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.

Atopic dermatitis and dental manifestations.

BACKGROUND: Atopic dermatitis is a chronic skin disease associated with epidermal dysfunction commonly seen in children. The aim of this study was to evaluate the possible correlation between atopic dermatitis and dental diseases in paediatric patients. METHODS: An observational study was conducted by the Department of Paediatric Dentistry of the Policlinico Tor Vergata among a group of 300 children, between 2 and 17 years of age and of both genders, for a period of 6 months from January 2013 to June 2013. Socio-demographic data including race, gender, and age were collected. Clinical and dermatological examinations were performed in all patients; family and medical history of atopy was recorded for each patient and relatives. RESULTS: Three hundred patients, aged between 2 and 17 years, with mean age of 8.9 (±2.12), were enrolled; 90/300 (30%) were affected by atopic dermatitis. Of those, 69/90 (76.6%) had a medical history of spoil habit, 49/90 (54%) had caries, 58/90 (64.4%) had malocclusion disease, 13/90 (14.4%) had anatomical dental abnormalities. CONCLUSIONS: In conclusion, in the current investigation we found a higher prevalence of atopic dermatitis in pediatric dentistry patients compared to the general population suggesting that dental diseases could be involved in the pathogenesis of AD.

Aphthous, celiac disease and other dental disorders in childhood.

BACKGROUND: Oral conditions and dental disorders are frequent in childhood. Recurrent aphthous stomatitis (RAS) is a common inflammatory condition characterized by painful recurrent, single or multiple ulcerations of the oral mucosa induced by genetic and environmental factors. Celiac disease (CD) is a chronic small intestinal immunemediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals pathogenetically related to oral condition. The aim of the study was to evaluate the different prevalence of oral conditions in CD patients compared to a control group. METHODS: From January 2013 to June 2013, 166 patients, between 2 and 17 years of age and of both genders, were examined in order to evaluate the presence and the medical history of oral conditions. Clinical features of patients affected by CD were compared with those of a control group with similar socio-demographic features. RESULTS: We found that the more common lesions in both groups were RAS (69% in CD patients vs. 43% in the control group), followed by dental disorders (76% in CD patients vs. 65% in the control group). Prevalence of RAS between the two groups was significantly different (P<0.0006). Prevalences of caries and dental abnormalities were the same in the two groups (45% vs. 45% and 16% vs. 16% respectively). CONCLUSIONS: In celiac patients there was a significant higher prevalence of RAS compared to a control group. These findings could be possibly associated with common pathogenetic mechanisms.

Cyclosporine: a novel therapeutic approach for Burning Mouth Syndrome.

BACKGROUND: The aim of this paper was to evaluate the efficacy and safety of topical cyclosporine applied as mouthwash in the treatment of burning mouth syndrome (BMS). METHODS: This was a prospective and pilot study conducted by the Department of Dermatology of the University of Rome Tor Vergata. Patients were treated with cyclosporine topically applied as mouthwash for 4 weeks. Clinical improvement was assessed using a 5 grade clinical evaluation scale and a visual analogue scale from 0 to 10 was also used to evaluate the burning symptoms. RESULTS: Fifteen patients between 22-85 years (61.1±19.3), 11 female and 4 male, with a mean duration of BMS of 12.5 months, completed the study. Five out of 15 patients presented a marked improvement, 6 patients showed a moderate response, 3 patients had a slight improvement and 1 patient did not show any change. The VAS showed a reduction from 8.7 to 3.5. Adverse events were not reported. CONCLUSIONS: Cyclosporine mouthwash appeared to be safe and beneficial for reducing the burning sensation in patients with BMS representing an alternative therapy in this condition.

Apheresis in the treatment of recalcitrant atopic dermatitis: case series and review of the literature.

BACKGROUND: Atopic dermatitis is a chronic disabling inflammatory skin disorder, typically characterized by intensely itching, oozing, crusted, eroded vesicles or papules developing on erythematous plaques. Conventional treatments, both topical and systemic, may produce unsuccessful and unsatisfactory results. OBJECTIVES: we aimed to assess the efficacy of apheretic treatments in patients with severe, recalcitrant AD, in particular, the pruritic component. PATIENTS AND METHODS: four patients affected by recalcitrant and debilitating atopic dermatitis, who had previously received conventional topical and systemic therapies with poor clinical improvement, were treated with extracorporeal photopheresis or therapeutic plasma exchange. RESULTS: a satisfactory response to apheresis was observed with a reduction of pruritus and skin lesions. CONCLUSION: In our experience, apheretic therapies might be used as monotherapy but, more effectively, in combination with topical and/or systemic treatments. Indeed, they proved to be a safe "enhancer" for increasing the efficacy of conventional therapeutics.

Combined surgical approach retromandibular and intraoral to subcondylar mandibular fractures.

BACKGROUND: Condylar and subcondylar fractures are very common and account for at least one third of all mandibular fractures. In literature, little agreement exists about the management of extracapsular condylar and subcondylar fractures in adults. Some studies provide better results of occlusion, masticatory function, mouth opening, and bone morphology with surgical treatment. Conversely, other studies report excellent results with conservative treatment avoiding complications such as facial nerve injury and unsightly scar. METHODS: In this study, we report our experience of 25 condylar/subcondylar fractures. We report the case of a man with bilateral subcondylar fractures treated by a double surgical approach, intraoral and retromamdibular. Intraoral approach lets us dissect the masseter and disconnect the temporal muscle tendon, thus favoring further reduction of fracture stumps, whereas retromandibular approach favors a good operative field and the positioning of titanium microplate. RESULTS: Postoperative monitoring reported good results of occlusion. Postoperative computed tomographic scans show the good reduction and positioning of titanium miniplate.

