Andrea Fior

Comparative effect of tacrolimus 0.1% ointment and clobetasol 0.05% ointment in patients with oral lichen planus.

BACKGROUND Oral lichen planus (OLP) is considered to be an autoimmune disease of unknown aetiology that affects the mucosae, especially the oral cavity. OBJECTIVE We compared tacrolimus 0.1% ointment and clobetasol 0.05% ointment for the treatment of OLP. PATIENTS AND METHODS A total of 32 patients (20 females and 12 males; all white, Italian origin, mean age of 43.6+/-18.4 years; 16 patients per treatment group) were treated with tacrolimus or clobetasol ointment for 4 weeks in a randomized, double-blind, clinical trial. Pain severity, burning sensation, and mucosal lesion extension were assessed using a four-point scale. RESULTS At the end of the treatment period, symptom scores were significantly lower in the tacrolimus group than in the clobetasol group. CONCLUSION The results of this study suggest that tacrolimus 0.1% ointment is more effective than clobetasol propionate 0.05% ointment in the treatment of OLP. However, other studies are needed to confirm the effectiveness of this treatment before it can be recommended for use in clinical practice.

Mandibular reconstruction using fresh frozen bone allograft after conservative enucleation of a mandibular odontogenic myxoma.

Abstract The purpose of this article was to report the clinical, radiographic, and histological findings about a case of a young woman affected by a mandibular odontogenic myxoma. Conservative tumor resection was followed by immediate reconstructive treatment using fresh-frozen human bone graft, instead of autologous bone graft, as material for bone regeneration. Odontogenic myxoma, according to the World Health Organization, is classified as a benign tumor of mesenchymal origin whether or not containing odontogenic epithelium. Radiological and histological examination of the lesion confirmed the presence of an odontogenic myxoma, which was 21.2 mm high and 47.6 mm long; the lesion underwent biopsy evaluation before enucleation. According to literature and with the aim of a patient free of disease, conservative enucleation of the lesion was performed. The residual bone defect was filled with fresh-frozen bone allograft. At 6 months after surgery, no evidence of major complications was observed; the computed tomography scan revealed effective bone regeneration through the grafted area. The use of fresh-frozen bone allograft, thanks to its osteoinductive and osteoconductive properties, may represent an optional choice for reconstruction of bone defects after jaw tumor removal.

Primary non-Hodgkin's lymphoma of the jaws: immunohistochemical and genetic review of 10 cases.

PURPOSE Non-Hodgkins lymphoma (NHL) comprises a group of malignant lymphoproliferative diseases characterized by clonal expansion of lymphocytes at various levels of ontogenetic development. The aim of this study was to review the immunohistochemical and cytogenetic features of 10 cases of NLH of the jaws to determine their respective derivation. PATIENTS AND METHODS Histopathologic and immunohistochemical review of 10 cases of large-cell lymphomas of the jaws, together with Southern blot analysis of 2 of the cases, was performed and results compared with the findings in the literature. RESULTS In the 10 cases studied, the average age of onset of the NHL was 51 years, with a male-to-female ratio of 3:2. Tumefaction was the first clinical sign of disease. Eight of 10 cases were high-grade, large-cell NHLs, centroblastic type. Two cases were high-grade, large-cell NHL, immunoblastic type. CONCLUSION The immunohistochemical and Southern blot data remain the principal laboratory aids in the diagnosis and characterization of NHL, and they provide critical information for guiding clinicians to the appropriate treatment protocol for these malignancies.

Metastatic Basosquamous Carcinoma: Report of Two Cases and Clinicopathological Considerations.

Basosquamous carcinoma is a rare cutaneous tumor considered by some authors as an aggressive type of basal cell carcinoma having a propensity for local recurrence and a potential risk for regional and distant metastatic spread. Herein we present 2 cases of basosquamous carcinoma of head and neck region, with metastatic spread to parotid gland (case 1) and to cervical nodes (case 2). Both patients had recurrence 2 years after initial treatment of the primary lesion (first patient: surgery; second patient: radiotherapy) and at the same time developed regional metastases. We conclude that basosquamous carcinoma must be considered as an aggressive variant of basal cell carcinoma having a great propensity to metastasize even at an early tumor stage. The clinical features, the morphologic aspects, and the treatment of this rare entity are discussed in this article.

