Predictive Factors in the Appearance and Evolution of Squamous Cell Carcinomas of the Oral Cavity.

Background: Oral squamous cell carcinoma (OSCC) registered an alarming fall in the average age of individuals diagnosed in the last decade. Objectives: The aim of our study is to assess the main risk factors for OSCC specific to Romania and to identify patients at risk for this pathology. The purpose is to implement in the future a screening and early diagnosis program for OSCC in our country. Materials and Methods: A ten-year case-control study was conducted on patients selected from "St. Spiridon" Hospital-Iasi, Romania. The study contained 1780 individuals diagnosed with oral squamous cell carcinoma. Results: For the patients under 46 years old: APC = -2.8 percent (95% CI: -24.4 to -7.1; p = 0.0012), with the observed rate of 30.18 percent. The incidence increased in patients aged 46 to 49 years (APC = 9.6%; 95% CI: 6.7 to -10.4; p = 0.0081). For the age group 49 to 64 years old: APC = -2.4 percent (95% CI: -5.3 to -1.6, p = 0.1239). For the age group 64-74: APC = -4.6, (95% CI: 1.4 to 6.9, p = 0.0108). The incidence of incidents was lower in the age group 74-80 (p = 0.0025). For the age group 80-91: APC = 8.1 (95% CI: 6.4 to 14.2, p = 0.0024), with the incidence of cases: APC = 8.1 (95% CI: 6.4 to 14.2, p = 0.0024). Univariate analysis revealed a substantially higher risk of developing oral carcinoma in males (OR = 4.43; CI: 3.84 to 5.80). Age above 60, cigarette usage and alcohol abuse are significant risk factors for OSCC. Patients with lymph node dissemination, ulcero-vegetant form, stages II and IV, whose therapeutic approach consisted of radiotherapy and chemotherapy or radiotherapy only had a worse rate of survival at 24 months post-therapy. Conclusions: Our study highlights the increase in the incidence of OSCC in Romania during the research period, the decrease in the average age of diagnosed patients, as well as the degree to which the studied population is exposed to the main risk factors specific to this geographical area.

The Impact of 3D Technology in Optimizing Midface Fracture Treatment-Focus on the Zygomatic Bone.

PURPOSE: In the context of the ongoing development and expanding availability of 3-dimensional (3D) printing, there is increasing interest in designing simplified workflows that would encourage more medical practitioners to include 3D printing in their current practice. The purpose of this study is to present our experience regarding the use of 3D printing in the preoperative planning and management of acute midface trauma, an area less explored by existing studies. METHODS: We performed a retrospective case series study including admitted patients who underwent surgical repair of midface fractures, in which 3D-printed stereolithic models were used preoperatively for shaping the osteosynthesis material. We recorded standard information about the patients, imaging method used, and type of midface fracture. We also logged the details and durations of each main step in the preoperative 3D printing workflow and documented the durations and outcomes of each surgical procedure. RESULTS: We identified 29 cases of midface fractures that benefited of a preoperative stereolithic model. From the 2 main methods of obtaining the virtual model, mirroring and virtual fracture reduction, the longest duration was recorded in a case in which the later method was used. The longest stereolithic model printing time was found in a complex midface fracture case. All the prebent osteosynthesis material was used intraoperatively and fitted the reduced fracture sites, also serving as an intraoperative guide for correct fracture reduction. The particularities, benefits, as well as the possible challenges associated with the application of 3D printing in acute trauma cases are discussed. CONCLUSIONS: Our 3D printing protocol was applicable and rendered favorable outcomes in the acute midface trauma setting. Proper understanding of the steps involved in achieving the stereolithic model is key for the adaptation of 3D printing to the current management of acute midface trauma.

Autologous Fat Grafting for Craniofacial Reconstruction in Oncologic Patients.

Due to the anatomical and functional complexity of the region, craniofacial tumor removal requires some of the most challenging surgical approaches, often complemented with advanced chemo-radiotherapy techniques. However, these modern therapies often lead to sequelae that can drastically reduce the quality of life for the surviving patients. Recent advances in the field of regenerative medicine opened new avenues for craniofacial reconstruction following head and neck cancer treatment. One of the most promising recent strategies relies on the use of autologous fat transplant. In this mini review, we briefly present some of the fat's biological properties that make it an ideal tissue for craniofacial reconstruction following cancer treatment. We then outline the recent advances that led to a better understanding of the detailed anatomy of the craniofacial fat depots. Furthermore, we provide a succinct review of the methods used for fat harvesting, processing and engrafting in the craniofacial area after head and neck tumor removal, discussing their main applications, advantages and limitations.

