Temporomandibular joint disorders in seronegative spondyloarthritis: what a rheumatologist needs to know?

Temporomandibular joint (TMJ) can be affected in the context of spondyloarthritis (SpA) with detrimental impact on individuals' quality of life. Intra-articular inflammation, synovitis, enthesitis, disc displacement and cervical vertebrae malalignment are some of the pathophysiological phenomena involved. Temporomandibular joint disorders (TMD) incidence appears to be higher in patients with ankylosing spondylitis and psoriatic arthritis, especially when clinical evaluation includes not only imaging but relevant history, TMJ examination and diagnostic criteria for TMD. The Visual Analogue Scale (VAS) pain score and Health Assessment Questionnaire Disability Index (HAQ) quality of life score could be useful tools. Panoramic radiographs and ultrasound can be used for screening but in symptomatic patients magnetic resonance imaging (MRI) is preferable. Conservative management and early pharmacological treatment can prevent permanent joint impairment. For refractory cases, early referral to Legislation for Oral and Maxillofacial Surgery (OMFS) specialists is indicated. The aim of this narrative review is to address the involvement of TMJ in SpA and to encourage clinicians to incorporate TMJ assessment in their physical examination and basic screening.

Investigation of the interplay between plasma lipids and macrophage polarization in small oral squamous cell carcinomas with different outcome: A pilot study of 17 cases.

INTRODUCTION: Growing evidence suggests a correlation of alternative polarization of macrophages (M2) with a bad outcome of oral cancer. Macrophage polarization plays a significant role in the progression of hyperlipidemia and atherosclerosis, being influenced from plasma cholesterol. On the other hand plasma lipids have been studied epidemiologically as risk factors in carcinogenesis. Goal of our pilot study was the investigation of a possible association of plasma lipids with tumor outcome through their potential influence on macrophage polarization. MATERIALS AND METHODS: 17 patients with small pN0 OSCC with different clinical outcome, treated operatively without postoperative R(C)T constituted our patient collective. Plasma lipids (total cholesterol and triglycerides) were studied in relation to macrophage polarization (determined through the expression of CD68, CD11c, CD163 and MRC1 antibodies) and tumor outcome. RESULTS: Patients with pathological chronic course of either plasma cholesterol or triglycerides demonstrated an increased infiltration with alternatively polarized macrophages in their specimens. Patients with pathological chronic course of plasma cholesterol showed moreover a bad tumor outcome. CONCLUSION: A role of plasma lipids in the tumor outcome via alternative macrophage polarization could be assumed. A larger prospective study is needed to confirm our preliminary results.

The free scapular/parascapular flap as a reliable method of reconstruction in the head and neck region: a retrospective analysis of 130 reconstructions performed over a period of 5 years in a single department.

BACKGROUND: The scapular/parascapular free flap was described by Saijo in 1978 and has since then been widely used in reconstructive procedures. MATERIALS AND METHODS: This is a retrospective study, describing our experience with the use of free scapula/parascapular flap in 130 reconstructions over a period of 5 years in the Department of Oral and Maxillofacial Surgery of the University Hospital of Erlangen. Demographical data, data regarding the underlying pathology, flap raising details, microvascular anastomoses, early and late postoperative complications will be presented. RESULTS: The flap was raised without problems and the donor site was primarily closed in all cases. Sixteen flaps required revision. Five transplants were lost (failure rate of 3.85%). Loss of part of the flap was observed in 3 cases (2.3%). CONCLUSION: The free scapula/parascapular flap is a versatile and reliable flap that can find many applications in the reconstruction of complex head and neck defects.

Osteo-radio-necrosis (ORN) and bisphosphonate-related osteonecrosis of the jaws (BRONJ): the histopathological differences under the clinical similarities.

OBJECTIVES: Both osteoradionecrosis (ORN) and bisphosphonate associated osteonecrosis of the jaws (BRONJ) present clinically as regions of exposed necrotic bone. The study aimed to demonstrate the histopathological differences behind the observed clinical similarities. STUDY DESIGN: Ten ORN specimens and ten BRONJ specimens were used, as well as ten samples of normal mandibular bone as control. Two bone-specific stainings were used, i.e. Sirius Red for the study of the relative presence of collagen types I and III and toluidine blue for the study the osteon density. RESULTS: The Red Green Blue (RGB)-analysis of the specimens stained with Sirius Red identified significant differences between the chromatic patterns observed in bone preparations of patients suffering from ORN when compared to both BRONJ and control samples. Moreover, the osteon density of the BRONJ samples was significantly lower when compared to ORN and normal bone samples. CONCLUSIONS: The demonstrated differences in the bone architecture and in the bone collagen content between the two pathological conditions most likely reflect underlying pathophysiological differences.

Oncocytic lipoadenoma of the parotid gland: a report of a new case and review of the literature.

Oncocytic lipoadenoma is a rare salivary gland tumour composed of adipose tissue and oncocytic epithelial cells in varied proportions. This tumour is still not included in the current WHO classification of salivary gland neoplasms. We herein report a further case of oncocytic lipoadenoma originating in the parotid gland of a 55-year-old woman. The tumour presented as a slowly growing asymptomatic left-sided parotid gland mass. The resected tumour measured 2.7 cm in maximum diameter and was composed of oncocytoma-like epithelial component admixed with mature adipocytes that made up 10% of the whole mass. Foci of sebaceous differentiation were seen. This rare variant of lipomatous salivary gland tumours is in need of more recognition and should be distinguished from other fat-containing salivary gland lesions, particularly lipomatous pleomorphic adenoma and myoepithelioma.