Third molar extraction. Current trends.

Extraction of third molars is the operation most frequently performed by oral and maxillofacial surgeons. The American National Institute of Health (1979) and the American Association of Oral and Maxillofacial Surgeons (1993) have organised consensus conferences to systematically analyse the scientific evidence and provide official guidelines for the management of third molars. However, some clinical aspects are still controversial: indications for preventive extraction, early extraction, prognosis of impacted teeth, continuous follow-up, relationship with anterior crowding and temporo-mandibular disorders. This article reviews the conclusions from the consensus conferences and integrates them with more recent data. The actual trend seems to justify a more conservative clinical approach rather than an aggressive extraction policy.

Unilateral fibroadipose degeneration of the masticatory muscles.

A unique case of fatty replacement of the masticatory muscles, causing progressive limitation of mouth opening, is presented. Both CT and MRI revealed an almost total substitution of the masticatory muscles with fatty tissue, confirmed by the histopathology at surgery. Myotomy of masseter and internal pterygoid muscles and coronoidotomy improved his symptoms. There is no known cause of fibroadipose replacement of muscle fibres.

Primary intraosseous verrucous carcinoma developing from a maxillary odontogenic cyst: case report.

Primary intraosseous carcinoma (PIOC) is an extremely rare lesion, almost always occurring in cranial bones. The origin of this tumor, specific to the maxillae, is associated with the cells of the epithelial rests of Malassez. Among the histotypes which can be included in these neoplasms, verrucous carcinoma is of particular interest due to its rarity: only a single case has been reported to date. After a short survey of the literature, the authors describe a directly observed case of verrucous carcinoma arising from a maxillary odontogenic cyst.

[Evaluation of psychological disorders in patients with cancer of the oral cavity]. / Valutazione delle anomalie psicologiche nei pazienti affetti da neoplasia del cavo orale.

BACKGROUND AND AIMS: This study aimed to evaluate the possible onset of forms of anxiety, major and minor depression and behaviour towards the disease shown by patients with oral cavity neoplasms. METHOD: An explorative comparative study was performed in 28 patients referred to the department of Stomatological Surgery at the Odontostomatology Clinic of Turin University. Ten patients were examined before surgery and 18 after. The tests were performed using Hamilton's scale, STAI X1 and X2 and IBQ. These tests were carried out either during hospitalisation or during outpatient check-ups by an interviewer who was not familiar with the diagnosis or the patient's personal history. RESULTS: In the group of subjects evaluated before surgery, there was a scant presence of psychological correlations to disease. This shows that negation is widely used. Almost all subjects revealed the presence of anxiety symptoms and 60% of subjects were affected by minor depression. The level of negation was even higher in the postoperative group. This shows that the characteristics of the defensive structure did not change. CONCLUSIONS: Patients showed a psychological structure, even some time after surgery, which was similar to that in the first group of subjects, namely those facing an active phase pathology. The above findings underline the need for greater attention to be paid to the quality of life of these subjects who, owing to improved treatment, are becoming increasingly numerous. The scores obtained show that the majority of these patients encounter major difficulties at a psychological level, even if they manage to overcome the disease in physical terms. In conclusion, this study highlights the need to offer these subjects valid psychological support during diagnostic and therapeutic procedures. It also underlines the need for longitudinal studies in larger and more homogeneous groups of patients suffering from this disease since they appear to be somewhat neglected by modern literature.

Parosteal osteosarcoma of the maxilla.

We describe the case of a 47-year-old female who presented with a small nodule in the buccal sulcus in the left maxillary incisor region. Clinical and radiographic examination revealed a small sclerotic neoplasm with a short pedicle. Histopathological examination confirmed a diagnosis of parosteal osteosarcoma. The contribution of CT to the diagnosis and management is discussed.

[A retrospective study on the importance of preoperative control in the prognosis of spinocellular carcinoma of the oral cavity]. / Studio retrospettivo sull'importanza del controllo prechirurgico nella prognosi del carcinoma spinocellulare del cavo orale.