Use of Cone-Beam Computed Tomography in Performing Submandibular Sialolithotomy.

PURPOSE: Sialolithotomy for submandibular gland lithiasis is a common procedure often performed in the office setting, with the patient under local anesthesia. The location, size, and number of the sialoliths can greatly influence the indication owing to the difficulty of the procedure for hilar and proximal calculi. The purpose of the present study was to report our experience regarding the advantages of using preoperative cone-beam computed tomography (CBCT) to evaluate submandibular gland lithiasis in patients undergoing sialolithotomy for calculi located anywhere in the area of Wharton's duct, with special regard to hilar and proximal calculi. MATERIALS AND METHODS: We performed a retrospective study by reviewing the medical records of patients with a diagnosis of sialolithiasis of the submandibular gland using CBCT performed the day of stone removal by sialolithotomy. We have described the operative technique and the CBCT landmarks used for intraoperative orientation and control. RESULTS: Thirty-two patients with submandibular sialolithiasis were included in the present study. A total of 51 salivary stones were identified using CBCT. Proximal and hilar calculi were encountered in 14 cases. The number of calculi diagnosed using CBCT matched the number of surgically removed calculi in all cases. Transient lingual nerve hypoesthesia was encountered in 2 patients. No obstructive symptoms recurred after surgery. CONCLUSIONS: We found that preoperative CBCT allows for an optimal understanding of the individual stone configuration in relation to the patient's anatomy. It allows for easy identification of the calculi during sialolithotomy, leading to greater confidence in approaching proximal and hilar stones.

A Functional Approach to Posttraumatic Salivary Fistula Treatment: The Use of Botulinum Toxin.

This manuscript highlights key aspects regarding the practical use of botulinum toxin for the conservative nonsurgical treatment of a rarely encountered, but significant posttraumatic complication-the parotid salivary fistula. It adds information to the scarce existing literature on the subject. The authors outline the main differences between postoperative and trauma-related parotid injury regarding salivary fistula treatment. A total of 6 patients with trauma-related salivary fistulas have been treated by Abobotulinum toxin A injections over the course of 5 years. The technique is detailed, describing the doses used in the presence of parenchyma and duct injuries, the location and number of injection points in relation to the wound pattern. The results were favorable, leading to the healing of the salivary fistulas in all patients, with 1 injection session, without additional conservative treatment. In our experience, the use of botulinum toxin is of great benefit for treating salivary fistulas in a traumatic context.

Correlations between HPV, p53 and p16 in malignancies involving the retromolar trigone-oropharynx junction.

The aim of this study is to enhance knowledge regarding the behavior of human papilloma virus (HPV)-associated malignancies between two territories - maxillofacial and otorhinolaryngology. The HPV status and genotype, p16 and p53 expression were performed in 50 patients with malignancies located at the junction between the oropharynx and retromolar trigone alone or oropharynx spread to the junction. These were correlated with the treatment response, prognosis and survival of this kind of tumor located in oral posterior region, marking the transition between two territories (maxillofacial and otorhinolaryngology) of the selected cases. Results showed better treatment outcome and improved prognosis in HPV-positive compared to HPV-negative patients, and a strong link between HPV presence and p16 expression. Multimodal treatment including surgery, radiotherapy and chemotherapy provided the best results, although surgery was only an option in a limited number of cases, due to the advanced stage at presentation and extension in the surrounding tissues, considering the complex anatomy of the area. In the context of the increasing incidence of HPV-positive head and neck cancer, HPV testing together with molecular profiling for p16 and p53 tumor markers could help diagnose malignancies in the initial stages, and also provide important clues towards a targeted, more efficient treatment.

Role of mucosal high-risk human papillomavirus types in head and neck cancers in Romania.

