Abstract Soft tissue sarcomas represent an heterogeneous group of rare mesenchymal tumors comprising 1% of all solid malignancies. Among them, liposarcoma is one of the most common histotypes with atypical lipomatous tumor/well differentiated liposarcoma and dedifferentiated liposarcoma (ALT/WDLPS and DDLPS) as the major sub-entities. The unavailability of predictive, prognostic and druggable biomarkers makes the management of these lesions challenging. In recent years CDK4 and its inhibitors have emerged as potential agents for these lesions especially for ALT/WDLPS and DDLPS but the results are not conclusive and need to be elucidated. This study involved 21 ALT/WDLPS and DDLPS patients. Histological analyses of MDM2 and CDK4 were carried out. Moreover, a DDLPS patient-derived cancer model was established in vitro and in vivo assessing the efficacy of palbociclib in combination and sequential treatment. Finally, in silico analyses on CDK4 expression were carried out. The results showed a higher expression of CDK4 and MDM2 in DDLPS compared to ALT/WDLPS. Moreover, no correlation between MDM2 expression and CDK4 was observed. Next, in vitro analysis of CDK4 inhibitor palbociclib showed an antagonistic effect when combined to other chemotherapeutics, while it exhibited a significant synergy when administered in sequential schedule with lenvatinib. Next, in vivo analysis on DDLPS xenotransplanted embryos assessing the efficacy and safety profile of the in vitro tested schedules confirmed the observed data. This proof-of-concept study sheds light on the natural history of ALT/WDLPS and DDLPS and provides the rationale for the clinical applicability of sequential treatment with palbociclib in the management of DDLPS.

BackgroundPolymorphous adenocarcinoma (PAC) represents the second most widespread neoplasm of the minor salivary glands. These tumors rarely develop a histological progression from low-grade to high-grade malignancy, named “high-grade transformation” (HGT). Only nine cases are described in literature.Case descriptionHere, we describe the case of a 76-year-old male patient with a PAC recurrence of the oral floor displaying HGT, and we explore the tumor cytomorphological features, genomic profiling, and the patient’s clinical management. The tumor mass was characterized by poorly atypical cellular elements with vesicular nuclei and comedonecrosis foci. The growth pattern was predominantly solid, tubular, and cribriform. The lesion did not show microsatellite instability or targeted molecular alterations. The case was successfully treated with radical surgery followed by radiotherapy.ConclusionWe report for the first time the recurrence of a PAC with HGT arising in the oral floor after 20 years from the primary lesion. These preliminary data and the literature analysis enhance the knowledge of this extremely rare disease.

Background: Liposarcoma (LPS) encompass one of most common soft tissue sarcoma (STS) histological subtypes accounting for 15% of all cases. They can be divided into four entities including atypical lipomatous tumor or well-differentiated LPS (ALT/WDLPS), dedifferentiated LPS (DDLPS), myxoid LPS (MLPS) and pleomorphic LPS (PLS). Their heterogeneity is reflected in their morphology, molecular landscape, prognosis and clinical behavior. Current treatment options for localized disease include surgery, (neo)adjuvant radiotherapy and chemotherapy; for the metastatic setting chemotherapy represents the cornerstone but its role needs to be elucidated. The unavailability of predictive biomarkers makes the management of these mesenchymal diseases even more challenging. Recent evidences have shed light on the key role of cyclin-dependent kinase 4 (CDK4) in cancer cells proliferation. Methods: This study involved 21 adult patients affected by liposarcoma (n= 5 ALT/WDLPS and n= 16 DDLPS). IHC analyses of CDK4 and MDM2 were performed on FFPE surgically resected specimens by experienced sarcoma pathologists. Moreover, a patient-derived DDLPS cell line was established and pharmacological profiling was performed. Next, standard and innovative drugs currently used for LPS management were assessed in both 2D and 3D culture systems. Finally, in silico analyses based on public repositories on STS were carried out including 260 sarcoma patients. Results: IHC results highlighted an higher expression of CDK4 and MDM2 biomarkers in DDLPS compared to ALT/WDLSP. Moreover, although CDK4 and MDM2 are codified by the same genomic region, their expression did not correlate (e.g. 100% of CDK4 and 2% of MDM2 in the same patient). Therefore we hypothesized that even exhibiting a low MDM2 expression, a patient could benefit from CDK4 inhibition. Furthermore, our data showed that in DDLPS cases CDK4 expression ranged from 90% to 100% in spermatic cord, skin and abdomen while it ranged from 5% to 50% in the retroperitoneum. The above observations prompted us to hypothesize a correlation of CDK4 expression with specific anatomical sites. Moreover, pharmacological profiling showed a synergistic effect exerted by sequential treatment with palbociclib and some chemotherapeutics including trabectedin, dacarbazine, eribulin and lenvatinib. Indeed we observed a 10% increase in cell proliferation inhibition compared to standard treatment. In addition, in silico analyses revealed the role of CDK4 as negative prognostic biomarker for PFS and OS in STS. Conclusions: Our study highlighted the promising role of CDK4 in the management of LPS patients. In particular, we pointed out encouraging results of sequential treatment combining CDK4 inhibitor palbociclib and chemotherapy. Furthermore, preliminary analyses highlighted the involvement of this biomarker as a potential prognostic tool for STS. Citation Format: Silvia Vanni, Graziana Gallo, Valentina Fausti, Giacomo Miserocchi, Chiara Liverani, Chiara Spadazzi, Claudia Cocchi, Chiara Calabrese, Giovanni De Luca, Massimo Bassi, Manlio Gessaroli, Angelo Campobassi, Federica Pieri, Giorgio Ercolani, Davide Cavaliere, Lorena Gurrieri, Nada Riva, Giovanni Martinelli, Laura Mercatali, Alessandro De Vita. Dissecting the role of CDK4 in liposarcoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5993.

