Clinical Remission in a 72-Year-Old Patient with a Massive Primary Cutaneous Peripheral T-Cell Lymphoma-NOS of the Eyelid, Following Combination Chemotherapy with Etoposide Plus COP.

Peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) is the rarest subtype of primary cutaneous lymphoma, accounting for approximately 2% of cutaneous lymphomas. The rarity of primary cutaneous PTCL-NOS means that there is a paucity of data regarding clinical and histopathological features and its clinical course. This malignancy is an aggressive and life-threatening hematological malignancy that often presents mimicking other less severe plaque-like skin conditions. Due to the nonspecific nature of these lesions, CD4-positive cutaneous T-cell lymphoma (CTCL) is often misdiagnosed as either mycosis fungoides or Sezary syndrome. We describe a patient who presented with a large tumoral mass in the right frontal area, with involvement of the right upper eyelid and the ocular globe, causing loss of vision greatly impacting the quality of life. Biopsy revealed primary cutaneous PTCL-NOS, treated successfully with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus etoposide combination chemotherapy. As elderly patients are indicated to receive attenuated doses of chemotherapy, CHOP-based regimens represent viable options.

Histological Change in Soft Tissue Surrounding Titanium Plates after Jaw Surgery.

The aim of this study was to evaluate the microscopic structure of soft tissue covering titanium plates and screws used in jaw surgery (mandible fracture and orthognathic surgery), after a minimum period of 12 months from insertion, and to quantify the presence of any metallic particles. Periosteum covering the osteosynthesis plates was removed from 20 patients and examined by light microscopy in order to assess the cell morphological changes and the possibility of metal particles presence in the soft tissue. Local signs of tissue toxicity or inflammation were taken into consideration when evaluating the routine removal of titanium maxillofacial miniplates. No signs of screw loosening or acute inflammation were detected on the osteosynthesis site, but de-coloration of the periosteum was seen, and metallic particles were observed to have migrated into the soft tissues. Even if the titanium is well-tolerated by the human body in time, without severe local or general complications, our findings suggest that plate removal should be considered after bone healing has occurred.

Principles of biomechanics in oral implantology.

BACKGROUND AND AIMS: The principles of biomechanics comprise all the interactions between the body (tissues) and the forces acting upon it (directly or via different medical devices). Besides the mechanical aspects, the tissues response is also studied. Understanding and applying these principles is vital for the researchers in the field of oral implantology, but they must be equally known by the practitioners. From the planning stages to the final prosthetic restoration, they are involved in each and every aspect. Ignoring them inevitably leads to failure. METHODS: The first part of this paper includes a review of our current research in oral implantology (mechanical, digital and biological testing), while the second part includes a review of the available literature on certain biomechanical aspects and their implications in everyday practice. RESULTS: Our research opens new study directions and provides increased chances of success for dental implant therapy. The practical aspects of our findings, combined with the available literature (from the basic principles described more than 40 years ago to the most recent studies and technologies) can serve as a guide to practitioners for increasing their success rate. CONCLUSION: While no therapy is without failure risk, a good understanding of the biomechanics involved in oral implantology can lead to higher success rates in implant supported prosthetic restorations.

Oral surgery for combined haemophilia A and B. The dos and don'ts presented in a clinical scenario.

BACKGROUND: Haemophilia A (factor VIII deficiency), B (factor IX deficiency) and C (factor XI deficiency) are common genetic bleeding disorders. Most often they are caused by the absence or defective function of coagulation factors, causing inefficient blood clots. CASE REPORT: The present manuscript describes a rare case of a combined haemophilia A and B patient, who underwent several extractions. The therapy and clinical management is presented, in the view of surgeon as well as haematologist. CONCLUSION: These patients are a serious challenge for the oral surgeons due to an increased number of accidents and complications. Scarce literature covering this topic contributes, as well, to the difficult management. Thus, several principles must be considered when diagnosing and treating haemophilia patients. KEY WORDS: Haemophilia, Oral surgery.

Observational study of the bisphosphonate-related osteonecrosis of jaws.