BACKGROUND: Limited information is available about the involvement of human papillomavirus (HPV) in head and neck squamous cell carcinomas (HNSCCs) in Romanian patients. OBJECTIVE: To evaluate the HPV-attributable fraction in HNSCCs collected in Northeastern Romania. MATERIALS AND METHODS: In total, 189 formalin-fixed paraffin-embedded tissue samples (99 oral cavity tumors, 28 oropharynx, 48 pharynx, and 14 larynx/hypopharynx) were analyzed for HPV DNA and RNA using Luminex-based assays, and for overexpression of p16INK4a (p16) by immunohistochemistry. RESULTS: Of the 189 cases, 23 (12.2%) were HPV DNA-positive, comprising half of the oropharyngeal cases (14/28, 50.0%) and 9/161 (5.6%) of the non-oropharyngeal cases. HPV16 was the most prevalent HPV type (20/23, 86.9%), followed by HPV18 (5/23, 21.7%) and HPV39 (1/23, 4.3%). Only two (2/189, 1.1%) HNSCC cases were HPV-driven, i.e. positive for both HPV DNA and RNA. CONCLUSION: A very small subset of HNSCC cases within this cohort from Northeastern Romania appeared to be HPV-driven.

A New Indication for Barbed Threads: Static Reanimation of the Paralyzed Face.

PURPOSE: The objective of this study was to present the authors' experience in static facial reanimation using a straightforward incisionless procedure adapted from techniques commonly used for performing minimally invasive facelifts. MATERIALS AND METHODS: Seventeen patients were treated by static suspension using barbed sutures and all resulting changes were reviewed. The technique used for suture placement is described in detail, as are the author's tips for achieving the best esthetic and functional results. All patients had preoperative indication for physiotherapy and rehabilitation procedures (local massage and mirror therapy). Facial nerve function was evaluated using the Arianna Disease Scale. RESULTS: The cosmetic outcome improved in all cases, with marked amelioration of the preoperative facial asymmetry. Oral competence was enhanced by elevating the oral commissure and reinforcing the cheek, and amelioration of symptoms related to lagophthalmos was achieved through increased support and decreased pull on the inferior eyelid. The addition of physiotherapy with specific rehabilitation exercises before the surgical intervention increased the success rate. CONCLUSION: This technique proved to be a good alternative to other static reanimation procedures because of its straightforward technique, availability, good outcomes, low complication rate, and ability to perform minor adjustments and corrections at any time.

Considerations of Platelet-Rich Fibrin Use in Oral Surgery.

Nowadays, tooth extraction has become a frequently performed surgical procedure whose most common postoperative outcome is alveolar bone atrophy. To reduce the bone dimensional changes, localized alveolar ridge augmentation or socket preservation with bone grafting is required. The socket may be filled with synthetic grafts, xenografts, autografts, allografts, autologous platelet concentrate. The use of platelet concentrates for healing improvement and regeneration of the soft and hard tissues in oral cavity is one of the latest achievements in dentistry. One of the newest practices in bone augmentation is the use of platelet rich fibrin, derived from the patient's own blood and can be very easily accepted by patients due to cost effectiveness, low donor morbidity and low rate of postoperative complications or infection. This biomaterial might be a solution for patients that have strong beliefs regarding the use of allografts or xenografts, or which are afraid of complications during or after autografting procedure. One cannot say that there is an ideal grafting material and must consider a person's religious affiliation or beliefs when performing bone augmentation.

Retromolar trigone--oropharynx junction maligns tumor surgery: transmandibular versus oral approach.

AIM: This study proposes a new approach to a borderline pathology between Otorhinolaryngology (E.N.T.) and Oral and Maxillofacial Surgery (O.M.F.), the malignant tumors of the oropharyngeal and retromolar trigone junction. MATERIAL AND METHODS: 52 cases of retromolar trigone and oropharynx malign tumors were solved in the ENT department of "St. Spiridon" Universitary Hospital Iasi between 2012 and 2014. All patients were males, 35-64 years old, in different TNM stages. The novelty stands in the multidisciplinary approach, with an operating team consisting of both E.N.T. and O.M.F. surgeons, which joined their knowledge and expertise in order to offer a better treatment for the patient. Human Papilloma Virus (HPV) infection has been known as a trigger factor in head and neck cancers. The connection between HPV infection and malignant tumors of the oropharyngeal--retromolar trigone junction, together with the other traditional risk factors (smoking, alcohol, stress and sexual behavior) are involved in the therapeutic protocols, improving the life quality, the survival rate and reducing the treatment costs. RESULTS AND DISCUSSION: Excision of the malignant tumors at the level of the junction between the oropharynx and retromolar trigone often requires repairing the tissular defects that remain using different flaps. Postsurgical mecanotherapy (physiotherapy) under the surveillance of an experienced physiotherapist is also needed for a complete recovery. CONCLUSIONS: This therapeutical protocol aims to assure a better life quality for the patients, with a faster postsurgical recovery and social reinsertion by reducing the healing time of the areas affected by inflammation and necrosis generated by the neoplastic process.