Surgical treatment of advanced forms of spinocellular carcinoma of the oral cavity (stages 3-4) has been integrated for a number of years with cycles of chemo- and/or radiotherapy both before and after surgery. This chemo-radio-surgical therapeutic protocol consists of four distinct stages, separated by precise treatment-free intervals, which enable the best efficacy to be achieved through synergy. A total of 60 patients were treated by our Ward using this protocol during the period March 1988-June 1992. At the time of surgery a complete negative outcome in the histological picture (pTO) was observed in 40% of cases; lesions had not regressed on only 16% of patients. A retrospective type study has been carried out using Kaplan-Meier's statistical analysis to evaluate the prognostic factors in this population: a significant correlation was found between disease-free time and survival, calculated at 40 months from the completion of the protocol, and histopathological TNM. Non correlation was found with clinical TNM: therefore, rather than the extent of the lesion at the time of diagnosis, its control during preoperative stages appears to be the major prognostic factor.

[Assessment of phonation in patients after oncologic surgery of the oral cavity]. / Valutazione foniatrica di pazienti sottoposti a chirurgia oncologica del cavo orale.

The authors evaluated word articulation ability in 33 patients undergoing integrated (chemo-radio-surgical) treatment for carcinoma of the oral cavity. Speech was intelligible in 22 patients. Severe language distortion was observed in 11 patients.

[Extracapsular lymph node metastasis in squamous cell carcinoma of the oral cavity after chemo-radio-surgical treatment protocol]. / Metastasi linfonodali extracapsulari nel carcinoma spinocellulare del cavo orale dopo protocollo terapeutico chemio-radio-chirurgico.

A total of 134 cases of spinocellular carcinoma of the oral cavity were treated by our division during the period March 1988-June 1992. This carcinoma histotype has a predominantly local evolution with rare long-distance hematic metastases. On the other hand, there are more frequent reports of metastases along the lymphatic route with an incidence which varies according to the site of tumour onset. Among the 134 patients treated a group of 77 were selected and admitted to a chemo-radio-surgical protocol consisting of four stages. During surgery patients in this group showed a marked reduction of both intracapsular and extracapsular lymph node involvement in almost all sites examined.

[Multidisciplinary treatment in advanced stages of spinocellular carcinoma of the oral cavity. Initial results]. / Trattamento multidisciplinare degli stadi avanzati di carcinoma spinocellulare del cavo orale. Primi risultati.

As in almost all forms of tumour, the best therapeutic results for those of the oral cavity is obtained following the first treatment which must be incisive and appropriate because it often represents the sole decisive possibility of recovery. In advanced forms (stages III and IV) it is best to establish a close collaboration between surgeon, cancer specialist and radiotherapist: this paper reports the authors' experience over the past 5 years with regard to advanced stages of spinocellular carcinoma of the oral cavity treated according to a chemoradiosurgical therapeutic protocol. Of the 134 cases treated by our unit, 77 were included in the protocol showing a 78% actuarial survival rate over 40 months.

[Eosinophilic granuloma of the maxillary bone. Review of the literature and report of a case of mandibular location in an HIV-positive patient]. / Granuloma eosinofilo delle ossa mascellari. Revisione della letteratura e presentazione di un caso di localizzazione mandibolare in paziente HIV positivo.

Following a short review of the literature, the authors report a case of an eosinophilic granuloma in bone in an immunodepressed patient (manifest AIDS) suffering from chronic hepatitis B and C. The possible link between the viral infection and immunodepression and the pathology in question in then discussed.

Histopathological findings after preoperative chemo-radiotherapy in oral and oropharyngeal carcinoma. A study of 28 resected specimens.

Serial sections of whole surgical specimens from 28 patients with locally advanced oral carcinoma were examined to assess the histopathological effects of a preoperative intravenous (i.v.) chemotherapy and radiotherapy protocol. In 15 cases (54%), no residual neoplastic tissue was found: in 9, the tumour area showed a dense hyalinised connective tissue, whereas in the other 6 cases foci of keratotic material were surrounded by a foreign body-type reaction. In 13 patients (46%), residual neoplastic tissue was observed: small fields of tumour were present in 6 cases, whereas tumour was widely persistent in 7. Lymph node metastases were observed in 9 cases (32%), with extracapsular spreading in 6 (21%). In 93% of cases, pathological staging on the specimen was more favourable than the clinical preoperative staging. 23 patients (82%) are alive without evidence of disease 30-55 months after surgery; 10 (43%) did not show any residual neoplastic tissue in the specimen; 10 patients (43%) showed persistence of tumour, but in 5 (21%) only small fields of tumour were observed. 4 patients (14%) died due to their tumour. The pathological data show that this protocol is successful in the treatment of advanced oral carcinoma; furthermore, they provide reliable information about the response to therapy and the subsequent course of the disease.

