Anti-SARS-CoV-2 antibody levels and kinetics of vaccine response: potential role for unresolved inflammation following recovery from SARS-CoV-2 infection.

The immune response after SARS-CoV-2 vaccine administration appears to be characterized by high inter-individual variation, even in SARS-CoV-2 positive subjects, who could have experienced different post-infection, unresolved conditions. We monitored anti-SARS-CoV-2 IgG levels and kinetics along with circulating biomarkers in a cohort of 175 healthcare workers during early immunization with COVID-19 mRNA-LNP BNT162b2 vaccine, to identify the associated factors. Subjects with a previous SARS-CoV-2 infection were characterized by higher BMI and CRP levels and lower neutrophil count with respect to naïve subjects. Baseline IgG levels resulted associated with CRP independently on BMI and inflammatory diseases. Among 137 subjects undergoing vaccination and monitored after the first and the second dose, three kinetic patterns were identified. The pattern showing a rapid growth was characterized by higher IgG levels at baseline and higher CRP and MCHC levels than negative subjects. Subjects previously exposed to SARS-CoV-2 showed higher levels of CRP, suggesting persistence of unresolved inflammation. These levels are the main determinant of IgG levels at baseline and characterized subjects belonging to the best performing, post-vaccine antibody kinetic pattern.

SARS-CoV-2 detection in primary thyroid sarcoma: coincidence or interaction?

INTRODUCTION: Thyroid dysfunctions associated with SARS-CoV-2 are emerging in scientific literature. During the second COVID-19 epidemic spread, we evaluated a patient with the suspect of subacute thyroiditis. METHODS AND RESULTS: Specimen from fine-needle aspiration of a hypoechoic undefined area was analyzed for cytology and for SARS-CoV-2 detection. SARS-CoV-2 was retrieved by real-time polymerase chain reaction on the cytologic sample, which was then cultured on Vero E6 cells and demonstrated to be cytopathic. Whole-genome sequence was deposited. Histological exam diagnosed a rare case of primary thyroid sarcoma with diffuse and strong expression of mouse double minute 2 homolog (MDM2) oncoprotein. Ultrastructural examination confirmed, in several neoplastic cells, the presence of viral particles in cytoplasmic vacuoles. CONCLUSIONS: In our hypothesis, SARS-CoV-2 and sarcoma coexistence could represent a synergistic interplay, ultimately favoring both viral persistence and tumor proliferation: the overexpression of MDM2 in tumor cells might have generated a favorable immunological niche for SARS-CoV-2 localization and, in turn, SARS-CoV-2 could have favored tumor growth by inducing MDM2-mediated p53 downregulation. Functional studies are needed to confirm this suggestive pathway.

Oral rehabilitation of oncology patients with dental implants after reconstruction surgery with autogenous flaps.

OBJECTIVE: Reconstruction after radical cancer surgery in terms of function and esthetics can be quite demanding. The aim of this study was to evaluate oral rehabilitation with autogenous flaps and dental implants for maxillofacial reconstruction in oncologic patients after implant insertions. MATERIALS AND METHODS: The study consisted of 19 patients diagnosed with either squamous cell carcinoma, fusocellular carcinoma, or mucoepidermoid carcinoma. The reconstruction of the maxillofacial defects was done with autogenous flaps (free fibular flap, antero-lateral thigh flap, radial forearm flap, or rotational pedicled temporal muscle flap). Implants were inserted on the average 32.03±19.51 months after reconstructive operations. A total of 82 implants were inserted. Mean follow-up after maxillo-facial surgery was 7.2 years (mean 86.56±22.04 months). Mean follow-up after implant insertions was 4.5 years (mean 54.6±21.82). Primary outcome was implant survival. Secondary outcome was evaluation of post-surgical complications. RESULTS: There were surgical revisions in seven patients after reconstructive surgery with flaps, mainly due to tumor relapse. Complications were seen in 11 patients. There was one implant failure. Overall implant survival rate was 98.8%. No relations were found between implant survival rate and gender, type of tumor, type of microvascular free flap, radiation therapy, chemotherapy, and prosthesis type. CONCLUSIONS: According to the results of this study, oral rehabilitation with dental implants inserted in free flaps for maxillofacial reconstruction after ablative oncologic surgery can be considered as a safe treatment modality with successful outcomes.