Background: In the last few years, skull base tumors involving the fronto-orbital region have been approached with complex, invasive, and time-consuming cranial reconstruction techniques. On the other hand, recent custom-made implants allow easier and faster procedures, with excellent aesthetic results. The authors propose an easy surgical-planned protocol with a synchronized “one-step” resection and reconstruction of these complex lesions, with a preformed poly-methyilmethacrylate (PMMA) cranioplasty. Methods: Our technique consists of a 2-phases procedure. In the first one, the so-called “virtual” phase, the authors get a tailored 3D-PMMA model based on high-resolution (HR) CT-scans of the patient's skull. Afterward, the authors perform the planned craniotomy on the 3D-PMMA model with the assistance of intraoperative navigation system. Therefore, a further CT-scan of the resected model is performed to develop the final implant. In the second phase, the “surgical phase,” a single procedure consisting in a cranial resection and custom reconstruction is performed with the assistance of stealth-navigation. The authors describe 6 cases of complex fronto-orbital-sphenoidal benign tumors that required skull reconstruction. All patients were examined 3 months after surgery through cosmetic (facial and eyes symmetry and globe position) and ophthalmology tests (visual field, visual impairment, and diplopia). Postsurgical HR CT-scans of the head and MRI-scans of the brain documented a total resection of the tumor and an optimal accuracy of skull reconstruction. Results: In all cases, the authors obtained a highly accurate skull reconstruction following cranio-orbital tumor resection, with a less aggressive and faster procedure compared to autologous bone graft. Final cosmetic and functional results were excellent, with good results in cases of presurgical exophthalmos and orbital asymmetry. None of the patients developed implant-related complications. Conclusions: The “one-step” resection and reconstruction of benign tumors involving the spheno-orbital region with neuronavigation assistance is a technique that allows an accurate tumor removal and a cranial-bone reconstruction within a single surgical procedure, with fewer complications and excellent cosmetic and functional results.

Adult rhabdomyosarcoma (RMS) represents an uncommon entity with an incidence of less than 3% of all soft tissue sarcomas (STS). Consequently, the natural history and the clinical management of this disease are infrequently reported. In order to fill this gap, we investigated the molecular biology of an adult RMS case series. The expression of epithelial mesenchymal transition-related gene and chemoresistance-related gene panels were evaluated. Moreover, taking advantage of our STS translational model combining patient-derived primary culture and 3D-scaffold, the pharmacological profile of an adult head and neck sclerosing RMS was assessed. Furthermore, NGS, microsatellite instability, and in silico analyses were carried out. RT-PCR identified the upregulation of CDH1, SLUG, MMP9, RAB22a, S100P, and LAPTM4b, representing promising biomarkers for this disease. Pharmacological profiling showed the highest sensitivity with anthracycline-based regimen in both 2D and 3D culture systems. NGS analysis detected RAB3IP-HMGA2 in frame gene rearrangement and FGFR4 mutation; microsatellite instability analysis did not detect any alteration. In silico analysis confirmed the mutation of FGFR4 as a promising marker for poor prognosis and a potential therapeutic target. We report for the first time the molecular and pharmacological characterization of rare entities of adult head and neck and posterior trunk RMS. These preliminary data could shed light on this poorly understood disease.

