinical examination. Moreover, the need for security for both patients and healthcare personnel has posed a further limitation to face-to-face meeting. Telemedicine has provided a valuable solution for such issues, allowing the evaluation of oral and maxillofacial surgery patients through technological interfaces, restricting physical consultations to cases with high clinical priority, intercepting suspects, and maintaining contact with discharged patients. Thanks to the experience gained during the previous wave of infections, the purpose of this study was to present a reorganization of clinical services for oral and maxillofacial surgery in order to help cope with the latest COVID-19 resurgence. Materials and methods. Using commonly available software for telecommunications and online meetings, the Oral and Maxillofacial Surgery Department of the University Hospital of Udine has reshaped the organization of healthcare services, with telemedicine central to the continuity of assistance, while at the same time minimizing the risk of exposure for both patients and operators. Additionally, the high number of patients evaluated through telemedicine improved our ability to define signs and symptoms of diseases using informatic tools, thus allowing the introduction of the concept of ‘telesemiology’. Results. During our previous lockdown experience, between March and April 2020, 78 patients were evaluated using teleconsultation. All outpatient examinations were rescheduled and translated into a virtual platform, allowing each patient to undergo evaluation in the most appropriate setting. Special attention was paid to the follow-up of oncological patients. The rehabilitation team represented a crucial element in maintaining contact with more complex patients in this crucial time. Conclusions. This study was based on our previous lockdown experience – a situation that many will be facing again over the coming months. Our hope is that the organizational structure that our department applied during the previous wave of infections may offer other colleagues a solution to facing the current COVID-19 recrudescence.

Frontiers in bioscience, Jun 27, 2023

Background: Facial reconstruction represents one of the main challenges for surgeons. Stem cells ... more Background: Facial reconstruction represents one of the main challenges for surgeons. Stem cells (SC) represent the most studied solution for tissue regeneration. This approach appears particularly promising in combination with bioengineered scaffolds and 3D bioprinting. The purpose of this systematic review is to define the main domains of current application of SC therapy within contemporary clinical workflows, evaluate indications and limitations, report current knowledge in this innovative field of research, and define the landscape of evidence for such approaches. Methods: A systematic review was performed on the pertinent literature regarding stem cell-based cell therapies currently available in the reconstruction of the face. The review used the main databases for scientific literature based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: A total of 15 papers were selected after an independent search was performed. The two major domains for current application of stem cells in clinical practice were bone and skin categories. Conclusions: Cell therapy in the field of facial reconstruction represents a promising approach. The evidence regarding the current clinical use, however, seems to show this option to be limited. Bioengineering advances and the parallel development of 3D bioprinting technology can potentially enhance the role of stem cells in the future.

International Journal of Oral and Maxillofacial Surgery, Jul 1, 2023

DOAJ (DOAJ: Directory of Open Access Journals), 2022

The Covid-19 global pandemic has suspended thousands of clinical education programs around the wo... more The Covid-19 global pandemic has suspended thousands of clinical education programs around the world. Also in Italy, as in the rest of the world, frontal teaching activities and internships in the medical field have been suspended. At the university hospital of Udine (North-Eastern Italy) it was decided to strengthen the use of simulation in all training stages to get over the block of training activities. Methods: A protocol has been drawn up with the aim of providing training in safety for every student of the degree courses in medicine and health area and for doctors in residency training. In this way it was possible to carry out training sessions with a maximum of 6 students engaged in the simulation activities offered by the Center (3D) virtual cadaver, laparoscopic pelvic trainer stations, ultrasound laboratory, microsurgery, etc.). The key points of the protocol were represented by i) internet booking of the training activity; ii) respect of safety measures (hand hygiene, safe distance, restricted total number of presences, constant use of the surgical mask) and iii) reorganization of the material and cleaning of the rooms. Results: Our educational strategy allowed to resume training activity maintaining adequate levels of safety for students and teachers. Applying our protocol, it was possible to guarantee safe access to our Medical Simulation Center (MSC) to a total of about 1400 students from different course of study during the period between June 2020 and February 2021. Conclusions: Our protocol could represent a practical tool in the management of resuming the activity at a MSC.

Rheumatology, Sep 17, 2020

Objective. Persistent (!2 months) major salivary gland enlargement in primary SS (pSS) patients i... more Objective. Persistent (!2 months) major salivary gland enlargement in primary SS (pSS) patients is a well-known sign of possible involvement by B cell lymphoma. The study aimed to evaluate the diagnostic accuracy and safety of US-guided core needle biopsy (CNB) of major salivary glands compared with open surgical biopsy. Methods. Prospective pSS patients (cases) with clinically persistent salivary gland enlargement underwent USguided CNB and were compared with retrospective pSS patients (controls) submitted to open surgical biopsy. The features analysed were pre-biopsy clinical and laboratory findings, adequacy of the material for histology and diagnostic-rendered and biopsy-related complications (reported by the patient with a questionnaire and clinically verified). Results. Thirteen cases underwent US-guided CNB: in nine, biopsy was performed on the parotid gland and in four it was performed on the submandibular gland. Sufficient material was obtained for pathological diagnosis in all samples. The final diagnoses were 5 (38.5%) B cell lymphoma, 1 (7.7%) lymphoepithelial sialadenitis, 4 (30.7%) other sialadenitis (granulomatous consistent with sarcoidosis, IgG4-related disease, chronic sclerosing, diffuse chronic) and 3/13 (23.1%) miscellaneous lesions. Thirteen controls underwent open surgical biopsy of the parotid. In one, inadequate material was obtained, while in 12 (92.3%) the pathologic diagnoses were 4 (33.3%) B cell lymphoma, 2 (16.7%) lymphoepithelial sialadenitis, 4 (33.3%) uncertain lymphoproliferative lesions and 2 (16.7%) miscellaneous lesions. Six cases (46.1%) reported six transient complications and 12/13 (92.3%) controls had 2 persistent and 14 transient complications. Conclusion. US-guided CNB represents a novel, clinically relevant and safe approach for the management of pSS patients with parotid or submandibular persistent enlargement.