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Background: Zinc L-carnosine promotes the transition from the inflammatory to the proliferative phase of wound healing by reducing the expression of pro-inflammatory signals and enhancing the expression of anti-inflammatory signals. This prospective cohort study aims to test the effect of a zinc–L-carnosine mouthwash in promoting oral surgical wound healing. Methods: From October 2022 to February 2023, the authors enrolled healthy adult volunteers who needed the extraction of bilateral molars at the Unit of Dentistry of the University of Bari. The authors studied the baseline wound healing of each patient after the first extraction. Three months later, the patients underwent the second extraction and rinsed their mouths with zinc–L-carnosine mouthwash twice per day for the following 28 postoperative days. For a month after each extraction, the patients received weekly follow-up visits by an oral surgeon blinded about the study to record the modified healing index score of the wounds (range 0–6 points). For statistical analysis, we used the one-tailed t-test for paired samples with a significance level set at p < 0.05 to compare the baseline scores with those recorded during the exposure to the zinc–L-carnosine mouthwash. Results: The authors enrolled four women and six men (mean age = 44.60 ± 19.22 years). On the seventh and fourteenth postoperative days, the mean difference between the modified healing index scores obtained by using the zinc–L-carnosine mouthwash and the baseline was not significant. On the twenty-first postoperative day, the mean score obtained by using the mouthwash was 5.2 ± 1.3 points and was significantly higher than the 4.7 ± 1.8 points of the baseline (p = 0.026). On the twenty-eighth postoperative day, the mean difference was significant as well (5.9 ± 0.3 points and 5.4 ± 1.1 points, respectively). Conclusion: The preliminary results of this study showed that the zinc–L-carnosine mouthwash improved the quality of oral surgical wound healing. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing surgery and general anesthesia often experience anxiety, fear and stress, with negative bodily responses. These may be managed by the pre-procedural application of anxiolytic, analgesic, and anesthetic drugs that have, however, potential risks or side effects. Music therapy (MT) can be used as a complementary no-drug intervention alongside standard surgical care before, during and after medical procedures. The aim of this study was to evaluate the effects of preoperative MT intervention compared to premedication with midazolam on levels of anxiety, sedation and stress during general anesthesia for elective stomatology surgery. Methods: A two-arm randomized and controlled single-center, parallel-group, pre–post event study was conducted. In total, 70 patients affected by stage I or II (both clinically and instrumentally N0) micro-invasive oral cancer and undergoing elective surgery under general anesthesia were assigned to the control group (CG) or to the music therapy group (MTG). MTG patients received preoperative music therapy intervention (MT) from a certified music therapist before surgery, while the CG patients did not receive MT but instead received premedication with intravenous midazolam, 0.02 mg/kg. Anesthesia was the same in both groups. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were recorded at the entrance to the operating room, just before the induction of anesthesia and every 5 min until the end of surgery. An anxiety visual analogues scale (A-VAS) was used to evaluate the level of anxiety. The bispectral index (BIS) monitor was used to measure the depth of sedation just before and 10 min after both music intervention and midazolam administration. Stress response was assessed 5 min before and 20 min after surgery via the control of plasma prolactin (PRL), growth hormone (GH), and cortisol levels. The patient global impression of satisfaction (PGIS) was tested 1 h after surgery. Participants in the MTG were asked to answer 3 questions concerning their experience with MT. Results: No statistical differences among the PRL, GH and cortisol levels between the two groups were registered before and after the treatment, as well as for PAS, PAD and HR. Significant differences in the A-VAS scores between the MTG and CG (p < 0.01) was observed. Compared to the CG, MTG patients had a statistically significantly lower BIS score (p = 0.02) before induction. A PGIS score of 86.7% revealed that patients in the MTG were very satisfied, versus 80% in the CG (p < 0.05). Conclusion: Preoperative music therapy could be an alternative to intravenous midazolam when aiming to promote a preoperative and post-operative state of anxiolysis and sedation in stomatology surgery, even if no differences were found in terms of the surgery-related stress response according to physiological and hormonal determinations. [ABSTRACT FROM AUTHOR]