INTRODUCTION: The bisphosphonate-related osteonecrosis of the jaw was first referred to in 2003. Bisphosphonates action is focused on the osteoclasts. The drastic inhibition of the osteoclastic function is harmful for the jaws which are the only bones of the human skeleton in relative contact with the external environment. The adverse effects of the bisphosphonate-related therapy include the pathology for which they are prescribed, the atypical fractures in pathological bone. METHOD: The aim of this research was to analyze the risk factors and the treatment methods in case of osteonecrosis of the jaws. To achieve these goals, the author analyzed the observation sheets of the patients admitted to the Oral and Maxillofacial Surgery Clinic during the period 2010-2015. The inclusion criteria were as follows: treatment with bisphosphonates, current or previous; the lesions of the mucous gingiva of the maxillaries followed by exposed necrotic bone, older than 8 weeks, with no tendency of healing; specific radiological image showing extended osteolysis with diffuse outline or radiopacity surrounded by radio-transparence, representing the necrotic bone sequestered; no metastasis in the necrotic maxillary bone; patient with no medical background of cervical-facial radiations. The patients who met these criteria were admitted in the study after signing the informed consent. Afterwards, the information found in the notes of the observational sheet (anamnesis, general examination and the imagistic investigation, treatment, postoperative recovery, prescription, postoperative recommendations) were gathered and submitted for statistic analysis. RESULTS: Of the 20 patients in total, 13 were women and 7 men, of ages ranging from 43 to 83. The most numerous cases were registered in the seventh age decade. All patients included in the study had lesions of the gingival maxillary mucosal areas with exposure of the subjacent necrotic bone. 60% of them were under intravenous treatment with zoledronic acid (Zometa®). A single patient was under oral treatment with bisphosphonates. 19 of these 20 patients developed osteonecrosis following a dental extraction while one case was due to the instability of the mandibular mobile prosthesis. 61% of the patients included in the study developed a necrotic process in the mandibular bone, 80% of the localizations were in the posterior area. As first intention, the choice of treatment was represented by local lavages with antiseptic solutions, general antibiotics and sequestrectomy. Of these patients, a third had relapsed and needed radical surgery treatment. CONCLUSIONS: Prevention of the bisphosphonate-related osteonecrosis of the jaw represents the best method of treatment. The development of bone sequesters damages the volume of the maxillary bone as such, reducing the chances for prosthetic functional rehabilitation of the dento-maxillary system. An increase in the quality of life by oral restoration of these patients may represent a challenge.

Evaluation of the Biocompatibility of New Fiber-Reinforced Composite Materials for Craniofacial Bone Reconstruction.

This study aims to assess the biocompatibility of new advanced fiber-reinforced composites (FRC) to be used for custom-made cranial implants. Four new formulations of FRC were obtained using polymeric matrices (combinations of monomers bisphenol A glycidylmethacrylate [bis-GMA], urethane dimethacrylate [UDMA], triethylene glycol dimethacrylate [TEGDMA], hydroxyethyl methacrylate [HEMA]) and E-glass fibers (300 g/mp). Every FRC contains 65% E-glass and 35% polymeric matrix. Composition of polymeric matrices are: bis-GMA (21%), TEGDMA (14%) for FRC1; bis-GMA (21%), HEMA (14%) for FRC2; bis-GMA (3.5%), UDMA (21%), TEGDMA (10.5%) for FRC3, and bis-GMA (3.5%), UDMA (21%), HEMA (10.5%) for FRC4. Cytotoxicity test was performed on both human dental pulp stem cells and dermal fibroblasts. Viability was assessed by tetrazolium dye colorimetric assay. Subcutaneous implantation test was carried out on 40 male Wistar rats, randomly divided into 4 groups, according to the FRC tested. Each group received subcutaneous dorsal implants. After 30 days, intensity of the inflammatory reaction, tissue repair status, and presence of the capsule were the main criteria assessed. Both cell populations showed no signs of cytotoxicity following the FRC exposures. In terms of cytotoxicity, the best results were obtained by FRC3 followed by FRC2, FRC4, and FRC1. FRC3 showed also the mildest inflammatory reaction and this correlated both with the noncytotoxic behavior and the presence of a well-organized capsule. The composite biomaterials developed may constitute an optimized alternative of the similar materials used for the reconstruction of craniofacial bone defects. According to authors' studies, the authors conclude that FRC3 is the best formulation regarding the biological behavior.

Antibacterial coating on biocomposites for cranio-facial reconstruction.

BACKGROUND AND AIMS: Despite the fact that implants are sterilized, antiseptic techniques are applied and systemic antibiotics are routinely administered prior to and after craniofacial surgery, infection rates between 3% and 40% are still reported for alloplastic implants, urging for implant removal. The present study focuses on the development of a fiber-reinforced composite (FRC) implant for craniofacial reconstruction with antimicrobial properties. METHODS: A new fiber-reinforced composite coated with gentamicin was developed and tested for bacterial adherence and antibacterial efficiency, using two of the most involved bacterial strains in the postoperative infections: Staphylococcus aureus and Pseudomonas aeruginosa. RESULTS: Bacteria were efficiently inactivated in direct contact with gentamicin coatings (p<0.05). The inhibition zone for Staphylococcus aureus ranged from 17.21 mm to 20.13 mm and for Pseudomonas aeruginosa ranged from 12.93 mm to 15.33 mm. Although no significant statistical results were found for bacterial adhesion and gentamicin concentration, (Staphylococcus aureus: ß= -0.974; p=0.144>0.05 and Pseudomonas aeruginosa: ß = -0.921; p=0.255>0.05), a negative relation was observed, indicating the reversed relation between the antibiotic dosage and the bacterial adherence. CONCLUSION: The results of the two applied microbiological protocols used in the study suggested that gentamicin eluting coating inhibited not only the bacterial growth, but also led to a lower initial bacterial adhesion to the surface of the implant. Thus, antibiotic coating of craniofacial implants may reduce the infection rate related to reconstructive surgery.