Medication-related osteonecrosis of the jaw: A survey of knowledge, attitudes, and practices among dentists in the principality of Asturias (Spain).

INTRODUCTION: The objective of this study was to investigate the knowledge and capabilities of dentists and dental students in their last year of study in regard to risk factors of medication-related osteonecrosis of the jaw (MRONJ) in Spain. MATERIAL AND METHOD: We conducted a cross-sectional study consisting of a questionnaire survey in Asturias, Spain. The study was divided into three groups: dentists who worked for the public dental health care system (n=32), dentists who worked exclusively as private health care practitioners (n=136), and dental students in their last year (year five) of study (n=38). The quantitative differences in the scores obtained in the resolution of clinical cases between students and dentists were evaluated. Differences between dentists were evaluated depending on number of years in practice, activity (private or public care), and area of specialty. The study tracked the possible differences in the general knowledge of MRONJ among dentists and students and the participants' adherence to the dental clinic guidelines regarding the MRONJ. RESULTS: Students from year five reached a higher score than those dentists with private practice activity (P=0.01). Significant differences between the students and the public health care dentists were not recognized, nor between the latter and the private health care dentists. The lowest percentage of correct answers among participants was related to implant surgery in patients treated with oral aminobisphosphonates. The dentists with more than 20 years of professional experience obtained significantly lower-than-average scores in the resolution of the clinical cases based on clinical guidelines (P=0.01). We did not observe any differences in the average test scores obtained by dentists dependent on their area of expertise. CONCLUSIONS: Knowledge of side effects of antiresorptive drugs decreases with years of professional practice. Training efforts on MRONJ should focus especially on those dentists who practice privately, who have over 20 years of professional experience, and who perform implant surgery on patients at risk of MRONJ.

Histological and radiological evaluation of subcutaneous implants in mouse of a 3D-printable material (Fulcure 720) and experimental application in mandibular reconstruction.

INTRODUCTION: The aim of this study was to evaluate the bioactivity of Fullcure compared to porous polyethylene implants (Medpor) in rats prior to custom-made scaffold support manufacturing for mandible segmental defects (MSD) reconstruction in sheep. METHODS: Twelve Fullcure and Medpor laminaes were implanted in the left and right dorsum respectively of six wistar rats. Toxicity was assessed by skin, kidney and liver histopathology three months post-implantation. Computed Tomography (CT) was carried out in order to assess radiological differences between implants. Fullcure containers were subsequently manufactured by CAD/CAM to hold scaffold cylinders for MSD reconstruction in sheep. RESULTS: No statistical differences were observed in tissue response between implants. Fullcure radiodensity was higher than Medpor (P<0.05). Fullcure manufactured support was successfully used for mandible repair in sheep. Nevertheless, the manufactured container did not accomplish the goal of guiding new bone formation according to the mandible shape. CONCLUSIONS: Fullcure showed similar biocompatibility and stronger radiodensity than Medpor. Despite its cheaper price and endless 3D-printing possibilities as scaffold holder for mandible reconstruction, further animal studies are needed to ensure Fullcure biocompatibility as implantable biomaterial.

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.

[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.

Myeloid sarcoma of the maxillary bone.

Myeloid sarcoma (MS) is a malignant tumour of myeloblasts rarely occurring in the maxillary bone. The tumour may precede or be concurrent with leukaemic infiltration of the bone marrow or herald blastic transformation of a myelodysplastic syndrome or a chronic myeloproliferative disorder. Myeloid sarcoma is uncommon in the oral cavity, but it can involve the palate, gingiva, extraction socket, and cheek. Recognition and diagnosis of myeloid sarcoma involving the soft tissues of the oral cavity in an otherwise asymptomatic patient is important and mandates an appropriate haematological diagnostic workup. We herein report on a new case without any evidence of haematological disorders. We discuss the pathological diagnosis and the therapeutical approaches.

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.

[Serious jaw osteolytic lesions]. / Le gravi lesioni osteolitiche dei mascellari.

