Impact of COVID-19 epidemic on maxillofacial surgery in Italy.

Maxillofacial departments in 23 surgical units in Italy have been increasingly involved in facing the COVID-19 emergency. Elective surgeries have been progressively postponed to free up beds and offer human and material resources to those infected. We compiled an inventory of 32 questions to evaluate the impact of the SARS-COV2 epidemic on maxillofacial surgery in 23 selected Italian maxillofacial departments. The questionnaire focused on three different aspects: the variation of the workload, showing both a reduction of the number of team members (-16% among specialists, -11% among residents) due to reallocation or contamination and a consistent reduction of elective activities (the number of outpatient visits cancelled during the first month of the COVID-19 epidemic was about 10 000 all over Italy), while only tumour surgery and trauma surgery has been widely guaranteed; the screening procedures on patients and physicians (22% of maxillofacial units found infected surgeons, which is 4% of all maxillofacial surgeons); and the availability of Personal Protective Equipment, is only considered to be partial in 48% of Maxillofacial departments. This emergency has forced those of us in the Italian health system to change the way we work, but only time will prove if these changes have been effective.

Immunohistochemical correlation between microvessel density and lymphoid infiltrate in radicular cysts.

OBJECTIVE: Radicular cysts occur as a result of the immunological response to continuous antigenic stimulation from root canals. We correlated the immunophenotypical composition of the lymphoid infiltrate to the microvessel density expressed by the count of CD34 reactive endothelial cells in radicular cysts. SUBJECTS AND METHODS: Thirty-four cases of radicular cysts were evaluated by immunohistochemistry, using antibodies against B- and T-cell antigens (CD20, CD3, CD4, CD8) and against the endothelial cell marker CD34. Statistical analysis was performed. RESULTS: In the epithelium, we observed a low amount of lymphoid infiltrate in all 34 radicular cysts, and a strong significant negative correlation between T and B lymphocytes and between T-helper and T-cytotoxic/suppressor lymphocytes. In the cyst capsule, we observed a significant positive correlation between B and T lymphocytes, B and T-cytotoxic/suppressor lymphocytes, T and T-helper lymphocytes and between the number of CD34+ blood vessels and T and T-helper lymphocytes, respectively. We observed a statistically significant correlation between percentage of CD34+ vessels and inflammatory infiltrate grade. CONCLUSIONS: Both humoral and cellular immune reactions and neovascularization are likely to occur in the complex events of tissue destruction. The inflammatory infiltrate has an important role in neoangiogenesis and consequently in radicular cysts development and growth.

Synchronous bilateral Warthin's tumours of the parotid glands: a case report.

Warthin's tumour is the most frequent monomorphic adenoma of the major salivary glands, representing about 2-15% of all parotid tumours. Most of the multifocal Warthin's tumours are unilateral, whereas bilateral Warthin's tumours are far less common; bilateral Warthin's tumours are metachronous with few synchronous cases having been described in the literature. The Authors present an interesting case of simultaneously occurring bilateral Warthin's tumours growing in the parotid glands.

Double skull lymphangioma. Case report and review of the literature.

OBJECTIVE: It is still controversial whether lymphangiomas are a true entity or a combination of congenital venous and lymphatic malformations. Lymphangioma diagnosis is made on a multifactorial basis and surgery should provide cosmetic and functional preserving results. Only few multiple localization have been described in the literature and to our knowledge this is the first case reported on a double localization (orbital and temporal) in the skull. CASE DESCRIPTION: A 10-year-old girl was referred to our department with a rapidly enlarging subcutaneous mass in the right eyebrow and upper eyelid, displacing the eyeball and causing proptosis and diplopia that occurred synchronous with her menarche. A head MRI scan showed two distinct lesions, one into the orbit causing bony destruction and the other one in the sub-temporal area. The little girl underwent an open biopsy, suggesting the diagnosis of lymphangioma. Surgery through an anterior approach with total removal of both lesions was performed. Pathological examination disclosed a lesion consisting of multiple cysts with erythrocytes and lymphs, confirming the diagnosis. At a 6- and 12-months follow-up, the girl was clinically intact with normal ocular movements and a follow-up MRI showed no evidence of residual disease and/or recurrence.

