Optimizing efficiency in the creation of patient-specific plates through field-driven generative design in maxillofacial surgery.

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.

Oxidative phosphorylation in bone cells.

The role of energy metabolism in bone cells is an active field of investigation. Bone cells are metabolically very active and require high levels of energy in the form of adenosine triphosphate (ATP) to support their function. ATP is generated in the cytosol via glycolysis coupled with lactic acid fermentation and in the mitochondria via oxidative phosphorylation (OXPHOS). OXPHOS is the final convergent metabolic pathway for all oxidative steps of dietary nutrients catabolism. The formation of ATP is driven by an electrochemical gradient that forms across the mitochondrial inner membrane through to the activity of the electron transport chain (ETC) complexes and requires the presence of oxygen as the final electron acceptor. The current literature supports a model in which glycolysis is the main source of energy in undifferentiated mesenchymal progenitors and terminally differentiated osteoblasts, whereas OXPHOS appears relevant in an intermediate stage of differentiation of those cells. Conversely, osteoclasts progressively increase OXPHOS during differentiation until they become multinucleated and mitochondrial-rich terminal differentiated cells. Despite the abundance of mitochondria, mature osteoclasts are considered ATP-depleted, and the availability of ATP is a critical factor that regulates the low survival capacity of these cells, which rapidly undergo death by apoptosis. In addition to ATP, bioenergetic metabolism generates reactive oxygen species (ROS) and intermediate metabolites that regulate a variety of cellular functions, including epigenetics changes of genomic DNA and histones. This review will briefly discuss the role of OXPHOS and the cross-talks OXPHOS-glycolysis in the differentiation process of bone cells.

The Transantral Endoscopic Approach: A Portal for Masses of the Inferior Orbit-Improving Surgeons' Experience Through Virtual Endoscopy and Augmented Reality.

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.

Working in the era of COVID-19: An organization model for maxillofacial surgery based on telemedicine and video consultation.

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. 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'. 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. 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.