Osteosarcoma of the jaws (OSJ) is a relatively rare disease, accounting for between 2% and 10% of all cases of osteosarcoma. It is morphologically and radiologically identical to the trunk and extremity variant, but distinct in several crucial aspects. The lesion is characterized by sarcomatous cells which produce a variable amount of osteoid bone. It arises centrally within the bone and can be subdivided into osteoblastic, chondroblastic and fibroblastic subtype, depending on the predominant cell type. Radiographically, these tumors display a spectrum of bone changes from well-demarcated borders to lytic bone destruction with indefinite margins and variable cortical bone erosion or, in some cases, images of sclerotic bone. Therapeutic options for OSJ include surgery, chemotherapy and radiotherapy, which are employed according to age of the patient, histological classification and localization of the tumor. Today, there is no general consensus in the treatment guidelines for the OSJ though surgery represents the key to the treatment. The main prognostic factor deeply influencing the patient's prognosis remains the complete tumor resection with negative surgical margins. The aim of the present review is to describe state of the art regarding diagnostic and surgical treatment aspects of the primary osteosarcoma of the jaws.

Objective: Squamous cell carcinoma（SCC） represents the most common histotype of all head and neck malignancies and includes oropharyngeal squamous cell carcinoma（OSCC）, a tumor associated with different clinical outcomes and linked to human papilloma virus（HPV） status. Translational research has few available in vitro models with which to study the different pathophysiological behavior of OSCCs. The present study proposes a 3-dimensional（3 D） biomimetic collagen-based scaffold to mimic the tumor microenvironment and the crosstalk between the extracellular matrix（ECM） and cancer cells.Methods: We compared the phenotypic and genetic features of HPV-positive and HPV-negative OSCC cell lines cultured on common monolayer supports and on scaffolds. We also explored cancer cell adaptation to the 3 D microenvironment and its impact on the efficacy of drugs tested on cell lines and primary cultures.Results: HPV-positive and HPV-negative cell lines were successfully grown in the 3 D model and displayed different collagen fiber organization. The 3 D cultures induced an increased expression of markers related to epithelial–mesenchymal transition（EMT） and to matrix interactions and showed different migration behavior, as confirmed by zebrafish embryo xenografts. The expression of hypoxia-inducible factor 1α（1α） and glycolysis markers were indicative of the development of a hypoxic microenvironment inside the scaffold area. Furthermore, the 3 D cultures activated drug-resistance signaling pathways in both cell lines and primary cultures.Conclusions: Our results suggest that collagen-based scaffolds could be a suitable model for the reproduction of the pathophysiological features of OSCCs. Moreover, 3 D architecture appears capable of inducing drug-resistance processes that can be studied to better our understanding of the different clinical outcomes of HPV-positive and HPV-negative patients with OSCCs.

