Recommendations for a safe restart of elective aerosol-generating oral surgery procedures following the COVID-19 pandemic outbreak: An Italian multicenter study.

Among healthcare workers, oral and maxillofacial surgeons are some of the most exposed to coronavirus disease (COVID-19). The aim of this retrospective study was to develop suggestions for continuing the work of oral and maxillofacial surgeons using a safe protocol for elective and urgent aerosol-generating procedures that could prevent the onset of new clusters. Based on the results obtained and a guidelines review of those Asian countries that had promptly managed the current pandemic, the following safety protocol was developed.

Trichoadenoma of the upper lip.

BACKGROUND: Trichoadenoma of Nikolowski, who describe the first cases in 1958, is a rare and benign tumor of the hair follicle. It is well-differentiated and slowly-growing. The clinical appearance of Trichoadenoma (TA) can be similar to basal cell carcinoma or epidermal cyst. RESULTS: We describe a 44-year-old male who was referred for nodular lesion on the upper lip and a TA was diagnosed. Oral examination showed exophytic yellow mass located between mucous membrane of the upper lip and vestibular gingiva, 1.2 per 0.8 cm. Anamnestic data was non-contributory. An excisional biopsy of the lesion was performed. Microscopically, the lesion consisted of multiple keratinous cysts lined with stratified squamous epithelium and intermingled with solid islands of basaloid cells lying within sclerotic stroma. The pathological diagnosis was TA. The surgical wound healed uneventfully. CONCLUSION: Because the lesion is unique, it is uncertain how aggressive or indolent the tumor might be. Therefore, the microscopical analysis is mandatory. At the best of our knowledge, this is the second case of trichoadenoma of the lip.

Nerve sheath myxoma of the tongue.

Nerve sheath myxoma (NSM) of the oral mucosa is a slow-growing, benign, often asymptomatic submucosal mass. We report on a case of classical NSM of the tongue, with diagnostic and therapeutic approach to the case. Many NSM arise within the endoneurium of a peripheral nerve. It is a rare condition with no apparent differences between sexes in its prevalence. It can occur at any age.

Oral metastasis of lung cancer. A challenge for the clinician.

BACKGROUND: Bone metastases are a major cause of morbidity in cancer patients. Jawbone metastasis from lung cancer is a rare condition that may occur in the late state of the disease. CASE REPORT: We report the case of a 74-year-old male presenting with an oral asymptomatic swelling that had grown substantially over the last 2 months. Biopsy and histological examination revealed the presence of a metastatic lung cell adenocarcinoma. DISCUSSION: Although metastases to the oral cavity are uncommon, clinicians may play a crucial role also in the diagnosis of primary tumors.

Mucosa-associated lymphatic tissue lymphoma of the lower lip in a child.

Mucosa-associated lymphatic tissue lymphoma of the lip in a child is a very rare clinical entity whose cause is poorly understood. We describe an 11-year-old boy who presented with a 5-month history of an asymptomatic nodule on the lower lip with the clinical appearance of a benign mucocele. After surgical excision of the lower lip lesion, lymphocyte phenotypic analysis and histologic examination of the specimen disclosed an extranodal marginal zone B-cell lymphoma of mucosa-associated lymphatic tissue type of the buccal minor salivary glands. Mucosa-associated lymphatic tissue lymphoma of the lip may clinically resemble a large mucocele. To prevent a delayed detection of lip mucosa-associated lymphatic tissue lymphoma, an incisional biopsy of large mucous cysts of the oral mucosa before marsupialization is recommended.

Preventive strategies and clinical implications for bisphosphonate-related osteonecrosis of the jaw: a review of 282 patients.

OBJECTIVE: To describe and evaluate the effectiveness of oral and dental prevention strategies for cancer patients who were about to begin bisphosphonate (BP) intravenous therapy with zoledronate. METHODS: Patients were divided into 2 groups according to their history with BPs: group PA (preventive approach) and group OB (observation). Group PA patients had never been previously treated with BPs, and group OB patients had already undergone therapy with BPs. All patients received a complete oral and dental examination and had a panoramic radiograph. If necessary, oral hygiene, and restorative and rehabilitation therapy were offered to patients. All patients participated in regular checkups every 6 months. Group PA patients underwent oral surgical procedures, as needed. RESULTS: A total of 282 patients (162 women, 120 men) were included in this analysis (PA: n = 217; OB: n = 65). In group OB, 4.6% of patients presented with osteonecrosis of the jaw (ONJ) at first visit and 10.8% developed new ONJ during the 18-month follow-up period. No patients in group PA had ONJ. Anti-angiogenic therapy was associated with ONJ (p < 0.01) and patients with a higher number of zoledronate infusions were significantly more likely to develop ONJ (p < 0.01). CONCLUSION: Although the incidence of BP-related ONJ is fairly low, it remains a painful and difficult complication to treat. An interdisciplinary preventive approach is essential to prevent and manage this condition.

Mucormycosis in immunocompetent patients: a case-series of patients with maxillary sinus involvement and a critical review of the literature.

OBJECTIVES: To review the current literature on mucormycosis in immunocompentent/otherwise healthy individuals, to which five new cases with maxillary sinus involvement have been added. METHODS: We searched in the PudMed database all articles in the English language related to human infections caused by fungi of the order Mucorales, in immunocompetent/otherwise healthy patients, starting from January 1978 to June 2009. In addition, we updated the literature by reporting five new cases diagnosed and treated at the oral medicine unit of our institution. RESULTS: The literature review showed at least 126 articles published from 35 different countries in the world, to a total of 212 patients described. The most affected country was India with 94 (44.3%) patients and the most representative clinical form was the cutaneous/subcutaneous with 90 (42.5%) patients. Our five immunocompetent patients with a diagnosed infection of Mucorales localized at the maxillary sinus completely healed with lyposomial amphotericin B. CONCLUSIONS: The literature analysis revealed that even in immunocompetent/otherwise healthy individuals mucormycosis infection has a worldwide distribution. What might be the real predisposing factors involved in its pathogenesis in such patients and the real causes of this peculiar geographic distribution still remains unknown. It is likely that, in our cases, a chronic insult of a well-defined and localized body area might have resulted in a local immunocompromission, thus fostering the development of an invasive fungal infection.

Lingual juvenile xanthogranuloma in a woman: a case report.

INTRODUCTION: Juvenile xanthogranuloma is a rare non-Langerhans cell histiocytosis that usually occurs during infancy and early childhood. The presence of single or multiple raised cutaneous lesions characterize this self-healing disorder. Extracutaneous sites are rare. CASE PRESENTATION: We present a rare case of oral juvenile xanthogranuloma in a 49-year-old Caucasian woman. The histopathologic diagnosis of the lingual neoformation was histiocitary proliferation with the presence of giant cells, Touton type, compatible with juvenile xanthogranuloma. CONCLUSION: To establish an accurate diagnosis, microscopic evaluation and immunohistochemical staining are necessary. Dentists, dermatologists and general practitioners may be the first to recognize this rare condition during the inspection of the oral cavity.