Management of functional dyspepsia in 2020: a clinical point of view.

Dyspepsia is a disorder that refers mainly to central upper abdominal pain or discomfort. When a cause of this symptom is not identified the condition is termed functional dyspepsia (FD), that affects a large part of the general population. The relevance of FD is due to its high prevalence, but also to its chronic or intermittent course. This induces a significant burden for each national healthcare system. The pathogenesis of FD is complex and multifactorial, depending on cultural, environmental, and biological factors. Although considered of main importance in the pathophysiology of several gastroduodenal diseases, in the context of FD Helicobacter pylori (H. pylori) infection plays a limited role. The diagnosis of FD requires the exclusion of organic gastroduodenal diseases as well as H. pylori infection. Thus, the diagnostic workup includes a complete anamnesis, biochemical tests, and endoscopy with biopsy (when requested), and the satisfaction of clinic criteria recommended by the Rome IV consensus. The treatment of FD is also challenging, in fact more and more studies focused on a wide range of different therapies, with a multitude of results. The aim of this literature review is to provide an update of the new evidences useful for diagnosis and management of FD.

Interdomal-columellar myolipoma: discovered at rhinoplasty.

UNLABELLED: Tumors of the adipose tissue located in the nose are extremely rare. This report draws attention to the first case of nasal tip-columellar myolipoma described in the literature. During an open rhinoplasty, the authors elevated the columellar flap and approached the tip, where they found a misdiagnosed 2 × 1 cm fatty mass wedged into the interdomal space continuing between the middle and medial cruses of the alar cartilages, which were laterally dislocated. The mass was excised by sharp and blunt dissection, and histopathologic examination resulted in a diagnosis of myolipoma. This report presents a novel location of myolipoma discovered incidentally. Its unexpected presence affected the surgeons in their operational decisions and forced them to make a rapid change in their surgical plan. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Rhytidectomy associated with autologous fat transplantation in Parry-Romberg syndrome.

Progressive hemifacial atrophy or Parry-Romberg syndrome is an uncommon degenerative and poorly understood condition characterized by progressive atrophy of 1 side of the face. It may involve several layers of tissue manifesting itself in a more or less aggressive form (mild, moderate, and severe). Generally, the restoration of contour and symmetry are the goals of the therapy in patients affected by this syndrome. In this article, we present the technique and the 6-year postsurgery result of a case of Parry-Romberg syndrome treated with 1-stage anterior lifting, removal of superficial muscular aponeurotic system, and autologous fat transplantation because the patient requested to recover more than atrophy and also 20 years of lost youth.

Follicular cyst of the jaw developing into a keratocyst in a patient with unrecognized Gorlin-Goltz syndrome.

Gorlin-Goltz (GG) syndrome is an inherited autosomal dominant condition. Its diagnosis may be clinically confirmed by checking either major or minor signs that define the diagnostic criteria. It may occur that, although GG syndrome is a well-known condition, only the specific symptom could be observed by different specialists. Therefore, the patient cannot be placed into an always complex clinical panel. We introduce an example in this report. Throughout a 20-year clinical history characterized by the lack of proper diagnosis and missed follow-up operations, a patient with GG syndrome underwent partial amputation of the jaw after severe complications. A 52-year-old man required an implant-prosthetic rehabilitation since becoming edentulous after a partial resection of the jaw due to a keratocyst, which was later reconstructed through a free fibula flap. The observation of a typical phenotype and various symptoms that succeeded for longer than 20 years, with anamnestic evaluation and clinical examination, led us to suspect a complex pathologic condition such as GG syndrome, which was not previously considered, although the patient had undergone several polyspecialistic evaluations. Diagnosis has been eventually confirmed by a genetic study, which was always mandatory. The simultaneous presence of muscular and skeletal malformations, basocellular nevi, and multiple cysts of the jaw can represent signs linking to a condition such as GG syndrome. There are many syndromes involving the head and neck region, and specialists are supposed to be alerted when faced with similar typical expressions associated with a characteristic soma so as to avoid delays in diagnosing the syndrome.

A new 3-phase therapy protocol in temporomandibular joint ankylosis: our experience.

Limitations in oral opening may be due either to intra-articular or extra-articular ankylosis (pseudoankylosis). The principal means of therapy usually consist of 2 steps: surgical removal of the ankylotic block and immediate functional rehabilitation. In the postoperative period, however, immediate and adequate functional rehabilitation is not always possible because of pain and swelling of the temporomandibular joint, resulting in a very high risk of relapse. To prevent this, the authors introduce a third phase between the 2 already mentioned (surgery and functional therapy) in which the oral opening obtained with surgery is held in place while clinical conditions (pain and swelling) are allowed to stabilize before initiating intensive physiotherapy. Through the discussion of 18 clinical cases (8 of which were treated in the traditional way), the authors report on the intermediate treatment phase introduced by them between the surgical stage and the rehabilitation. Immediately after the operation, a handmade wedge, that is, a bite block of suitable size, is placed between the dental arches for a period of about 3 weeks, while appropriate pharmacological therapy was administered. The results showed an improvement of the mandibular movements both in opening and laterally, on the right and left sides, in patients treated with the new protocol. The proposed protocol holds the opening obtained with surgery until the clinical conditions make it possible to initiate intensive physiotherapy. In this way, the authors obtained better results in both recovery and in mandibular movements.