Oral DiseasesVolume 28, Issue 7 p. 2052-2054 LETTER TO THE EDITOR Identification of a novel RAB3IP-HMGA2 fusion transcript in an adult head and neck rhabdomyosarcoma Alessandro De Vita, Alessandro De Vita orcid.org/0000-0002-1677-5797 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Conceptualization, Data curation, Formal analysis, Writing - original draftSearch for more papers by this authorAnna Ferrari, Anna Ferrari orcid.org/0000-0002-7022-9906 Biosciences Laboratory, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Data curation, Formal analysisSearch for more papers by this authorGiacomo Miserocchi, Corresponding Author Giacomo Miserocchi giacomo.miserocchi@irst.emr.it orcid.org/0000-0001-6618-1981 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Correspondence Giacomo Miserocchi, Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, FC, Italy. Email: giacomo.miserocchi@irst.emr.it Contribution: Data curationSearch for more papers by this authorSilvia Vanni, Silvia Vanni orcid.org/0000-0003-1192-7322 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Data curationSearch for more papers by this authorChiara Domizio, Chiara Domizio Biosciences Laboratory, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Data curationSearch for more papers by this authorEugenio Fonzi, Eugenio Fonzi orcid.org/0000-0001-8389-8220 Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Data curationSearch for more papers by this authorValentina Fausti, Valentina Fausti orcid.org/0000-0003-0432-1445 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Formal analysisSearch for more papers by this authorFederica Recine, Federica Recine orcid.org/0000-0002-1610-2744 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Medical Oncology Unit, Azienda Ospedaliera San Giovanni Addolorata, Roma, Italy Contribution: Formal analysisSearch for more papers by this authorMassimo Bassi, Massimo Bassi Maxillofacial Surgery Unit, Bufalini Hospital, Cesena, Italy Contribution: Data curationSearch for more papers by this authorAngelo Campobassi, Angelo Campobassi Maxillofacial Surgery Unit, Bufalini Hospital, Cesena, Italy Contribution: Data curationSearch for more papers by this authorChiara Liverani, Chiara Liverani orcid.org/0000-0002-4279-1926 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Data curationSearch for more papers by this authorChiara Spadazzi, Chiara Spadazzi orcid.org/0000-0001-6710-5980 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Data curationSearch for more papers by this authorClaudia Cocchi, Claudia Cocchi orcid.org/0000-0002-7736-9039 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Data curationSearch for more papers by this authorGiovanni De Luca, Giovanni De Luca Pathology Unit, Bufalini Hospital, Cesena, Italy Contribution: Formal analysisSearch for more papers by this authorFederica Pieri, Federica Pieri Pathology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy Contribution: Data curation, Formal analysisSearch for more papers by this authorLorena Gurrieri, Lorena Gurrieri Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Formal analysisSearch for more papers by this authorGiandomenico Di Menna, Giandomenico Di Menna Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Formal analysisSearch for more papers by this authorSebastiano Calpona, Sebastiano Calpona Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Formal analysisSearch for more papers by this authorAlberto Bongiovanni, Alberto Bongiovanni orcid.org/0000-0002-3845-4687 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Formal analysisSearch for more papers by this authorGiovanni Martinelli, Giovanni Martinelli orcid.org/0000-0002-1025-4210 Scientific Directorate, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Data curation, Project administrationSearch for more papers by this authorToni Ibrahim, Toni Ibrahim orcid.org/0000-0003-0259-4167 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Conceptualization, Formal analysisSearch for more papers by this authorLaura Mercatali, Laura Mercatali orcid.org/0000-0003-2162-8238 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Conceptualization, Formal analysisSearch for more papers by this author Alessandro De Vita, Alessandro De Vita orcid.org/0000-0002-1677-5797 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Conceptualization, Data curation, Formal analysis, Writing - original draftSearch for more papers by this authorAnna Ferrari, Anna Ferrari orcid.org/0000-0002-7022-9906 Biosciences Laboratory, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Data curation, Formal analysisSearch for more papers by this authorGiacomo Miserocchi, Corresponding Author Giacomo Miserocchi giacomo.miserocchi@irst.emr.it orcid.org/0000-0001-6618-1981 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Correspondence Giacomo Miserocchi, Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, FC, Italy. Email: giacomo.miserocchi@irst.emr.it Contribution: Data curationSearch for more papers by this authorSilvia Vanni, Silvia Vanni orcid.org/0000-0003-1192-7322 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Data curationSearch for more papers by this authorChiara Domizio, Chiara Domizio Biosciences Laboratory, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Data curationSearch for more papers by this authorEugenio Fonzi, Eugenio Fonzi orcid.org/0000-0001-8389-8220 Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Data curationSearch for more papers by this authorValentina Fausti, Valentina Fausti orcid.org/0000-0003-0432-1445 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Formal analysisSearch for more papers by this authorFederica Recine, Federica Recine orcid.org/0000-0002-1610-2744 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Medical Oncology Unit, Azienda Ospedaliera San Giovanni Addolorata, Roma, Italy Contribution: Formal analysisSearch for more papers by this authorMassimo Bassi, Massimo Bassi Maxillofacial Surgery Unit, Bufalini Hospital, Cesena, Italy Contribution: Data curationSearch for more papers by this authorAngelo Campobassi, Angelo Campobassi Maxillofacial Surgery Unit, Bufalini Hospital, Cesena, Italy Contribution: Data curationSearch for more papers by this authorChiara Liverani, Chiara Liverani orcid.org/0000-0002-4279-1926 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Data curationSearch for more papers by this authorChiara Spadazzi, Chiara Spadazzi orcid.org/0000-0001-6710-5980 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Data curationSearch for more papers by this authorClaudia Cocchi, Claudia Cocchi orcid.org/0000-0002-7736-9039 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Data curationSearch for more papers by this authorGiovanni De Luca, Giovanni De Luca Pathology Unit, Bufalini Hospital, Cesena, Italy Contribution: Formal analysisSearch for more papers by this authorFederica Pieri, Federica Pieri Pathology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy Contribution: Data curation, Formal analysisSearch for more papers by this authorLorena Gurrieri, Lorena Gurrieri Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Formal analysisSearch for more papers by this authorGiandomenico Di Menna, Giandomenico Di Menna Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Formal analysisSearch for more papers by this authorSebastiano Calpona, Sebastiano Calpona Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Formal analysisSearch for more papers by this authorAlberto Bongiovanni, Alberto Bongiovanni orcid.org/0000-0002-3845-4687 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Formal analysisSearch for more papers by this authorGiovanni Martinelli, Giovanni Martinelli orcid.org/0000-0002-1025-4210 Scientific Directorate, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Data curation, Project administrationSearch for more papers by this authorToni Ibrahim, Toni Ibrahim orcid.org/0000-0003-0259-4167 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Conceptualization, Formal analysisSearch for more papers by this authorLaura Mercatali, Laura Mercatali orcid.org/0000-0003-2162-8238 Osteoncology and Rare Tumors Center, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy Contribution: Conceptualization, Formal analysisSearch for more papers by this author First published: 30 September 2021 https://doi.org/10.1111/odi.14036Citations: 1 Toni Ibrahim and Laura Mercatali equal contribution. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. CONFLICT OF INTEREST The authors declare no conflicts of interest. Open Research PEER REVIEW The peer review history for this article is available at https://publons.com/publon/10.1111/odi.14036. Citing Literature Volume28, Issue7October 2022Pages 2052-2054 RelatedInformation