Background: This study describes the management protocol for capillary-venous malformations in pediatric patients and reports the epidemiology of diagnosed and treated cases at the Unit of Odontostomatology of the Aldo Moro University of Bari from 2014 to 2022. Methods: The authors classified the intraoral and perioral capillary-venous malformations by superficial diameter (<1 cm, 1–3 cm, >3 cm) and ultrasonographical depth extension (≤5 mm, >5 mm). All patients underwent pulsed-mode diode laser transmucosal photocoagulation (8–12 W/cm2); those with malformations that were wide (>3 cm) and deep (>5 mm) received intralesional photocoagulation, too (13 W/cm2). The children received general anesthesia based on their compliance and lesions' extension. The follow-up lasted six months. Results: A total of 22 females and 14 males (age range 4–18 years) presented 63 capillary-venous malformations. Five patients with Sturge–Weber syndrome, seven with hereditary hemorrhagic telangiectasia, and five with angiomatosis showed multiple malformations. The authors found no intraoperative or postoperative complications. Seventeen patients with lesions >1 cm and >5 mm deep required multiple laser sessions to heal. Conclusion: The results of the current study support diode laser photocoagulation as the gold standard for the treatment of intraoral and perioral capillary-venous malformations in pediatric patients. [ABSTRACT FROM AUTHOR]

Gardner's syndrome (GS) is a combination of polyposis, osteomas, fibromas, and sebaceous cysts. The aim of the study is to highlight whether maxillofacial osteoma could represent an early detection symptom of GS. Patients with suspected osteoma of the jaw underwent genetic and radiographical examinations. The database gathered 19 patients with oral osteoma that was histologically diagnosed; the whole sample was positive for APC gene mutation. Other cranial and peripheral locations were reported. Osteoma of the jaw is a crucial predictive factor of GS, and dentists and oral and maxillofacial surgeons must be aware of the importance of a timely diagnosis. [ABSTRACT FROM AUTHOR]

Metastases from lung cancer to the oral cavity and to the head and neck generally are very infrequent and usually manifest in advanced stages of the disease. Even more rarely, they are the first sign of an unknown metastatic disease. Nevertheless, their occurrence always represents a challenging situation both for clinicians, in the management of very unusual lesions, and for pathologists, in the recognition of the primary site. We retrospectively studied 21 cases of metastases to the head and neck from lung cancer (sixteen males and five females, age range 43–80 years; eight cases localized to the gingiva [two of these to the peri-implant gingiva], seven to the sub-mandibular lymph nodes, two to the mandible, three to the tongue, one case to the parotid gland; in eight patients, metastasis was the first clinical manifestation of an occult lung cancer) and proposed a wide immunohistochemical panel for a proper identification of the primary tumor histotype, including CK5/6, CK8/18, CK7, CK20, p40, p63, TTF-1, CDX2, Chromogranin A, Synaptophysin, GATA-3, Estrogen Receptors, PAX8, PSA. Furthermore, we collected data from previously published studies and narratively reviewed the relevant literature. [ABSTRACT FROM AUTHOR]

(1) Background: The aim of this study was to compare the histopathological features of syndromic and non-syndromic odontogenic keratocysts (OKs) using conventional and Confocal Laser Scanning Microscopy (CLSM) with their biological behaviour. (2) Methods: Data from the medical records of 113 patients with histological diagnosis of (single and/or multiple) OKs were collected. Globally, 213 OKs (120 syndromic and 93 sporadic) were retrieved, and their histological slides were re-evaluated with conventional H&E staining and with autofluorescence on the same slides using CLSM (Nikon Eclipse E600 microscope). (3) Results: Syndromic OKs showed more satellite cysts than sporadic cases, as well as a basophilic layer in the basement membrane, which was absent in sporadic OKs; both were highlighted with CLSM. The basement membrane in syndromic OKs appeared amorphous and fragile, thus possibly being responsible for the epithelial detachment and collapse, with scalloped features. Furthermore, the basal epithelial layers in such cases also showed increased cellularity and proliferative activity. All these histological features may possibly justify their higher tendency to recur. (4) Conclusions: CLSM is useful advanced technology that could help to quickly and easily discriminate between syndromic and non-syndromic OKs and to more accurately predict their biological behaviour in order to set fitter clinico-radiological follow-ups for individual patients. [ABSTRACT FROM AUTHOR]

