Oral lichen planus: therapy and phenotype.

BACKGROUND: Lichen planus (LP) is a mucocutaneous disease of chronic inflammatory nature. Although many therapeutic options are available, none are curative. The aim of this article was to describe a therapeutic algorithm that take into consideration the clinical futures of oral LP (OLP). METHODS: Patients affected by symptomatic OLP were enrolled into three groups to receive cyclosporine mouthwash, retinoic acid lotion 0.05%, and autologous platelet-rich plasma (PRP) gel in the treatment of reticular, plaque-like, and erosive-type respectively. The products were applied as follows: retinoic acid BID for 8 weeks, cyclosporine mouthwash OD for 8 weeks, PRP once a week for 8 weeks. Patients were assessed at 2, 4, 8, and 12 weeks. Improvement was evaluated as complete response, partial response and no response. RESULTS: A total of 20 Caucasian patients, 8 male and 12 female, mean age 56 years (range 40-74) concluded the study. Seven patients showed a complete response, 7 patients a partial response, and 6 patients no response. CONCLUSIONS: We propose a therapeutic algorithm that take into consideration the clinical features and symptoms of OLP. Long-term experience on larger series of cases are necessary to confirm our data.

Pindborg tumor in children.

Pindborg tumor or calcifying epithelial odontogenic tumor is a rare benign neoplasm. The average age at diagnosis is 40 years without a significant prevalence for one sex. The most frequent localization is the mandibular premolar and molar area; less frequently the lesion is found in the maxilla, while other localizations like the maxillary sinus are extremely rare. Ethiology of this lesion is not clear. The complete surgical removal of the lesion is usually considered the most common type of treatment. The authors report a peculiar case of Pindborg tumor characterized by a rare localization of the lesion (maxillary incisal area) and by the young age of the patient (nine years old). The correct treatment in the case of a small mass is the surgical enucleation of the lesion. The purpose of the surgical treatment is the radical resection of the neoplasm with clean margins in order to reduce the risk of recurrence of disease. Recurrence of disease many years after surgical therapy has been reported that is why a clinical and instrumental long-term follow-up of the patient are suggested.

LeFort III advancement with and without osteogenesis distraction.

The LeFort III osteotomy is the surgical treatment performed in patients with mid-facial retrusions in craniofacial dysostoses such as Crouzon, Apert, Pfeiffer syndromes, etc. The first authors to report the accomplishment of this osteotomy were Gillies and Harrison in 1951, this technique was then resumed and improved by Tessier in 1967, who made five different variants mainly regarding the typology of the osteotomy concerning the lateral wall of the orbit. Recently, distraction techniques have been applied to the upper mid-face which foresees a gradual advancement of the mid-face through the osteogenetic distraction procedure. The purpose of this retrospective clinical outcome study is to evaluate and compare the two different surgical techniques through the experience acquired during the treatment of 15 cases of craniofacial dysostoses from 1990-2005, and through international literature. The standard surgery technique was performed in 5 of these patients, whereas the osteogenetic distraction technique was performed in the remaining 10. All patients were studied preoperatively through the acquisition of photographic images, cephalometric analysis of the skull, and the study on plaster models of the occlusion of the dental arches. The instrumental exams required before surgery are the following: telecranium X-rays in two projections, orthopanoramic X-rays, CT. The results of this study indicate that the osteodistraction technique represents the choice treatment in severe retrusions of the mid-face while the traditional surgical technique remains indicated in adult patients that are in need of moderate advancements.

Pigmented villonodular synovitis of the temporomandibular joint.

Pigmented villonodular synovitis (PVNS) is a relatively rare disease, affecting the synovial-lined joints. PVNS was first fully described by Jaffè in 1941, who considered it to be a benign inflammatory state of the synovium of an uncertain etiology. Reports of this disease in the temporomandibular joint (TMJ) are extremely rare. The authors report a case of a 38-year-old woman affected by pigmented villonodular synovitis of the TMJ. Clinical examination revealed the presence of a preauricular mass in the left side; a computed tomography scan showed a 3.0 x 2.0 cm preauricular mass in close continuity to the TMJ capsule. The purpose of this report is to describe the clinicopathological features of a case involving the TMJ. The previously reported cases in the literature are also reviewed.