Treatment of N in the upper maxillary tumors.

From 2002 to 2008, 86 patients have undergone surgical treatment of malignant upper maxillary tumors at the Maxillo-Facial Surgery Department, Tor Vergata University, Rome. All the N-positive patients at the time of the T therapy have undergone lymph node surgical emptying. In 6 patients, a laterocervical emptying was performed when laterocervical metastases were found. In the remaining 68 patients, with no evidence of N, we did not perform laterocervical emptying. We found in our patients a high percentage of cervical metastasis in T2 squamous cell carcinoma of the maxilla (32.1%). In this article, the authors present the results of their experience in treating N in upper maxillary tumors. This research study highlights some important aspects that have to be considered. Squamous cell carcinoma of the maxilla extending to the oral cavity (T1-T2) shows a higher laterocervical lymphophily than the superoposterior ones (T3-T4). Presence or appearance of lymph node metastases is a high-malignancy index, with a subsequently very negative prognosis. Considering the large percentage of cervical recurrences in T1-T2 squamous cell carcinoma of the maxilla that spread up in the hard palate mucosa and upper gum and the consequently high morbidity, performing a prophylactic laterocervical emptying in these patients could be advisable. Even in the recent literature, we found opinion in favor of this behavior.

Central giant cell granuloma of the jaws.

Central giant cell granuloma was classified by the World Health Organization in 2005 as a rarely aggressive idiopathic benign intraosseous lesion that occurs almost exclusively in the jaws. It occurs most frequently in young women (aged <30 y). This osteolytic lesion histologically consists of proliferation of fibrous tissue, hemorrhagic focuses, hemosiderin deposits, osteoclast-like giant cells, and reactive bone formation. Differential diagnosis has to be made with other osteolytic neoformations of the jaws, both unicystic and multicystic (odontogenic tumors, fibrous dysplasia, cysts, etc). From 2002 to 2008, we surgically treated 8 cases of giant cell granuloma. Our article focuses on a 59-year-old woman who came to our department with a swelling on the right side of the face. Computed tomography examination showed an osteolytic and expansive neoformation spreading up from the lateral wall of the nose to the anterior wall of maxillary sinus and above up to the inferior margin of the eye socket. Besides, it was contiguous to the canine root apex, the first and second bicuspids. Intraoral incisional biopsy confirmed the histologic picture of central giant cell granuloma. After a few days, she underwent surgical excision of the neoformation, preserving the lateral wall of the nose, the anterior wall of maxillary sinus, the eye socket, and the dental elements, respectively. Results of the histopathologic examination confirmed the previous biopsy. A follow-up at 30 months excluded any relapse.

Intraosseous hemangiomas.

Intraosseous hemangiomas are classified as benign tumors of vascular nature. Some authors describe them as hamartomas. They originate and expand inside bone structures. They are usually congenital, rarely of posttraumatic origin. In the Maxillo-Facial Surgery departments of the Universities of Rome "La Sapienza" and "Tor Vergata," from 1990 to 2004, 11 cases of intraosseous hemangioma have been diagnosed. In 6 cases, the neoplasm localized in the zygomatic region; in 3 cases, at the mandible level; in 1 patient, in the maxillary site; and in 1 patient, in the frontal bone. Literature review and the case of a male patient affected by left orbitozygomatic hemangioma are described.

Reconstruction of premaxilla with fibula free flap.

The reconstruction of the maxilla after surgical excision of malignant neoplasms has always presented significant difficulties. The excision of the premaxillary region involves considerable aesthetic and functional problems and, thus, presents particular reconstructive difficulties. The difficulties in the reconstruction of this area are related to the advanced anterior position and to the structural complexity of the premaxilla. In addition, soft tissue reconstructions, which might be used potentially to create an oral-nasal diaphragm, are often functionally and aesthetically unsatisfactory. Microvascular options have dramatically improved the reconstructive possibilities. Among free flaps, the fibula, scapula, and iliac crest are most used in the reconstruction of the upper jaw because of their advantageous compositional characteristics and plasticity. In our experience, however, the fibula free flap has emerged as the best reconstructive option for the premaxillary region because of the length of the pedicle, the flexibility and good quality of the bone, the reduced bulk of the soft tissue, and the low potential for problems at the donor site.

The importance of the head and neck region in regression of advanced MCC: a clinical report.

This paper presents the case of a 76-year-old woman who experienced a total regression of a Merkel cell carcinoma (MCC). The primary site of the tumor was on her right eyebrow. After this lesion was excised, the patient presented a massive locoregional metastasis on the right parotid gland and the laterocervical lymph nodes. No distant metastases were detected. An incisional biopsy into the right parotid gland confirmed the diagnosis of MCC metastasis. No surgical treatment was prescribed because of the advanced stage of the disease. Spontaneous total regression on the parotid and the neck mass was observed within 3 months. This is the 15th case of spontaneous regression in total and the 14th case with a site of origin in the head and neck region.