G. Lorenzini

Cervical necrotizing fasciitis of odontogenic origin involving the temporal region – A case report

Necrotizing fasciitis (NF) is a soft-tissue infection, usually polymicrobial, that causes necrosis of fascia and subcutaneous tissue while sparing skin and muscle. We report a case of cervical NF complicating dental infection in a 50-year-old woman, who presented with infection involving mucosa of the right mandible and temporal muscle, and masticator spaces, requiring extensive surgery and antibiotic therapy. Prompt diagnosis and immediate aggressive surgical debridement of all compromised tissues are critical to reducing morbidity and mortality in these rapidly progressive infections.

Absence of lymphatic vessels in human dental pulp: a morphological study

Few and controversial data are available in the literature regarding the presence of lymphatic vessels in the human dental pulp. The present study was designed to examine morphologically the existence of a lymph drainage system in human dental pulp. Human dental pulp and skin sections were immunohistochemically stained with specific antibodies for lymphatic endothelium (D2-40, LYVE-1, VEGFR-3 [vascular endothelial growth factor receptor-3], and Prox-1), with the pan-endothelial markers CD31 and von Willebrand factor (vWF), and with the blood-specific marker CD34. Several blood vessels were identified in human pulps and skin. Lymphatic vessels were found in all human skin samples but in none of the pulps examined. Western blotting performed on human dermis and on pulps treated with collagenase (to remove odontoblasts) confirmed these results. Transmission electron microscopy indicated that vessels which, by light microscopy, appeared to be initial lymphatic vessels had no anchoring filaments or discontinuous basement membrane, both of which are typical ultrastructural characteristics of lymphatic vessels. These results suggest that under normal conditions human dental pulp does not contain true lymphatic vessels. The various theories about dental pulp interstitial fluid circulation should be revised accordingly.

Gingival Leiomyosarcoma in a Young Woman: Case report and literature review

Leiomyosarcoma (LMS) is a rare mesenchymal malignancy, of which 3-10% of cases occur in the head and neck region. We report a 22-year-old woman who was referred to the University Hospital of Siena, Italy, in 2016 with an ostensibly benign asymptomatic lump on the mandibular gingiva. The lesion grew rapidly, causing otalgia in the right ear. An excisional biopsy was performed and primary LMS was diagnosed histologically. Subsequently, the patient underwent radical re-excision of the perilesional mucosa, a partial bone resection and the extraction of four teeth. No recurrences or metastases were detectable at a 20-month follow-up. This report discusses the differential diagnosis of LMS with regards to other benign and malignant lesions and reviews the recent literature on primary and secondary oral LMS. Due to its innocuous clinical features-including its asymptomatic nature and presentation at a young age-this aggressive malignancy can go undetected; therefore, an early histopathological diagnosis is crucial.

L’attività antimicrobica dei fitoterapici in odontoiatria

Riassunto Obiettivi L’obiettivo dello studio e fornire un quadro delle diverse applicazioni terapeutiche antimicrobiche che i fitoterapici possono avere in campo odontoiatrico, nonche degli effetti collaterali che alcune terapie a base di erbe possono indurre a livello del cavo orale. Materiali e metodi E stata condotta un’attenta revisione della letteratura scientifica internazionale a partire dal 1995 in PubMed, Embase e Scopus mediante l’utilizzo di appropriate parole chiave. Risultati e conclusioni Gli studi esaminati hanno mostrato importanti proprieta medicinali delle piante per uso odontoiatrico. Ulteriori ricerche sono pero necessarie per valutare meglio l’efficacia clinica dei fitoterapici (trial clinici, studi prospettici), la tossicita, gli effetti collaterali, le interazioni con altre categorie di farmaci, al fine di possedere basi scientifiche sempre piu valide.