Hamartomatous sialolipoma of the submandibular gland: case report.

Sialolipoma is a rare tumour of the salivary gland that is composed of mature adipocytes and normal salivary gland tissue. We report an unusual case of a sialolipoma of the submandibular gland in a 77-year-old woman. The location of this tumour has not to our knowledge been previously described. The tumour was excised and has not recurred during 22 months postoperatively.

Le Fort I osteotomy and the use of bilateral bichat bulla adipose flap: an effective new technique for reconstructing oronasal communications due to cocaine abuse.

The aim of the study was to describe a new and effective method for reconstructing small- and medium-sized oronasal communications in cases of deficient blood supply of oronasal mucosa.A male patient, aged 45, was presented with a hard palate defect due to chronic cocaine inhalation. The defect was corrected using bilateral Bichat bulla adipose flap and a Le Fort I osteotomy. The surgical technique was described, together with its advantages. Surgery lasted 2 hours. The reconstructive technique had been easy to execute. Six months after the surgery, the defect has been corrected without complications.Le Fort I osteotomy and the use of a bilateral Bichat bulla adipose flap is an effective technique to correct small- and medium-sized palatal defects not solvable with simple oral mucosa flaps. The technique is easy to execute and it showed a high efficacy with minimal impact on the patient's esthetic appearance.

Surgical therapy for osteonecotic lesions of the jaws in patients in therapy with bisphosphonates.

OBJECTIVE: Surgical therapy to improve the symptoms and the lesions in osteonecrosis (ON) of the jaws in patients in therapy with bisphosphonates. DESIGN: to evaluate the patient's therapeutic protocols, performance status, and factors promoting ON to prevent surgical failure. MATERIALS AND METHODS: 18 patients affected by osteonecrotic lesions of the jaws associated to BF, were treated by surgery. RESULTS: The results were recorded after 6 months. All the patients showed improvement of symptoms, in particular the pain. In addition, all the patients referred to a sensation of fresh and clean mouth, the disappearance of fetor ex ore, and a healthy mouth. CONCLUSIONS: The management and the resolution of BF osteonecrotic lesions is arguable and complex because in most cases, the patients are affected by oncologic disease when the better approach is prevention, but when the ON lesion is clear, surgery can improve the symptoms and in some cases, it can be resolute. To prevent surgical failure, it can be useful to evaluate the patient's therapeutic protocols, performance status, and factors promoting ON.

Maxillary corticotomy and extraoral orthopedic traction in mature teenage patients: a case report.

AIM: The authors' propose to combine the reverse pull headgear with a Delaire type face mask and a maxillary corticotomy to treat a Class III non-growing patient with maxillary retrusion. The aim of this report is to present two cases in which this treatment strategy was successful. BACKGROUND: Several studies suggest the majority of Class III dento-skeletal malocclusions have components of maxillary retrusion. Early treatment of these patients with maxillary protraction devices have shown promising results. Facemask therapy has some important limits. Most important is the optimal timing of treatment between the ages of six to ten years. Closure of the maxillary suture occurs as a child ages which results in an increase of maxillary resistance to protraction. REPORT: A proposed therapy carried out in orthodontic and surgical phases was used in the treatment of two young patients. They were both beyond the optimal age range for the application of the orthopedic device (a girl 15 years old and a boy 16 years old), however, they had not reached the necessary skeletal maturity for orthognathic surgery. SUMMARY: The described technique has the advantage of being quick and easy to perform with a low surgical risk yielding satisfactory results after 15-20 days of therapy instead of the six to nine months associated with traditional procedures.

A new method for assessment of craniofacial malformations.

Many assessments of craniofacial malformations are generally undertaken to assist in surgical intervention including physical examination, cephalometric radiographs in anteroposterior and lateral views, stereolithographic models, and anthropometric measurements integrated with three-dimensional computed tomography (3-D CT) reconstructions to quantify skeletal deformities. In the present report, the use of 3-D Malformation Analysis, a three-dimensional methodology for planning craniofacial operative procedures, is presented. In addition to cephalometric and anthropometric databases, the measurements from 3-D surface reconstructions from CT were used intraoperatively to establish the correct position of skeletal segments.

Fanconi anemia manifesting as a squamous cell carcinoma of the hard palate: a case report.

Fanconi anemia is a rare autosomal recessive disorder characterized by various congenital malformations, progressive bone marrow failure at a very young age and of solid tumors development. The authors present a rare case of a squamous cell carcinoma of the hard palate in a Fanconi Anaemia patient. The atypical clinical manifestation rendered the diagnosis more difficult. This case, for age of appearance, sex and localization, is unique in international literature. We recommend a quarterly follow up of the oral-rhino-pharynx complex in FA patients and to consider as carcinomas, all oral lesions that last more than two weeks.

Orthognathic surgery: an informed consent model.

In this study, the authors propose an informed consent form for orthognathic surgery. A careful review of the international literature and clinical practice suggested the feasibility of dividing the informed consent form into two parts. In first part, the diagnostic procedures and the therapeutic and surgical times are described. The patient must sign it as soon he or she accepts the orthodontic/surgical therapy proposed. The second part describes the possible problems and difficulties of the procedure, and it must be read by the patient before starting the therapy. In the opinion of the authors, this informed consent form allows the patient to know the risks related to the orthodontic/surgical therapy, thus preserving the surgeons from the civil risk and penalties of omission.