[Surgical management of pleomorphic adenoma of the salivary glands: our experience]. / Trattamento dell'adenoma pleomorfo delle ghiandole salivari: nostra esperienza.

BACKGROUND: Pleomorphic adenoma is a benign epithelial tumour of adenoid structure preferentially arising from the parotid gland. AIM: To analyse the outcome of patients with pleomorphic adenoma from salivary glands in order to evaluate the surgical strategy. PATIENTS AND METHODS: This is an audit of a 15-year period where 347 pleomorphic adenomas of the salivary glands were treated by the authors. Data was collected and reviewed from the records of all the patients in order to analyze gender, age, site, operative procedure, postoperative complications and recurrences. RESULTS: The pleomorphic adenoma preferentially originated in the parotid gland (89.1%), and rarely in other glands. The tumour occurred more often in females than in males (F:M=1.5). Average age was 43.43 years. Pericapsular enucleation of parotid neoplasms was the commonest operation performed. Other procedures were: superficial parotidectomy, total conservative parotidectomy, submandibular total sialoadenectomy and radical surgery for lesions of the palate. Postoperative complication was temporary facial weakness in 18 patients; 2 patients developed the Frey's syndrome. No recurrences were developed in follow-up period (25-177 months). CONCLUSION: The epidemiological aspects of pleomorphic adenoma of salivary glands retrieved in our study are similar to those reported in literature; moreover this study demonstrates that pericapsular enucleation is a viable alternative to superficial parotidectomy for the majority of parotid localizations, associated with reduced morbidity without oncological compromise.

Salivary glands tumours: a retrospective study of 454 patients.

AIM: Salivary glands tumors constitute a highly heterogeneous group in human oncological pathology. They show different clinical, epidemiological, histopathological and evolutionary characteristics. METHODS: In this paper we have analysed their epidemiological aspects in 454 patients with salivary glands tumors surgically treated at the Maxillofacial Surgical Unit of the Azienda Ospedaliero-Universitaria ''Ospedali Riuniti Umberto I-G.M. Lancisi-G. Salesi'', Ancona, Italy, from 1990 to 2002, to evaluate the incidence of the different types of neoplasia and their age and sex distribution. RESULTS: Our results show that 63.22% of salivary glands tumors occur in the parotid gland, with a predominance of benign tumours, pleomorphic adenoma being the most prevalent histological type. A higher prevalence was observed in the female sex. CONCLUSIONS: Malignant tumors were more common in the elderly than in young patients and the most common histological types were mucoepidermoid carcinoma and adenoid cystic carcinoma.

Angiogenesis in oral squamous cell carcinoma.

Many retrospective studies have recently shown that microvessel density could represent a valid independent prognostic factor for overall survival and disease-free survival for primary tumours. The fact that oral tumours with a higher microvessel density showed a tendency to present distant metastasis and a bad prognosis, suggested that angiogenetic activity would play a pivotal role also in oral carcinomas, exerting a negative effect on the clinical course and representing an independent negative prognostic factor also for this type of tumour. Based on these results, microvessel density was evaluated, in the present study, in 64 cases of squamous cell carcinoma of the oral cavity, using immunohistochemical analysis with anti-CD34 monoclonal antibody. Possible correlations between microvessel density and clinico-pathological parameters were analysed, such as: age, sex, tumour localization and size, TNM stage and histological grading. Statistical analysis has shown that microvessel density differs in the 3 histological groups (G1, G2, G3) (p = 0.0331), and between node-positive and node-negative patients (p < 0.0001). No statistical correlation was observed between microvessel density and other clinical parameters such as age, sex, tumour site and size.

[The impacted canine in orthodontics]. / Il canino incluso in ortodonzia.

The Authors after statistic elaborations about 6343 cases of impact tooth treated in Division of Odontostomatology and Maxillo-Face Surgery Regional Hospital "Umberto 1." of Ancona from 1974 to 1988 pay attention about the impact canine. They explay about the operative protocol that they divided in orthodontic and surgery times, emphatised the scrupulous execution of protocol to take a final success.