Analysis and comparison of quality of life and patients' satisfaction between dental-skeletal dysmorphisms and Obstructive Sleep Apnea (OSA) patients following orthognathic surgery.

OBJECTIVE: The aim of this study was to evaluate the impact of orthognathic surgery on the patients' satisfaction and quality of life (QoL) in patients with dental skeletal dysmorphisms and Obstructive Sleep Apnea (OSA). SUBJECTS AND METHODS: Patients were grouped into two cohorts, patients with OSA (G1) and patients with dento-skeletal dysmorphisms (G2). SF-36 questionnaire was obtained from all subjects before interventions. A standardized follow-up protocol, including a second SF-36 questionnaire was planned as at least 6 months after surgery. The impact of surgery on satisfaction was evaluated by post-operative patient satisfaction-based survey. RESULTS: 61 patients were included as: 21 OSA (G1), 12 Class II (G2-a) and 28 Class III (G2-b) patients. The mean post-operative follow-up was 65.47±26.36 months. In the SF-36 results, when pre and post operative surveys were compared, the quality of life increased significantly for G1 in all items except for body pain. In G2, when pre and post operative surveys were compared, the quality of life increased significantly in items related to emotional well-being, health transition, role limitations due to emotional problems, while other parameters did not significantly change. When groups were compared, there was no difference among them except for physical functioning which was improved for OSA patients. According to the Rustemeyer results, overall post-operative satisfaction score was 84.92±14.72%. There was a significant difference for patient satisfaction considering facial aesthetics in both groups. For chewing function there was no difference for patient satisfaction in G1, but there was a significant difference in G2 patients. CONCLUSIONS: Orthognathic surgery seems to be beneficial in terms of patients' satisfaction and patients' satisfaction for both dental skeletal dysmorphism and OSA patients.

Custom made/patient specific alloplastic total temporomandibular joint replacement in immature patient: a case report and short review of literature.

OBJECTIVE: Temporomandibular joint reconstructive surgery in a growing patient represents a challenging situation. Autogenous and alloplastic reconstructive options are being studied in literature; however, there are still some limitations. The objective of this case report is to evaluate a novel custom-made prosthetic system in a 12-year-old TMJ ankylosis patient. CASE PRESENTATION: The patient had complaints of temporomandibular joint ankylosis and hypoplasia. The patient had already been operated two times with autogenous grafts. Swelling and tumefaction were apparent on the right side of the face. Mouth opening was 1.5 centimeters, with limitations in lateral and protrusive movements of the jaws. Hypertonic muscles and pain upon palpation were registered. There were no signs of luxation, fracture, or traumatic avulsion. After examination, unilateral TMJ ankylosis was apparent on TC scans. Revision surgery was planned with the use of true plastic temporomandibular joint customized prosthesis. The patient underwent a TMJ reconstruction surgery using CADCAM custom-made patient specific prosthesis. The follow up period of this patient was 46 months and showed successful healing with no complications. CONCLUSIONS: Replacement of TMJ with custom made alloplastic material that is reported can be considered as a safe and useful option for growing young individuals in selected cases.

Solitary fibrous tumor of parotid gland: a case report and short review of literature.

OBJECTIVE: This case report represents a solitary fibrous tumor, which is a very rare neoplasm in the parotid gland. CASE PRESENTATION: 80-year-old Caucasian female patient with palpable, immobile, painless, slow growing, semi-rigid-elastic neoplasm in the left parotid gland, that was existing for four months. There were no signs of inflammation and facial paralysis. The tumor was initially interpreted as a salivary gland neoplasm of uncertain origin. Fine needle aspiration was performed 2 times; however, the precise diagnosis was challenging. The tumor was excised, regional lymphadenectomy was performed. Morphological and immunophenotypical findings were consistent with solitary fibrous tumor of parotid gland. Currently, the patient is under regular follow-up period at 9 months with no evidence of metastasis or recurrence. CONCLUSIONS: Although very rare, solitary fibrous tumor (SFT) should be suspected in cases of slow growing, solid, well-defined nodules of the parotid gland. The SFT of the parotid gland are usually benign tumors, however there is a low risk of recurrency and malignant behavior with metastatic potential. Complete resection of the tumor should be performed since it is crucial for management without any recurrence.