Le Fort I osteotomy to correct malocclusion after reconstruction of the maxilla with the free fibula flap.

Malocclusion and facial asymmetry may follow microsurgical jawbone reconstruction. We describe the use of a Le Fort I osteotomy to correct malocclusion after fibula flap reconstruction of the maxilla. A 49-year-old patient with an extremely atrophied maxilla underwent alveolar crest augmentation by free fibula transfer. Bone healing was uneventful, but gross asymmetry of the reconstructed maxilla was apparent 3 months after surgery, with canting of the alveolar bone on the right side and residual skeletal discrepancy in the sagittal plane. A Le Fort I osteotomy was planned to correct malocclusion 6 months after fibula transfer. The maxilla was moved downward and forward and impacted in the right molar region. There were no postoperative complications. Solid bone union was achieved between the mobilized maxilla and the buttresses 3 months after surgery. At that time, osteointegrated implants were inserted, and an implant-supported prosthesis was completed. Neither bone resorption nor implant failure was encountered after 12 months of masticatory loading. Surgical correction of malocclusion after maxillary bone augmentation with the fibula flap is possible. Le Fort I osteotomy represents a reasonable option after microvascular alveolar bone reconstruction of the maxilla, when additional movements are required to restore facial symmetry and occlusion.

Reconstruction of full-thickness cheek defect with a folded cervico-pectoral cutaneous flap following ablation of advanced oral cancer in elderly patient

BackgroundReconstruction of full-thickness cheek defects involving both the oral lining and the external facial skin following ablative surgery remains a difficult task. Free flap reconstruction is the main modality of treatment, but sometimes there is a reluctance to use it in elderly patients with several comorbidities for an increased risk of non-cancer-related cause of death.MethodsThis article describes a folded cervico-pectoral fasciocutaneous flap that has been used to reconstruct a full-thickness cheek defect in elderly patients. Moreover, surgical technique and aesthetic results 2 years after surgery are discussed in this article.ResultsCurrently, after 2 years, the patient is free of disease and enjoys good health.ConclusionsIn conclusion, folded cervico-pectoral fasciocutaneous flap is a fast and practical technique for reconstructing full-thickness cheek defects after tumor excision. The flap was straightforward to perform and reliable in both blood supply and cosmetic outcome, and it provides a good alternative to free flaps for cheek and upper neck reconstruction of elderly patients.Level of Evidence: Level V, therapeutic study.

Secondary Correction of Facial Deformities Following Major Resection and Reconstruction: Fat Stem Cell for Restoration of Facial Asymmetries

Autologous fat grafting is a reconstructive and cosmetic procedure used to restore form and function in many areas of the body. It can restore the natural tissue volume and fill up soft tissue defects by sequential injection of lipoaspirate, using dedicated instrumentation. The authors discuss fat retrieval and volume restoration and regenerative potential of fat grafting in the face. Patient selection, donor site selection, time schedule, and surgical technique are described. Five representative cases are presented to show the results.

Microsurgical reconstruction of the mandible in a patient with evans syndrome: a case report and review of the literature.

In this report, we describe the first successful case of microvascular free tissue transfer in a patient with Evans Syndrome (ES), a rare form of idiopathic thrombocytopenic purpura (ITP) and associated autoimmune hemolytic anemia (AIHA). Microvascular surgery in the setting of ES is likely to have higher complication rates because of the increased risk of postoperative bleeding and free flap thrombosis. The case presented here opens up to the feasibility of microvascular reconstruction of patients with coagulation disorders like ES. Every effort should be made to control for hemolytic, thrombocytopenic, and thrombophilic states associated with ES. In the absence of evidence-based treatment guidelines for ES, personalized treatment protocols with high-dose corticosteroids, immunoglobulin, and postoperative anticoagulation regimen are highly recommended.