Epidemiology and pathology of parotid tumors five-year retrospective study.

AIM: To retrospectively analyze the epidemiological, clinical and pathological data of parotid tumors. MATERIAL AND METHODS: Reassessment of the histologic diagnosis of parotid tumor in the patients admitted to the Oral and Maxillofacial Surgery Unit of the Iasi "Sf. Spiridon" University Emergency Hospital during 2009-2013. Data on gender, age, place of residence, location, size, surgical procedure type and histopatological type were recorded. RESULTS: The risk of developing pleomorphic adenonma is 7.40 times higher in women and 4.08 times higher before the age of 50 years. The risk of Warthin tumor is 16.47 times higher in male patients and 3.58 times higher in urban patients. People older than 50 years have a 7.14 times higher risk of developing malignancy and rural people have a 2.41 times higher risk of developing cancer. Diabetes, obesity and systemic hypertension were not important risk factors in our study. CONCLUSIONS: According to this study age and the place of residence could be important predictors for parotid gland tumors. Since in Romania there are few epidemiological data regarding the parotid gland pathology, further cohort studies are needed for a better understanding of their clinical and pathological behavior.

A new approach to aesthetic maxillofacial surgery: surgical treatment of unilateral exophthalmos due to maxillary sinus mucocele.

Maxillary sinus mucocele, known as a rare condition, can cause major therapeutic difficulties, especially when it invades the orbit leading to exophthalmia. Treatment is very difficult because the eye globe has to be repositioned, and the facial symmetry needs to be reconstructed as a result of malar bone invasion. This article reports the case of a 54-year-old patient with unilateral exophthalmia caused by the evolution of a maxillary mucocele that extended toward the orbit after destroying the malar bone and the orbital floor. The treatment consisted of a 1-step restoration of both the orbit floor and the malar bone using a temporomandibular flap composed of 2 bone fragments. Lipostructure and a titanium mesh to reconstruct the calvarial defect were necessary to restore facial aesthetics after placing back the eye globe in its initial site. After surgery, the patient followed a complex rehabilitation program including massage kinesiotherapy and psychological consultation and support. These had an essential contribution to the successful final outcome in terms of psychological impact, functionality, and aesthetics.

Hemangioma of the parotid gland: case report.

Hemangiomas account for half of the parotid gland tumors occurring in children. After a rapid increase in the first months of life, some of them gradually regress (until complete disappearance) in a period of several years. Hemangiomas that do not regress over time, grow in size (possibly within a short period of time) or develop complications such as intralesional acute bleeding or thrombosis require aggressive therapy: intralesional corticosteroid injection, sclerotherapy. radiation therapy, laser photocoagulation. embolization, or surgical removal. We present the case of a 12-year-old boy with hemangioma of the left parotid gland diagnosed by CT scan, angio-CT with 3D reconstruction and angiography successfully treated by superselective intraarterial embolization with acrylic glue followed after 4 days by left superficial parotidectomy with facial nerve preservation.

[The platysma myocutaneous flap (PMF) for reconstruction of defects after extended parotidectomy]. / Lamboul musculocutanat platisma în reconstructia dupa parotidectomia extinsa.

