Immediate placement and temporization of implants: three- to five-year retrospective results.

The immediate placement of dental implants in esthetic areas is a primary challenge for modern implantology. The underlying treatment goal is to preserve the natural periodontal architecture; in recent years, however, a concurrent goal has been to reduce the period between implant placement in the fresh extraction socket and delivery of the definitive restoration, but adequate long-term data are still lacking on the efficacy of this technique. A 3- to 5-year retrospective analysis of 282 dental implants immediately placed into extraction sockets, and temporized with nonoccluding provisional prostheses has been undertaken. All recorded outcomes and complications, as well as a proposed protocol for management of immediate function, are discussed.

Extracapsular lumpectomy and SMAS flap for benign parotid tumours: an early outcome in a small number of cases on Frey's syndrome and facial nerve dysfunction.

Parotidectomy is the most common approach for benign salivary neoplasms. The aim of the present study was to retrospectively analyse no. 34 extracapsular lumpectomies (ELs) performed with superficial musculoaponeurotic system (SMAS) flaps on 32 patients for benign parotid tumours. Based on the extent of the surgical defect the surgical resection was associated with sternocleidomastoid (SCM) muscle rotation flap in 8 patients, superficial temporal artery fascial flap (STAFF) in 2, and temporalis muscle rotation flap in 2. None of the patients affected by pleomorphic adenoma or Warthin's tumour had a complete facial palsy. Only 1 patient (2.9%) had a postoperative transient partial facial paralysis with incomplete eye closure. Neither haematoma formation, nor wound infection was observed, while seroma formation occurred in only 1 patient (2.9%). No cases of Frey's syndrome occurred. An SMAS flap should be performed in primary postparotidectomy reconstruction; a temporoparietal fascia flap (TPFF) if a major defect is anticipated, or when the SMAS has to be resected; an SCM muscle flap covered by an SMAS flap is the method of choice in more extensive rare defects.

Effect of p63 expression on survival in oral squamous cell carcinoma.

BACKGROUND: P63 is the protein codified by p63 gene, a p53 gene homolog, known for its pivotal role in cell cycle regulation, and involved in the tumor differentiation. Aims of the present study were to assess the frequency and pattern of p63 protein expression in oral squamous cell carcinoma (OSCC) in relation to the main tumour characteristics and to verify whether p63 can be considered a marker of prognosis in patients with OSCC. MATERIAL AND METHODS: In a retrospective study, a cohort of 64 OSCC patients was investigated for p63 protein expression and its cellular localization by immunohistochemistry (monoclonal mouse anti-human p63 protein-clone 4A4). After grouping by p63 expression, OSCCs were statistically analyzed for the variables age, gender, histological grading (G), TNM, staging, recurrence, and overall survival rate. RESULTS: The overall frequency of p63 overexpressed was of 57.8 percent. Various p63 staining patterns were observed according to G score, with a significant correlation between p63 overexpression and the lowest G score (P < 0.0001). No statistically significant difference was found between p63 pattern expression and age, sex, staging. OSCC patients with p63 overexpressed were found to have a poorer survival rate with respect to OSCCs with a normal pattern of expression (P = 0.024). CONCLUSIONS: On the basis of these results, it is possible to suggest p63 pattern expression as a reliable indicator of histological grading and an early marker of poor prognosis.

[Video-assisted thyroidectomy with minimally invasive central cervicotomy: initial experience in an endocrine surgery division]. / Tiroidectomia videoassistita con minicervicotomia centrale. Esperienza iniziale in una Divisione di Endocrinochirurgia.

Minimally invasive video-assisted thyroidectomy, a recently developed technique, has been shown to be feasible and safe. Nevertheless, to obtain the best results, the surgeon should be well trained in endoscopic surgery. We attempted to answer the question whether an endocrine surgery division with no previous experience in endoscopic neck surgery could easily import the new technique. The inclusion criteria were nodules < or = 3.5 cm diameter or thyroid lobe volume less than 15 ml, and no thyroiditis or previous neck surgery. Suspect malignant nodules were excluded. The procedure was carried out through a 20 to 30 mm central neck incision, with external retraction and no neck insufflation. The vessels were ligated or closed by means of clips. From March 2004 to March 2005, 127 thyroidectomies were performed, of which 36 were thyroid lobectomies. Of these, 12 lobectomies by minimally invasive video-assisted thyroidectomy were performed for monolateral goiter (4 left, 8 right). There were no intraoperative complications. No recurrent laryngeal nerve palsy or permanent hypoparathyroidism occurred. The mean operative time was 74.4 min (median: 70; range: 45-115). The results, in terms of patient comfort, reduced postoperative pain and cosmetic quality were excellent. The technique allowed careful assessment of the inferior and superior laryngeal nerve. Thorough haemostasis was aided by the magnification of the image and optimal illumination. The learning curve appeared short, owing probably to previous experience in conventional endocrine surgery and the closer similarities of minimally invasive video-assisted thyroidectomy to enhanced-view conventional surgery than to laparoscopic surgery. In our experience the clinical impact was limited as a result of the small percentage of patients fulfilling the strict inclusion criteria.

[Dysphagia in oral medicine]. / Disfagia in medicina orale.

Dysphagia, defined as a difficulty in swallowing of fluids and/or food, is one of the most frequent symptoms of oesophageal, gastrointestinal or ENT diseases. Interestingly, dysphagia can be also the initial or late symptom of several oral diseases: e.g. traumatic ulcerations, immunomediated or infectious lesions, malignant neoplastic disease or mucositis in chemio-radiotherapy. The presence of this frequent symptom, with or without oral evident lesions, can suggest the presence of oral or perioral diseases, promoving adequate diagnostic-therapeutic management. In this paper, authors describe aetiology, pathogenesis and clinical aspects of oral diseases, as being more frequently associated with dysphagia; moreover, they describe the most important clinical and epidemiological features of systemic diseases associated with dysphagia.

[Oral manifestations in gastroesophageal reflux disease]. / Manifestazioni orali da reflusso gastroesofageo.

The gastroesophageal reflux (passage of gastric contents into the oesophagus and the mouth) is the main sign/symptom of a very frequent gastroesophageal reflux disease. Thus, acid regurgitation originates from stomach and it is responsible of the onset of typical symptoms and mucosal injury. Also in oral cavity the noxious acid agent is able to injury oral cavity (soft and hard tissues). These effects are described from international literature, even if a greater interest has shown to date only for hard tissue injury.