[Benign tumors of epithelial origin of the salivary glands. The authors' own experience and cases]. / Tumori benigni di origine epiteliale delle ghiandole salivari. Esperienza e casistica personale.

Following a review of the most recent literature on benign tumours of the salivary glands of epithelial origin, the paper illustrates an up-to-date classification of these tumours in anatomical and pathological terms. The author's personal clinical experience in 50 cases of major and minor salivary glands operated during the period between 1985 and 1991.

[Verrucous carcinoma of the oral cavity. Personal experience with combined chemo-surgical treatment]. / Carcinoma verrucoso del cavo orale. Esperienze personali sul trattamento chemio-chirurgico integrato.

Following an introduction regarding the anatomo-pathological and clinical aspects of verrucous carcinoma of the oral cavity, the authors review several recent reports concerning the prognosis and treatment of this tumour and its possible evolution. This is followed by a wide-ranging discussion of the differing opinions put forward by various researchers regarding the possible role of radiotherapy and in particular the high risk of triggering off latent forms and provoking the differentiated and more aggressive forms of carcinoma. The authors then illustrate their experience of integrated chemo-surgical treatment, excluding radiotherapy, administered over the past six years to patients who were brought to their attention suffering from this form of carcinoma.

[Warthin's tumor. Review of the literature and personal experience]. / Il tumore di Warthin. Revisione della letteratura ed esperienza personale.

Warthin's tumour is a much debated clinical case-characterised by the presence of epithelial proliferation and lymphoreticular stroma. Numerous controversies concern this type of tumour so much so that recently is was even denied that it can be considered a real tumour. The present paper aims to review the state of the art and report the authors' personal experience.

[Condylar osteosynthesis after Krenkel's technic. The authors' personal experience]. / Osteosintesi di condilo secondo la tecnica di Krenkel. Esperienza personale.

The paper illustrates the authors' use of surgery to treat condylar fractures using Krenkel's technique which entails a cutaneous incision under the mandibular corner and the application of a clip screw in relation to the longitudinal axis of the upright branch of the jaw. This surgical technique, which is above all indicated in cases of low subcondylar fractures, provides a rigid internal fixation of the fracture stumps, thus preventing intermaxillary lock. Several stages in the operation are described in dental and the intrinsic advantages of this method are then outlined together with the results obtained.

[The lymphocytogram in recurrent aphthous stomatitis. The etiopathogenic aspects]. / Il linfocitogramma nelle stomatiti aftose ricorrenti. Considerazioni eziopatogenetiche.

The paper studies the distribution of circulating lymphocytic phenotypes in 20 cases of recurrent aphthous stomatitis. The statistical analysis of data, together with that found in 40 normal subjects, reveals the selective immunoactivation of cytotoxic T lymphocytes and NK cells similar to that found during the course of acute viral diseases. In etiopathogenetic terms, results should therefore be considered as a possible demonstration of the viropathic genesis of this disease.

[Fractures of the temporo-zygomatic arch. The clinical and therapeutic aspects]. / Fratture dell'arcata temporo-zigomatica. Considerazioni cliniche e terapeutiche.

Fractures of the orbito-maxillo-zygomatic complex are often associated with fractures of the temporo-zygomatic arcade. After a brief discussion, the authors describe a simple method to support the fractured arcade in the event of inadequate containment and/or the precarious stability of the latter.

[Surgical experience of complex fractures of the middle third of the facial skeleton treated without an intermaxillary block]. / Esperienza chirurgica di fratture complesse del terzo medio dello scheletro della faccia trattate senza blocco intermascellare.

Having illustrated the functional and anatomical aspects of the upper jaw and the importance of the anterior and posterior pillars as load-bearing structures for the middle third of face, the paper reports a series of fractures of the upper jaw treated with plaque osteosynthesis without an intermaxillary block. The functional and esthetic advantages are underlined.

[Glossopharyngeal neuralgia]. / La nevralgia del glossofaringeo.

Glossopharyngeal neuralgia, such less common than trigeminal neuralgia, is characterized by paroxysm of unilateral pain with sudden onset radiating from the oropharynx and base of the tongue, to the ear. Often precipitated by swallowing the glossopharyngeal neuralgia is occasionally accompanied by bradycardia or syncope. Conservative treatment consists of anticonvulsant drugs. Surgical treatment consists of section of the rootlets of the ninth and, in part, tenth cranial nerves. In some selected patients microvascular decompression without section of rootlets is also been made.