Aims: Langerhans Cell Histiocytosis is a rare hematologic disorder usually affecting children and most commonly involving the head and neck region. Primary oro-facial manifestations are rare, and their diagnosis is often challenging as they are numerous and often resemble common pathologies, refractory to conventional medical and/or instrumental treatments. For such reasons, the diagnosis is frequently delayed, as is the following staging and therapy onset. We retrospectively studied 45 pediatric patients affected by Langerhans Cell Histiocytosis with onset in the head and neck, to examine their clinical and radiological features at the early stage. Materials and Methods: The study was a retrospective bi-institutional analysis (Department of Pediatric Dentistry and Pediatric Oncology of "Sapienza" University of Rome, Department of Interdisciplinary Medicine of the University of Bari "Aldo Moro"), which enrolled 45 patients (age range 0-18 year-old) affected by Langerhans Cell Histiocytosis with oro-facial onset. Data regarding clinical appearance, number, site, synchronous or metachronous occurrence, involved tissues/organs, radiographic features and clinical outcomes were collected, listed and overall differentiated by two age ranges (0-10-year-olds and 10-18-year-olds). Results: Patients were 26 males and 19 females, with an average age at the time of diagnosis of 4.8 3.8 years (median = 3.9 years). The most common findings were inflamed, hyperplastic, painful and often ulcerated gingival lesions (22 cases), associated with deciduous tooth mobility and/or dislocation with bone loss in 18 cases, followed by nine single eosinophilic granulomas of the mandible and two of the maxilla. Lesions of the palatal mucosa were observed in six patients; nine patients showed on radiograms the characteristic "floating teeth" appearance in the mandible with synchronous lesions of the maxilla in six. Paresthesia was relatively un-frequent (three cases) and the pathological fracture of the mandible occurred in six. Head/neck lymph nodes involvement was associated with oral lesions in 12 cases and skull lesions in 14. Otitis (media or externa) was detected in four instances, exophthalmia in two, cutaneous rush in nine, contextual presence or subsequent onset of insipidus diabetes in eight. As for therapy, single or multiple small jaw lesions were all surgically removed; chemotherapy with vinblastine alone or associated with corticosteroids was the principal treatment in almost the 80% of cases; more than 50% of patients received corticosteroids, while only three patients received adjunctive radiotherapy. The overall mortality account for less than 9% (four of 45 cases) and recurrence observed in eight patients after therapy. Conclusions: Langerhans Cell Histiocytosis may mimic several oro-facial inflammatory and neoplastic diseases. Considering the potential disabling sequela following head and neck localization of Langerhans Cell Histiocytosis in children, especially at the periodontal tissues with teeth and alveolar bone loss, lesion recognition along with the histological examination of suspicious tissues is mandatory to achieve an early diagnosis and to prevent further organ involvement. [ABSTRACT FROM AUTHOR]

Featured Application: Authors are encouraged to provide a concise description of the specific application or a potential application of the work. This section is not mandatory. Reduction of the wound healing time after surgical procedures along with good hemostasis, and the reduction of post-surgical edema, pain and infective complications are generally desirable to both clinicians and patients. Recently, a gel compound containing sodium hyaluronate and four synthetic aminoacids (glycine, leucine, proline, lysine) and marketed as Aminogam® (Errekappa Euroterapici, Italy), has been proposed as a medical device promoting faster wound healing after oral surgery procedures. To assess its achievable clinical benefits, we studied retrospectively 580 cases (290 study cases and 290 control cases) undergoing oral surgery and receiving Aminogam ® gel application. More precisely, cases were divided into 7 groups on the bases of the kind of surgery (teeth extraction, oral surgery in patients taking bisphosphonates, surgical treatment of jaw osteonecrosis related to bisphosphonates therapy, placement of endosseous implants, diode laser surgery of oral mucosa lesions with second intention healing without stitches, diode laser photocoagulation of slow flow vascular malformations and bone surgery). In all instances, Aminogam® gel was applied at least five times a day until the wound healed completely. We compared the elapsed time between surgery and complete healing with Aminogam® application compared to control cases receiving no other drug treatment. Our results confirmed that the overall time of healing is certainly reduced in cases receiving Aminogam® gel regardless of the kind of oral surgery. [ABSTRACT FROM AUTHOR]

The aim of this study is to report on the oral lesions detected in 123 patients diagnosed at the University Hospital of Bari from October 2020 to December 2020, focusing on the correlation of clinical and pathological features in order to purpose a new classification. Methods. General and specialistic anamnesis were achieved and oral examination was performed. The following data were collected: age/gender, general symptoms and form of Covid-19, presence and features of taste disorders, day of appearance of the oral lesions, type and features of oral lesions and day of beginning of therapies. If ulcerative lesions did not heal, biopsy was performed. Results. Many types of oral lesions were found and classified into four groups considering the timing of appearance and the start of the therapies. Early lesions in the initial stages of Covid-19 before the start of therapies was observed in 65.9% of the patients. In the histopathological analysis of four early lesions, thrombosis of small and middle size vessels was always noticed with necrosis of superficial tissues. Conclusion. The presence of oral lesions in early stages of Covid-19 could represent an initial sign of peripheral thrombosis, a warning sign of possible evolution to severe illness. This suggests that anticoagulant therapies should start as soon as possible. [ABSTRACT FROM AUTHOR]

