Does COVID-19 Vaccination Warrant the Classical Principle "ofelein i mi vlaptin"?

The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic warrants an imperative necessity for effective and safe vaccination, to restrain Coronavirus disease 2019 (COVID-19) including transmissibility, morbidity, and mortality. In this regard, intensive medical and biological research leading to the development of an arsenal of vaccines, albeit incomplete preconditioned evaluation, due to emergency. The subsequent scientific gap raises some concerns in the medical community and the general public. More specifically, the accelerated vaccine development downgraded the value of necessary pre-clinical studies to elicit medium- and long-term beneficial or harmful consequences. Previous experience and pathophysiological background of coronaviruses' infections and vaccine technologies, combined with the global vaccines' application, underlined the obligation of a cautious and qualitative approach, to illuminate potential vaccination-related adverse events. Moreover, the high SARS-CoV-2 mutation potential and the already aggregated genetical alterations provoke a rational vagueness and uncertainty concerning vaccines' efficacy against dominant strains and the respective clinical immunity. This review critically summarizes existing evidence and queries regarding SARS-CoV-2 vaccines, to motivate scientists' and clinicians' interest for an optimal, individualized, and holistic management of this unprecedented pandemic.

The role of perineural invasion in treatment decisions for oral cancer patients: A review of the literature.

PURPOSE: The role of perineural invasion (PNI) in the management of patients with oral squamous cell carcinoma (OSSC) is still controversial, and there is no consensus regarding the most appropriate therapeutic approach. The purpose of this study is to review the findings in the literature describing OSCC as a neurotropic malignancy, with the aim of correlating perineural invasion with treatment decisions and disease prognosis. MATERIALS AND METHODS: A literature search was conducted of references based on the MEDLINE and Cochrane Database of Systematic Reviews, with subject keywords including four main categories: perineural invasion, perineural spread, oral squamous cell cancinoma, neurotropic carcinoma. RESULTS: In this systematic review and analysis, more than 350 publications met the eligibility criteria of the authors. CONCLUSION: Perineural invasion (PNI) is a widely recognized indicator of poor prognosis in oral cancer patients, strongly correlating with aggressive tumor behavior, disease recurrence, and increased morbidity and mortality. Elective neck dissection could be an indicator in improving neck control in PNI-positive patients, while the addition of adjuvant postoperative radiotherapy may not significantly improve survival rates. Various molecular markers have been correlated with perineural tumor spread, but further investigations are required before targeting PNI as part of advanced cancer therapies.

Ewing's Sarcoma of Mandible: An Impressive Case of Spontaneous Mandible Regeneration.

Ewing's sarcoma (ES) is an uncommon aggressive bone malignancy that mainly affects children and adolescents. Mandible involvement is quite rare and usually represents metastasis from another skeletal site. Combined therapy including wide surgical resection and preoperative and postoperative chemotherapy has been demonstrated as the mainstay of therapeutic approach. As improved therapeutic modalities have significantly increased survival over the last decades, functional and esthetic reconstruction of the postmandibulectomy defect is usually necessary for patient's total rehabilitation. We report a case of ES of the mandible with special consideration to the postresection spontaneous structural and functional regeneration of the mandible. HOW TO CITE THIS ARTICLE: Chatzistefanou I, Kabesi S, Paraskevopoulos K, Koliouskas D, Antoniades K. Ewing's Sarcoma of Mandible: An Impressive Case of Spontaneous Mandible Regeneration. Int J Clin Pediatr Dent 2016;9(3):273-277.

Primary mucosal melanoma of the oral cavity: current therapy and future directions.

BACKGROUND: Primary mucosal melanoma of the oral cavity is a highly aggressive malignancy of melanocytic origin. The aim of this study is to report a case series of oral mucosal melanomas (OMMs) and provide a review of the literature with regard to treatment guidelines for and prognosis of this pathologic entity. STUDY DESIGN: We report three cases of OMMs treated in our institutions and the results of a literature review, in which the words "oral" and "mucosal melanoma" were used as the main keywords. RESULTS: Surgical resection of the primary tumor with wide resection margins appears to be the recommended primary treatment modality with the aim to achieve tumor-free margins. Elective neck dissection and adjuvant radiotherapy have been advocated for locoregional control. Chemotherapy has not been shown to improve survival and is mainly used for palliative purposes. Immunotherapy and biochemotherapy seem to significantly improve survival and could open new therapeutic horizons. CONCLUSIONS: The prognosis of OMMs remains poor despite treatment. Early diagnosis and aggressive surgical resection followed by adjuvant therapies could be the key to improving survival. Multicenter randomized clinical trials, which may be difficult to conduct because of the rarity to the lesion, would aid in the development of new strategies.

Adenoid cystic carcinoma of the minor salivary glands: a retrospective series of 29 cases and review of the literature.

OBJECTIVE: Approximately 78% of minor salivary gland tumors are malignant, of which adenoid cystic carcinoma (ACC) represents 15% in our series. ACC is an uncommon tumor characterized by slow growth and a high potential for recurrence. This series of 29 consecutive patients examines clincopathologic features, management, and survival outcomes. MATERIALS AND METHODS: This study is a retrospective chart review of 29 patients with ACC of the minor salivary glands in a period of 23 years (1989 and 2012). RESULTS: The mean age was 61.2 years (16-89 years), with no gender predilection. The majority occurred in the palate/maxilla (66%) and initial presentation was stage IV. Mean follow-up was 42.6 months. Recurrence rate was 10% local, 14% distant over the observation period. CONCLUSIONS: The palate/maxilla is the preferred location for occurrence, and initial presentation at stage IV is common. Postoperative radiation remains a common strategy to prevent local recurrence in lesions with adverse features.

The role of neck dissection and postoperative adjuvant radiotherapy in cN0 patients with PNI-positive squamous cell carcinoma of the oral cavity.

INTRODUCTION: Loco-regional recurrence is one of the main causes of treatment failure in patients with oral squamous cell carcinoma (OSCC). Perineural invasion (PNI) is widely accepted as an oncologic feature strongly associated with aggressive behavior, disease recurrence and poorer prognosis. This study investigated the role of PNI in OSCC patients, regarding the controversial issues of its impact on loco-regional recurrence, neck management and postoperative adjuvant treatment decisions. MATERIALS AND METHODS: A total of 367 patients with OSCC were analyzed at a tertiary care cancer center with the purpose of investigating the prognostic significance of PNI regarding neck involvement, local recurrence, regional recurrence and disease-specific survival. Two subgroups of 39 patients each, one with PNI-positive and one with PNI-negative tumors, but otherwise similar histopathological features, were retrospectively analyzed. All patients had negative resection margins, no lympho-vascular invasion and pN0-1 disease without ECS. The mean follow up period was 42.7 months. RESULTS: Univariate and multivariate analyses showed that the perineural invasion was an independent prognostic factor for lymph node metastasis and regional recurrence, but not for local recurrence. Elective neck dissection was strongly associated with a lower risk of regional recurrence, as well as with a better disease-specific survival, in PNI-positive cN0 patients. Postoperative radiation therapy appears not to reduce the incidence of recurrence. CONCLUSION: Perineural invasion should be considered as an independent predictor for cervical lymph node involvement. Elective neck dissection could therefore be an indicator in improving neck control and subsequently disease-specific survival in cN0 patients with PNI-positive SCC.