Background We review here our substantial experience in using Alexis Carrel's technique with a geometrical optimization for microsurgical end-to-end anastomoses. Methods The technique used for microsurgical end-to-end anastomoses is described. We performed a retrospective analysis of head and neck free flaps where we used the described microsurgical anastomoses technique at Bufalini Hospital in Cesena, Italy. Patients' demographic data, intraoperative findings, and postoperative progress, including complications, were accurately recorded. We also recorded the cases where vessel size discrepancy was observed intraoperatively, either arterial or venous. Results The described technique has been used in 300 consecutive flaps in the last 18 years, with an average of 16 free flaps per year. No significant problems were encountered using this simple technique. Comprehensive flap survival was 98%. We had 5 free flap failures, and in all cases, the main problem was not related to the microvascular anastomoses. Vessel size discrepancy was recorded in 25% of the total. Conclusions Alexis Carrel's technique for microvascular end-to-end anastomoses is still a very efficient end safe technique. Our geometrical optimization of it is a useful trick to keep in mind for the microvascular surgeon, especially in hospitals with a small volume of microsurgical procedures per year. Level of evidence: Level III, therapeutic study.

A neonate presented to our clinic for evaluation of unusual congenital cleft lip. The clinical follow-up showed at first an ulceration of the lesion and then a stable result after propanolol systemic therapy. After 18 months of clinical follow-up, surgical treatment was performed, which consisted of double unilimb Z-plasty according to Mulliken's microform cleft lip repair. Knowing the existence of these strange vascular anomalies of the lip will allow us to improve the differential diagnosis and treatment plan.

Objective: Meningiomas of the spheno-orbital region were in the recent past, approached with complex reconstruction techniques that were often invasive and time consuming. We propose a simple protocol to perform a single-step resection and reconstruction of these lesions.

Purpose: To evaluate a solution for functional restoration of the fibular osteocutaneous flap "single strut", after wide resections for oral cavity malignancy and to identify the key points of this procedure.Methods: Out of 43 mandibular reconstructions using fibular flap, 9 cases were selected for rehabilitation by implant supported dental prosthesis, overcoming the fibular height deficiency by orthopaedic prosthodontic structures. The fibular/mandibular height discrepancy was recorded. The evaluation criteria included x-rays and clinical measurement of bone and gingival perimplant level and reported satisfaction of the patients, as recorded by a questionnaire.Results: In all cases the prosthetic solution was a screw retained fixed prosthesis. The average number of implants placed into the "neo-mandible" was 5. The maximum observation follow-up period after loading was 44 months. There were no reports of surgical or implant complications. The mean peri-implant bone loss was 1,7 mm.Conclusion: Orthopaedic dental prosthesis, anchored on implants, is a good solution in order to overcome the fibular height deficiency, even in presence of good conditions of the residual dentition in the healthy portion of the reconstructed mandible. It is important to arrange a correct project of both the implant insertion and the prosthetic manufacture based on biomechanical considerations and on a proper control of the occlusion.