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.

Mitochondrial activity of orbicularis oris muscle in unilateral cleft lip patients.

To better evaluate the role of a possible mitochondrial alteration in the pathogenesis of cleft lip, we obtained and examined 38 orbicularis oris muscle specimens taken from the cleft margin of both cleft and noncleft sides of 10 unilateral cleft lip infants at the time of primary closure. Part of each sample was frozen in liquid nitrogen/cooled isopentane, while the remainder was fixed in 2.5% glutaraldehyde, postfixed in osmium tetroxide, and embedded in Araldyte resin. Ten-micrometer-thick sections were obtained from the frozen samples and stained for histologic (Gomori trichrome) and histochemical (adenosine triphosphatase, nicotinamide adenine dinucleotide-tetrazolium reductase, cytochrome c-oxidase, succinate dehydrogenase) techniques. Ultra-thin sections (70 to 100 nm) of the resin-embedded specimens were stained with uranyl acetate and lead cytrate and were examined with a Zeiss 109 transmission electron microscope operating at 80 kV. Muscular fiber-type ratio was found to be 19.2 percent type 1 and 80.8 percent type 2 fibers on the cleft side and 26.3 percent type 1 and 73.7 percent type 2 fibers on the noncleft side. We detected aspecific structural alterations, such as variations in the fiber size without fiber group atrophy or fiber-type grouping with the ATPase reaction, in all biopsies. Although Gomori trichrome revealed a dark staining and red granularity of the fibers, suggesting an increase in mitochondria activity, no ragged-red fibers or cytochrome c-oxidase-negative/succinate dehydrogenase-positive fibers were found. At the ultrastructural level, the mitochondrial morphology was always preserved, without inclusions or variations in size and/or shape. On the other hand, we invariably noticed an increase of the number of mitochondria, associated with abnormal glycogen deposits, in some areas of every specimen. Both of these two latter findings were regularly localized at the periphery of the sarcolemma, resembling the so-called lobulated fibers, an aspecific sign of muscular flogosis. Our findings, although excluding an inherent metabolic myopathy of orbicularis oris muscle in unilateral cleft lip patients, evinced both an increased oxidative metabolism and a generic inflammatory condition of that muscle, the nature of which must still be defined.

[Chondrosarcoma of the jaws. A review of the literature and the diagnostic and therapeutic considerations]. / Condrosarcoma dei mascellari. Revisione della letteratura e considerazioni diagnostico-terapeutiche.

Following a general introduction, the paper reports a case of rapidly developing chondrosarcoma of the upper jaw. The biological behaviour of this rare form of neoplasia at a maxillofacial level is briefly discussed together with the outcome.

[Submucosal cleft of the palate]. / Le schisi submucose del palato.

After a brief review of the literature, the evolution of the concept of submucous cleft palate is described and its clinical diagnostic and therapeutic aspects examined. In particular, it is emphasised that however rare, this condition is important as one of the main causes of velopharyngeal insufficiency and therefore overt rhinolalia. The report ends with the presentation of two classic clinical cases in which severe rhinolalia was satisfactorily cured by surgery.

[Dermoid cysts of the floor of mouth]. / Considerazioni sulle cisti dermoidi del pavimento della bocca.

After brief mention of the embryogenesis of oral organs, a case of congenital dermoid cyst of the floor of the mouth treated surgically intraorally is reported. A short discussion on differential diagnosis follows.

[The use of lyopholized dura mater in reconstructive surgery of mouth floor neoplasms]. / Impiego della dura madre liofilizzata nella chirurgia ricostruttiva dei carcinomi del pavimento orale

Lyophilised dura mater is proposed for the reconstruction of the mouth floor after surgical stripping in case of T1, T2 and T3 cancer, The features of this substance are described, along with the surgical modalities involved.