Diagnostic Salivary Tests for SARS-CoV-2.

The diagnosis of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection relies on the detection of viral RNA by real-time reverse transcription polymerase chain reaction (rRT-PCR) performed with respiratory specimens, especially nasopharyngeal swabs. However, this procedure requires specialized medical personnel, centralized laboratory facilities, and time to provide results (from several hours up to 1 d). In addition, there is a non-negligible risk of viral transmission for the operator who performs the procedure. For these reasons, several studies have suggested the use of other body fluids, including saliva, for the detection of SARS-CoV-2. The use of saliva as a diagnostic specimen has numerous advantages: it is easily self-collected by the patient with almost no discomfort, it does not require specialized health care personnel for its management, and it reduces the risks for the operator. In the past few months, several scientific papers, media, and companies have announced the development of new salivary tests to detect SARS-CoV-2 infection. Posterior oropharyngeal saliva should be distinguished from oral saliva, since the former is a part of respiratory secretions, while the latter is produced by the salivary glands, which are outside the respiratory tract. Saliva can be analyzed through standard (rRT-PCR) or rapid molecular biology tests (direct rRT-PCR without extraction), although, in a hospital setting, these procedures may be performed only in addition to nasopharyngeal swabs to minimize the incidence of false-negative results. Conversely, the promising role of saliva in the diagnosis of SARS-CoV-2 infection is highlighted by the emergence of point-of-care technologies and, most important, point-of-need devices. Indeed, these devices can be directly used in workplaces, airports, schools, cinemas, and shopping centers. An example is the recently described Rapid Salivary Test, an antigen test based on the lateral flow assay, which detects the presence of the virus by identifying the spike protein in the saliva within a few minutes.

Maxillomandibular advancement for the treatment of obstructive sleep apnoea syndrome: a long-term follow-up.

Obstructive sleep apnoea syndrome (OSAS), which is characterised by repetitive episodes of pharyngeal collapse during sleep, is gaining much attention because of the important deleterious consequences it might have on the patient's health. We therefore organised a retrospective longitudinal study to report the long-term follow-up of maxillomandibular advancement (MMA) as a treatment for OSAS. A total of 19 patients with severe OSAS was treated during the period 2007-2016. They were followed up six months postoperatively (T1) and after a mean follow up of 6.7 (range 4-10) years (T2, between November 2017 and February 2018) for the polysomnography variables, and the Epworth sleeping scale (ESS) and body mass index (BMI) were recorded. All polysomnographic variables improved significantly from baseline to T1 and from baseline to T2. The ESS significantly improved from baseline to T2. Nearly all patients at T1 and over two-thirds at T2 had a 50% reduction of the apnoea/hypopnoea index when compared with baseline, and a value lower than 20 of the same index. The BMI did not change significantly from T0 to T2. Our long-term follow-up has documented the stability of the outcomes of the MMA for the treatment OSAS.

Clinical and functional outcomes of cad/cam mandibular reconstruction with free fibular flap comparing traditional versus micro-invasive intraoral surgical approaches.

The surgical incision plays a pivotal role in any surgical procedure. A good surgical approach should allow optimal visualization, respect the anatomy and ensure the best aesthetic outcome possible, especially when the lesions involve the face. In this retrospective study, carried out from June 2014 to April 2018, different types of surgical approaches to perform mandibular reconstruction were compared. Twentyone patients who underwent mandibular reconstruction with free fibular flap (FFFs) using CAD-CAM technology and Virtual Surgical Planning (VSP) were included in the study, regardless the condition, the timing of reconstruction (primary vs secondary), the number of fibular segments or the type and size of the mandibular defect. The patients were treated for mandibular defects secondary to benign or low-grade oncological lesions and different non-oncological conditions. However, patients requiring neck dissection were excluded from the study. Patients were divided into two groups according to the type of surgical approach used: 7 patients received a traditional transcervical approach together with an intraoral approach, while 14 patients were operated through an intraoral approach combined with different microinvasive approaches, including the sub-mandibular, the retro-mandibular and the preauricular approaches. Different factors were statistically compared: characteristics of the harvested fibula, surgical timing, days of hospitalization, as well as complication, functional and aesthetic outcomes. According to this study, no statistically significant differences were observed between the two groups in any of the features considered. These results support the hypothesis that the combination of different microinvasive approaches and the traditional approach are superimposable, and they can be safely exchanged when the underlying defects allow it.