UNLABELLED: In order to reestablish the facial symmetry after the tumor removal, we can use sternocleidomastoid muscle transposition, dermis-fat graft, superficial musculoaponeurotic system (SMAS) plication, temporoparietal fascia flaps, microvascular free flaps and the platysma muscle flap. The technic depends on the size of the defect. MATERIAL AND METHODS: In this study we present our results of using a superiorly based platysma myocutaneous flap for reconstruction of defects after extended parotidectomy. The patients were treated for malign tumor of parotid gland which invaded the skin. RESULTS: All flaps were readily harvested at the time of tumor resection. Only two patients presented venous congestion. No flap was lost. There was no morbidity of donor site. The cosmetic outcome was satisfactory. DISCUSSION: The platysma myocutaneous flap is an alternative to more complex reconstructive technics, such as free flap transfer, and gives a satisfactory cosmetic result. CONCLUSIONS: The platysma myocutaneous flap is easy to harvest and has low donor site morbidity. The main disadvantage is represented by the vascularity problems.

[Cutaneous carcinoma of the face. Clinical and histopathological forms. Retrospective study of 308 cases]. / Carcinoamele cutanate ale fetei--forme clinice si his- topatologice. Un studiu retrospectiv PE 308 cazuri.

UNLABELLED: Cutaneous carcinomas are the most frequent malignant tumors, the majority of them being located on the face, scalp and back. AIM: To assess the clinical presentation and pathology aspects of the patients with face skin carcinomas admitted to our clinic. MATERIAL AND METHODS: The retrospective study was carried out on a series of 308 patients diagnosed and treated for cutaneous carcinoma of the face in the Department of Oral and Facial Surgery of lasi over a period of 5 years (January 2006 - December 2010). The following parameters were analyzed: demographic data, size and location of the tumor, clinical presentation, and pathology aspects. RESULTS: Basal cell carcinoma accounted for 75.97% of the cases, the nodular, superficial and morphea types being the most common. As to the microscopic aspects, the nodular/solid, superficial, and basosquamous (metatypical) types were the most frequent. The squamous-cell carcinoma represented 18.18%, mainly in the ulcero-vegetant and nodular forms. The moderately and well differentiated forms prevailed. Carcinomas of the skin adnexes as well as Merkel cell carcinomas were the most rare (4.22% and 0.65%, respectively). CONCLUSIONS: The face is the most common location of the cutaneous carcinomas requiring early diagnosis and treatment as a key factor to favorable long term outcome.

[Malherbe's calcifying epithelioma--comment on two clinical cases]. / Epiteliom calcificat malherbe--observatii pe marginea a doua cazuri clinice.

Malherbe's calcifying epithelioma (also called trichomatricoma, pilomatrixoma or pilomatricoma) is an uncommon benign cutaneous tumor, which takes the form of a solitary, firm, asymptomatic, slowly growing nodule, developed subcutaneously on the face, neck, or proximal upper extremity. With an incidence of 1/800-1000 cutaneous tumors, pilomatricoma is more common in the first two decades of life, predominantly affecting the women. Multiple locations and associations between this entity and other diseases such as Steinert's myotonic dystrophy or Gardner syndrome have been described in the literature. The clinical diagnosis is often difficult, most cases being mistaken as sebaceous cysts. The treatment of choice is surgical excision. Incomplete surgical excision can be followed by local recurrence because most lesions are poorly defined; therefore, patients should be monitored after surgical excision to prevent this from happening. We present two cases admitted in 2010 and 2011 to the Iasi Department of Oral and Maxillo-Facial Surgery: a 55-year-old female patient with a Malherbe's calcifying epithelioma located in the left temporal region, and a 51-year-old female patient with the same disease but located in the left masseter region.

[The value of 3-dimensional model in the reconstruction of mandibular segment defect. Observations in a clinical case]. / Valoarea modelului tridimensional in reconstructia pierderilor de substanta segmentare ale mandibulei. Observatii pe marginea unui caz clinic.

The use of autogenous bone graft in the reconstruction of mandibular defects following tumor extirpation is a reliable method for further functional rehabilitation. The exact amount of bone needed for harvesting is usually achieved by estimation of the gap and direct measuring. We present the case of a 51-years old patient referred to our clinic for a recurrent mandibular keratocyst. Besides clinical examination, the diagnosis work-up consisted of ortopantomography and computertomography (CT). Based on CT images, a graphic reconstruction of the mandible was realized and a 3D negative template of the scheduled mandibular defect was printed. The tumor was removed by a segmental resection of the mandible, while a fragment of bone tissue similar to the 3D model was harvested from the iliac crest. This bone fragment replaced the mandible defect and was fixed by means of four plates and titanium screws. No postoperative complications occurred. The pathology result confirmed the diagnosis of keratocyst. In conclusion, this method proved to be useful for precise planning of the shape and size of the graft in addition to exact placement of the graft in an acceptable prosthodontically position for future dental implant rehabilitation.