Among oral and maxillofacial diseases, the maxillary osteolytic lesions constitute a rich and investigated field to define the more appropriate diagnosis and treatment. In the maxillary region, the same tumors of the other bones (osteogenic sarcoma, chondroma, etc.) cause found together with tumors and dysembryoplasias connected with the teeth development (ameloblastoma, odontoma, odontogenic myxoma, etc.). Moreover in the medullary spaces of the bones, there are reticular and hematopoietic cells that are connected with different diseases (leucemia, myeloma, lymphoma, etc.). What's more, due to the possible presence of pseudotumors (fibrous dysplasia, giant cell tumor, etc.) and metastases of tumors of other regions (breast, lung, prostate gland, etc.), the diagnosis of this disease could be difficult. In this paper the more important pictures of this disease, that due to its recurrence or malignity needs an accurate diagnosis by imaging like CT, CT-3D, MR, etc, are analyzed. The more suitable surgical approach is presented, according to the forms of the disease.

[Involvement of the submadibular region in epidermoid carcinoma of the mouth floor. Prospective study of 31 cases]. / Coinvolgimento della regione sottomandibolare nel carcinoma epidermoide del pavimento orale. Studio prospettico di 31 casi.

BACKGROUND: To evaluate the primary or secondary involvement of the submandibular gland in floor of mouth squamous cell carcinoma. METHODS: An analytic-observational study of prospective type was carried out on 31 patients operated for floor of mouth carcinoma, between June 1993 and January 1996, in a reference hospital for a population of 1,100,000 inhabitants. The investigated variables were: age, sex, tumor localization, clinical TNM, type of cervical surgery, evolution, number of positive cervical metastasis, state of the submandibular gland and presence of the periglandular metastasis. The follow-up period was about 48 to 76 months. The exact Fischer test was used for the statistical study. RESULTS: Histopathological examination identified cervical metastasis as 34.1% of the ipsilateral neck dissections. The average number of positive nodes was 3 (range: 1-9). Cervical periglandular metastases were found in 31.7% of neck dissections, but in no case was microscopic affectation of the submandibular gland found. The existence of intraglandular positive nodes was not found either. In our study, the sensibility and specificity of the clinical exploration of the submandibular region were high (84% and 88% respectively). The presence of cervical metastasis and the size of the tumor conditioned the appearance of recurrences. CONCLUSIONS: In accordance with our study, periglandular metastases in carcinoma of the floor of mouth, are frequent, but submandibular gland involvement is unusual.

Giant cervico-mediastinal lipoma. A clinical case.

The lipoma is a circumscribed mesenchymal tumour originating from adipose tissue. The lesion is usually small and asymptomatic, and is most frequently located in the neck region. The case of a 77-year-old woman with chronic extrasystolic arrhythmia caused by a non-specified ischemic cardiopathy is reported. The woman presented a swelling at the front of her neck, observed for the first time about 6 months previously. This swelling progressively increased in size, provoking dysphagia, dysphonia, persistent cough, dyspnea, light jugular turgor and palpitations. Chest X-rays showed and opaque area at the front of the neck, which extended beyond the jugular incisure by about 2 cm. NMR of the neck showed a gross lipomatous formation at the front, mainly of the left, continuing in the front mediastinal region; the trachea was dislocated to the right and compressed at the back; the vasculo-nervous fasciculus, especially on the left, was compressed and enveloped by the adipose formation. The Holter test confirmed the presence of ventricular and supra-ventricular extrasystoles. Surgery was carried out under local anaesthesia because the displacement of the laryngo-tracheal axes precluded intubation. Histological analysis of the 9 x 4 x 2.2 cm mass confirmed the diagnosis of lipoma. After removal of the mass all the symptoms, which had been provoked by compression, as well as the cardiac arrhythmias disappeared. The prompt disappearance of the latter was particularly surprising. The possibility of the external compression of the nervous structures of the neck should be taken into consideration in cases of ventricular arrhythmia of unknown origin, and systematic study of the region carried out.

In vitro short-term response of human erythrocytes to implant materials used in maxillo-facial rigid internal fixation.

A short-term in vitro experimental study was performed to analyze the effects of metallic miniplates used in maxillo-facial rigid internal fixation on some functional features of human erythrocytes that represent a pivotal rheological component for correct blood flow in the tissular area surrounding metallic implants. In our working conditions, no interference on osmotic fragility, intracellular ATP content and spontaneous hemolysis was observed. Conversely, a statistically significant increase of rigidity in the deeper lipid region of erythrocyte membrane was verified. On the basis of our results, the in vitro erythrocyte modifications after 18 h of whole blood/metallic device contact are relatively small and negligible.