Drug-induced gingival overgrowth: an in vitro study on cyclosporine and human gingival fibroblasts.

Gingival overgrowth is a serious side-effect that accompanies the use of cyclosporine. Up to 97% of the patients submitted to immunosuppressant drugs have been reported to suffer from this side-effect. Several conflicting theories have been proposed to explain the fibroblast's function in gingival overgrowth. To determine whether cyclosporine alter the inflammatory responses, we investigated its effects on gingival fibroblast gene expression as compared with untreated cells. Fragments of gingival tissue of healthy volunteers (11-year-old man, 68-year-old-woman and 20-year-old-man) were collected during operation. Cells were incubated with cyclosporine and gene expression of 29 was investigated in gingival fibroblasts cell culture, compared with untreated cells. The gene expression level was significantly deregulated only for 10 genes (CCL1, CCR1, CCR4, CCR5, CCR10, IL1A, IL1B, IL5, IL6R and TNFSF10) that were found to be downregulated except for TNFSF10. These results seem to demonstrate that cyclosporine has no inflammatory effect on healthy gingival fibroblast. In the future, it would be interesting understand, the possible effect of the drug on inflammation of patients affected by gingival hyperplasia.

Impact of reconstructive microsurgery on patients with cancer of the head and neck: a prospective study of quality of life, particularly in older patients.

Treatment of cancer of the head and neck often requires extended resection and major reconstructive surgery, both of which can have great functional and emotional impact. It is fundamental to evaluate the outcome with respect not only to the clinical aspects but also to the quality of life (QoL) perceived by the patients. In the light of the reported increasing incidence of oral cancer in older patients, we decided to see if there was an association between QoL and age. Between June 2015 and December 2016 we submitted the Italian version of the 36-item Short Form Health Survey (SF-36) to 30 patients (mean (range) age 65.5 (23-87) years) who had had resection and microsurgical reconstruction at the Ospedale Maggiore Policlinico of Milan. The questionnaires were completed before operation, and 12 months afterwards, and clinical and personal data were also collected. From the results of SF-36 we obtained the Short Form 12 (SF-12), Physical Health Composite Score (PCS), and Mental Health Composite Score (MCS) and looked at how age influences the variation in QoL scores. The variation between SF-36 and SF-12 results (preoperatively and postoperatively) did not seem to correlate with age. Our study confirmed that reconstructive microsurgery can be realistically proposed to older as well as younger patients because, according to the QoL index, older patients are able to manage (and therefore take advantage of) this complex surgical technique.

Bimaxillary orthognathic surgery with a conventional saw compared with the piezoelectric technique: a longitudinal clinical study.

The only cutting technique used for osteotomies in orthognathic surgery for many years has been a saw, but recently piezoelectric surgery has been introduced as a possible alternative. The aim of this study was to find out if piezoelectric surgery can be more comfortable for patients having orthognathic surgery. A total of 25 patients with dentofacial deformities (seven male and 18 female), were treated from January 2016 to September 2017. In 11 patients, osteotomies were made using a conventional saw, while in 14 a piezoelectric device was used. The variables assessed were: operating time, postoperative swelling, postoperative pain, and cutaneous sensitivity of the upper and lower lips. The duration of operation for the piezosurgery group was significantly longer than that for controls, but the patients had less swelling at all follow-up visits, and the difference was significant at the 30-day follow-up (p=0.045). Those who had piezosurgery had significantly less pain at the three-day follow up (p=0.035). There was a significant difference in cutaneous sensitivity only for the right side of the upper lip and only at the one-day follow-up. We conclude that piezoelectric surgery offers some advantages in lessening swelling and the perception of pain after orthognathic surgery, but further investigations are required.

Use of the orbital fat pad in eyelid reconstruction.

