Serum anti-p53 antibodies as a diagnostic tumor marker: observations in patients with malignant and premalignant oral cavity lesions.

AIM: To determine whether serum anti-p53 antibody (p53-Abs) positivity in patients with oral carcinoma corresponds with tumor localization, histological grade, stage, and recurrence. METHODS: The study population was divided into three groups: controls; patients with a premalignant lesion; and patients with oral squamous cell carcinoma (SCC). The third group was composed of patients attending outpatient services for pathological diagnosis or for follow-up monitoring only. The cancer patients had undergone resective surgery in local anesthesia. Serum p53-Abs levels were measured using a commercial enzyme-linked immunosorbent assay (ELISA) and monitored over a 3-year follow-up period. RESULTS: Controls and patients with premalignant lesions did not test positive for p53-Abs at ELISA testing. Patients with a malignant lesion tested positive at initial diagnosis when a high histopathological grade lesion was present or localized to the posterior region of the oral cavity. Postoperative serum p53-Abs levels gradually declined until complete seronegativity. Patients with a recurrent tumor tested positive for p53-Abs. CONCLUSION: Seropositivity for p53-Abs may be associated with histopathological tumor grade, localization, and recurrence. The findings suggest that serum p53-Abs analysis is a useful diagnostic marker for oral SCC.

Descriptive and topographic anatomy of the accessory infraorbital foramen. Clinical implications in maxillary surgery.

AIM: Study of frequency and position of accessory infraorbital foramen in a large craniological sample. METHODS: A sample of 1 064 skulls from the craniological collection of the Department of Anatomy, Pharmacology and Forensic Medicine of the University of Turin (Italy) was investigated. RESULTS: Accessory infraorbital foramen was found in 4.7% of the skulls (5.4% in male and 4.26% in female skulls) with a higher frequency on the left side, both in male and in female skulls. CONCLUSION: These results increase our knowledge of the interindividual anatomic variability of the infraorbital region and can be of help for the maxillo-facial surgeon, especially in trunk block of the infraorbital nerve.

[Odontogenic tumors. The importance of a correct histopathological diagnosis]. / Tumori odontogenetici. Importanza di una corretta diagnosi istopatologica.

The troubles in the exact diagnosis of odontogenic tumors spring from the poor knowledge of the histological type of the lesion, from mutations in the ectodermal cells of the tumors and from the uncommonness of the pathology. Wrong diagnosis in this field of stomatology often lead to unnecessary surgical resection and could be avoid with better cooperation between surgeon and pathologist.

Enhancement of calcyclin gene RNA expression in squamous cell carcinoma of the oral mucosa, but not in benign lesions.

Oral cancer is a neoplasm with some known causes. Proliferation genes are significant among its few pathogenetic and prognostic factors. Calcyclin is a cell-cycle-related gene, the function of which is still unclear. Its expression and that of Haras and histone-H3 have been investigated in an assessment of their pathogenetic role in squamous cell carcinoma. RNA extracted from the pathological and normal mucosa of patients with squamous cell carcinoma (SCC) and benign lesions was reverse transcribed and amplified by the polymerase chain reaction (PCR). The expression of all three genes in the pathological mucosa was enhanced in SCC only. This suggests that they may be involved in its pathogenesis and provides another parameter for the differentiation of malignant and benign lesions.

[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.

[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.

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.

[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.

[The problem of the mandible in surgery of tonsillar tumors: proposal of a technique]. / Il problema della mandibola nella chirurgia dei tumori tonsillari: proposta di una tecnica.

The Authors report a technique of a conservative transmandibular approach for the surgical treatment of tonsillar region malignancies. The procedure is based upon the preparation of a vascular mandibular flap through two osteotomies, which are performed, the first above the mandibular foramen and the second below the mental foramen. The main advantages of present technique are: lip-chin-splitting is avoided and, due to the preservation of mandibular vascular and nervous supply, it is possible to accomplish, without risk, postoperative radiotherapy. Moreover, if dictated by oncologic reasons, this conservative procedure may easily be transformed into a radical surgery (commando or neck-jaw operation).

[Multiple lipomatosis or Launois-Bensaude disease. Technics for surgical treatment in our clinical experience]. / La lipomatosi multipla o morbo di Launois-Bensaude. Tecniche di trattamento chirurgico nella nostra esperienza clinica.

Only 200 cases of this extremely rare disease of unknown etiology have been reported in the literature. The paper examines the various surgical techniques and describes two cases operated by the authors.

Desmoplastic fibroma of the mandible: a case with an unusual clinical presentation.

A new case of desmoplastic fibroma of the mandible is reported. The patient was a 29-year-old woman who presented with a 5-year course of abscess-like lesions simulating a chronic apical infection. Radiographically, a nonspecific, small osteolytic area was observed. A wide resection of the tumor and the neighboring bone was performed.

[Carcinoma of the oral cavity: integrated treatment]. / Carcinoma del cavo orale: trattamenti integrati.

An integrated chemoradio-surgical technique for treating carcinoma of the oral cavity is described. The results obtained are particularly promising. Longer-term follow-ups are needed for final assessment.

[Intra-arterial chemotherapy. Presentation of a method to insure patency of the catheter]. / Chemioterapia endoarteriosa. Presentazione di una metodica per assicurare la pervietà del catetere.

Following some brief remarks on the main techniques of antineoplastic chemotherapy, a simple technique for guaranteeing patency of the endarterial catheter is presented. Using a special microchannel infusor, it was possible to prevent catheter obstruction in 100% of the cases treated.