[Generalized gingival enlargement--early clinic manifestation in acute leukemia. Case report]. / Hiperplazia gingivala generalizata-- manifestare clinica precoce în leucemia acuta. Prezentare de caz.

Leukemia is a hematological disorder arises from a hematopoietic stem cell characterized by a disordered differentiation and proliferation of neoplastic cells. Rapidly forming generalized gingival hyperplasia is usually the first sign of this disease (especially in acute forms). This case report describes a 54-year-old female who presented rapid gingival enlargement in only three weeks time, heralding the presence of acute monocytic leukemia (AML-FAB M5). The patient was immediately referred for hematologic management, but died five weeks later. Dentists and generalists should always be on guard to observe any oral manifestations that may lead to the early diagnostic of systemic diseases.

Immunohistochemical and transmission electron microscopy study regarding myofibroblasts in fibroinflammatory epulis and giant cell peripheral granuloma.

Fibroblasts represent the main cellular population in the connective tissue; they have a central role in extracellular matrix (ECM) synthesis, degradation and remodeling. These cells may express a substantial heterogeneity regarding their morphology and functions in pathological conditions and during tissue remodeling. Myofibroblasts are a good example for heterogeneity and phenotypical changes. These cells can be morphologically and immunologically defined by the expression of specific cytoskeleton proteins. Myofibroblasts show cytoplasmic actin microfilaments organized as stress fibers and interconnected by gap or adherens junctions. These cells come also in contact with extracellular matrix by focal contacts. Myofibroblasts play fundamental roles in pathologic conditions, even by activation and proliferation or by deletion. Moreover, these cells seem to be involved in formation and repair of the ECM compounds, proliferation and differentiation of the epithelial, vascular or neurogenic elements. The purpose of the present study is to emphasize the presence and distribution of myofibroblasts in the reactive stromal tissue of granulation tumors in the oral area, fibroinflammatory epulis and giant cells peripheral granuloma, by means of immunocytochemical and transmission electron microscopy studies. Both tumor types shown a common characteristic of the presence of reactive inflammatory stromal tissue and myofibroblasts are a common issue.

Research on serum and saliva concentration of some bivalent cations in patient with suppurations of the oro-maxillo-facial area.

UNLABELLED: Bivalent cations, such as calcium, magnesium, zinc, copper and manganese play important roles in some physiological and pathological processes on the human body. AIM: To determine possible modifications in serum and saliva concentration of total-Ca2+, total-Mg2+, Zn2+ and Cu2+ in patients with suppurative infections of the oro-maxillo-facial area and eventually their significance for the mentioned pathology. MATERIAL AND METHOD: Study included 47 patients with suppurative infections of the oro-maxillo-facial area, hospitalised during 2006-2008 in the oro-maxillo-facial clinic of "Sfântul Spiridon" Hospital Iasi and 43 healthy control volunteers. RESULTS: Results revealed decreased serum Zn2+ (0.94 +/- 0.21 vs. 1.39 +/- 0.14 mg/L, p < 0.01), decreased serum Zn2+/Cu2+ ratio and increased serum and saliva total-Mg2+ concentration (27.34 +/- 2.61 mg/mL in patients vs. 23.83 +/- 1.61 mg/L in healthy controls- serum, p < 0.05 and 3.79 +/- 0.41 mg/mL in patients vs. 3.21 +/- 0.40 mg/mL in healthy controls - saliva, p < 0.05) in patients with suppurative infections of the oro-maxillo-facial area vs. healthy controls. There were no statistically significant differences in total-Ca2+ concentrations in saliva and serum. Our data are in agreement with medical literature revealing zinc deficiency as a predisposition factor to infection. CONCLUSION: We consider that a significant increase in total-Mg2+ saliva concentration, as well as a decrease in Zn2+/Cu2+ serum ratio could be considered a marker for predisposition to oro-maxillar suppurations.