Eyelid reconstruction, though challenging, can produce a functional, esthetically pleasing lid. This should preferably be accomplished with a one-stage procedure, using robust, well-vascularized tissues similar to those being replaced, with minimal associated donor morbidity. According to the experience with Bichat pedicled flap in oral reconstruction, the authors propose the use of pedicle infraorbital fat pad for repair of conjunctival defect. Seven patients underwent eyelid reconstruction of full-thickness oncological or post-traumatic defects. In all cases, the reconstruction involved an orbital fat pad flap for the posterior lamella in addition to local flaps for the anterior lamella. All of the flaps survived. The transferred fat flap had a complete epithelization, histologically documented. No tumor relapse occurred in oncological cases. The results have been satisfactory both for clinical evaluation and for the patients. Reconstruction of the palpebral inner lamella with the orbital fat pad is a simple and low-morbidity procedure that has good morphological and functional results.

Parry Romberg Syndrome and linear facial scleroderma: management in pediatric population.

Among all different types of cutaneous scleroderma, Parry Romberg syndrome and linear scleroderma "en coup de sabre" typically involve the visage. Gradual degeneration of the tissues, from the skin up to the bone, is the stigmata of the diseases and the range of clinical manifestations is wide. They typically start during childhood and slowly progress before stabilizing. Considering the gravity of the associated deformity and its impact on facial function and appearance, we strongly advocate a prompt intervention that however must be tailored on paediatric patients. There is not a general consensus on hemifacial atrophy treatment, but autologous fat grafting has been proved to be a suitable technique, due to its low morbidity, repeatability and efficacy in correcting volume defects and in improving skin texture. Following the same concept of safeness and non-invasiveness we propose 3D stereophotogrammetric acquisitions as a possible tool for the pre- and post-surgical follow up, indispensable to evaluate the surgical results. We present our case series composed of 8 paediatric patients, aged between 11 and 17 years, who underwent several lipofilling procedures, from 2012 to 2016. Starting from 2015, 3D stereophotgrammetric data has been obtained.

Bilateral coronoid hyperplasia: a report of six cases.

Bilateral coronoid process hyperplasia is a rare condition defined as an abnormal elongation of the mandibular coronoid process, formed of histologically normal bone. Coronoid process hyperplasia usually develops progressively, and the clinical symptoms are often similar to those of temporomandibular joint disorders (TMD). Therefore, it is often misdiagnosed as TMD initially. From 2013 to 2016, six patients were referred to our maxillofacial surgery unit by their dentist, to evaluate mouth opening with suspected TMJ disorder. Average age was 30 years No hypertrophy of the masseter muscles was found and the patient had no history of pain and/or dysfunction of the temporomandibular joint. Average maximal incisal opening was 16.3 mm. (Rance 13-20 mm). At the end of surgery the average mouth opening achieved was of 40.3 mm. After 6 months from surgery an average mouth opening of 41 mm was obtained, with no recidivism in the coronoid process growth or decrease in the mouth opening. The only successful treatment to restore the mouth opening caused by coronoid process hyperplasia is surgical correction of coronoid-malar interference by coronoidectomy or coronoidotomy. Commencement of physiotherapy is recommended to begin between three days and one week after surgery. We also recommend the use of the TeraBite®, a simple manual physiotherapy device.

Oral melanoma with osteocartilagineous differentiation: a case report and literature review.

Osteocartilagineous differentiation within malignant melanoma is a rare occurrence with several implications for diagnosis. Most of the reported cases have occurred in acral lentiginous malignant melanomas. In this paper, the authors describe the clinical, morphological, immunohistochemical features and surgical treatment of a case of primary oral mucosal melanoma with osteocartilaginous differentiation and they review the existing literature. The clinical history of a 67-year-old man affected of oral malignant melanoma was described from the first presentation to the second recurrence. FISH analysis on primary lesion and on relapses showed positive results both in epithelioid and in osteocondroblastic areas. Because of the scarcity of literature in osteogenic melanoma, histological identification may be problematic and prognostic factors and therapeutic protocols are nor well established. Immunohistochemical and molecular techniques can help to diagnosis this rare lesion.

Bidirectional flux of fluids and microbiota at implant-abutment connection of FMD Storm implant system: an in vitro stud y using RT-PCR.

The purpose of the present microbiological study was to evaluate bacterial leakage at implant-abutment connection level of a new type of implant (Storm implant (FMD, Falappa Medical Devices®, Rome, Italy) using Real-Time Polymerase Chain Reaction (RT-PCR). This implant presents a polygonal external implantabutment connection with a geometry that provides a hex on which engage complementary abutments. To identify the capability of the implant to protect the internal space from the external environment, the passage of genetically modified Escherichia coli across implant-abutment interface was evaluated. Four Storm implants (FMD, Falappa Medical Devices®, Rome, Italy) were immerged in a bacterial culture for 24 h and bacteria amount was measured inside implant-abutment interface with Real-time PCR. Bacteria were detected inside all studied implants, with a median percentage of 15% for P. gingivalis and 14% for T. forsythia. Our results are similar to those reported in the English literature. Additional studies are needed to explore the relationship in terms of microbiota between the internal implant and implant-prosthetic connection. In addition, the dynamics of internal colonization needs to be thoroughly documented in longitudinal in vivo studies. As a result, microbial leakage along the implant abutment interface was acceptable and considered the most probable explanation for peri-implantitis.

Bacterial colonization of the implant-abutment interface of conical connection with an internal octagon: an in vitro study using real-time PCR.

Bacterial leakage at the implant-abutment connection of a two-piece implant system is considered the main cause of peri-implantitis. Prevention of bacterial leakage at the implant-abutment connection is mandatory for reducing inflammation process around implant neck and achieving bone stability. Micro-cavities at implant-abutment connection level can favour bacterial leakage, even in modern two-piece implant systems. The conical connection with an internal octagon (CCIO) is considered to be more stable mechanically and allows a more tight link between implant and abutment. As P. gingivalis and T. forsythia penetration might have clinical relevance, it was the purpose of this investigation to evaluate molecular leakage of these two bacteria in a new two-implant system with an internal conical implant-abutment connection with internal octagon (Shiner XT, FMD Falappa Medical Devices S.p.A. Rome, Italy). To verify the ability of the implant in protecting the internal space from the external environment, the passage of genetically modified Escherichia c oli across implant-abutment interface was evaluated. Four Shiner XT implants (FMD, Falappa Medical Devices®, Rome, Italy) were immerged in a bacterial culture for 24 h and bacteria amount was measured inside implant-abutment interface with Real-time PCR. Bacteria were detected inside all studied implants, with a median percentage of 6% for P. gingivalis and 5% for T. forsythia. Other comparable studies about the tightness of the tested implant system reported similar results. The gap size at the implant-abutment connection of CCIOs was measured by other authors discovering a gap size of 1­2µm of the AstraTech system and of 4µm for the Ankylos system. Bacterial leakage along implant-abutment connection of cylindrical and tapered implants, Shiner XT, (FMD Falappa Medical Devices S.p.A. Rome, Italy) showed better results compared to other implants. Additional studies are needed to explore the relationship in terms of microbiota of the CCIO. In addition, the dynamics of internal colonization needs to be thoroughly documented in longitudinal in vivo studies.

Replica-guided trauma surgery.

The aim of this study is to present a new approach to the surgical treatment of fractures of the middle third of the face, based on the use of resorbable materials and stereolithographic models. From 2009 to 2014, we treated 10 cases of orbitozygomatic trauma mostly as secondary surgery. For each case, an anatomical replica had been produced simulating the expected result and was then used to contour the resorbable plates on its surface, even before the beginning of the surgical procedure itself. The plates and meshes already bended act as a guide to bony reduction procedure. No complications occurred: all patients healed well, without inflammatory reactions. The results obtained corresponded to the expected results. This technique has been employed for primary or secondary treatment of fracturesof the middle third facial, where it is not always easy to understand the displacement of bony segments and where the use of resorbables plates could be particularly beneficial, as they do not interfere with the maxillofacial skeleton physiology and avoid the necessity to remove plates and screws. Combined use of stereolithographic model and resorbable materials allow a new surgical approach based on the realization of the surgical procedure on the model, then transferred from the patient to the model, thanks to plates and meshes. This technique helps to overcome many of the limits of the conventional technique: the need of minimal surgical access, in order to minimize facial scarring and the vasculo-nervous structures that cross the head and neck district and the obligation to restore not only the morphology but also the biological functions.