Juvenile nasopharyngeal angiofibroma is a rare vascular neoplasm, mostly occurring in adolescent males, and representing 0.05% of all head and neck tumors. Nevertheless, it is usually recognized as the most common benign mesenchymal neoplasm of the nasopharynx. Usually, it originates from the posterolateral wall of the nasopharynx and, although histologically benign, classically shows a locally aggressive behavior with bone destruction as well as spreading through natural foramina and/or fissures to the nasopharynx, nasal and paranasal cavities, spheno-palatine foramen, infratemporal fossa and, very rarely, to the cranial cavity. Extranasopharyngeal angiofibroma is considered a distinct entity due to older age at presentation, different localizations (outside the nasopharyngeal pterygopalatine fossa) and attenuated clinical course. Extranasopharyngeal angiofibroma has been sporadically described in the oral cavity. We report a case of extranasopharyngeal angiofibroma with primary and exclusive involvement of the adherent gingiva of the anterior maxilla, managed by preoperative diode laser trans-mucosal photocoagulation and subsequent surgical removal. The current literature on primary extranasopharyngeal angiofibroma is also reviewed. [ABSTRACT FROM AUTHOR]

The most recently reported techniques for the rehabilitation of the atrophic posterior maxilla are increasingly less invasive, as they are generally oriented to avoid sinus floor elevation with lateral access. The authors describe a mini-invasive surgical technique for short spiral implant insertion for the prosthetic rehabilitation of the atrophic posterior maxilla, which could be considered a combination of several previously described techniques based on the under-preparation of the implant site to improve fixture primary stability and crestal approach to the sinus floor elevation without heterologous bone graft. Eighty short spiral implants were inserted in the molar area of the maxilla in patients with 4.5–6 mm of alveolar bone, measured on pre-operative computed tomography. The surgical technique involved careful drilling for the preparation of implant sites at differentiated depths, allowing bone dislocation in the apical direction, traumatic crestal sinus membrane elevation, and insertion of an implant (with spiral morphology) longer than pre-operative measurements. Prostheses were all single crowns. In all cases, a spiral implant 2–4 mm longer than the residual bone was placed. Only two implants were lost due to peri-implantitis but subsequently replaced and followed-up. Bone loss values around the implants after three months (at the re-opening) ranged from 0 to 0.6 mm, (median value: 0.1 mm), while after two years, the same values ranged from 0.4 to 1.3 mm (median value: 0.7 mm). Clinical post-operative complications did not occur. After ten years, no implant has been lost. Overall, the described protocol seems to show good results in terms of predictability and patient compliance. [ABSTRACT FROM AUTHOR]

Peripheral giant cell granulomas (PGCG) associated with hyperparathyroidism (HPT) are rare clinical entities. The aim of this study is to report on 21 PGCGs of the oral cavity as the first clinical sign of unknown primary HPT (PHPT) referred to the Complex Operating Unit of Odontostomatology of Aldo Moro University of Bari from 2009 to 2019. Surgical treatment consisted in conservative enucleation of the lesion, if possible, with contextual bone rim osteoplasty with piezosurgical tools and following histological examination. After histological diagnosis of PGCG, PHPT screening was performed dosing parathyroid hormone and serum calcium. In all the patients haematological investigation demonstrated elevated values of parathyroid hormone and serum calcium ruling out an unknown PHPT. Specifically, after endocrinological evaluation, patients showed PHPT related to: parathyroid adenoma (13), parathyroid hyperplasia (two, one of which occurred in a intra-thyroidal parathyroid), and parathyroid carcinoma (1) and were scheduled for surgical treatment. Considering that PGCGs could represent the first clinical sign of an undiagnosed PHPT and the screening of PHPT is a non-invasive and cheap exam, in case of histological diagnosis of a giant cell lesion, both central and peripheral, especially in patients with synchronous or history of methacronous giant cell lesions, parathyroidal screening should be mandatory. [ABSTRACT FROM AUTHOR]

Among all melanomas, the mucosal type is very rare and may occur in the sino-nasal mucosa, vagina, anus and the oral cavity. At variance with melanomas of the skin, no risk factors, such as familiarity, UV-exposure and skin phenotype, have been clearly identified for such neoplasms. Frequently, the diagnosis is delayed and achieved at advanced stages or when metastases have already occurred. The authors report on a case of mucosal melanoma of the oral cavity presenting as a mass of the hard palate in a 50-year old male, and the corresponding diagnostic-therapeutic pathway. [ABSTRACT FROM AUTHOR]

Aims: To report on the clinico-pathological features of a series of 14 intra-oral mucoepidermoid carcinomas showing exclusive intra-cystic growth. Materials and methods: All mucoepidermoid carcinomas diagnosed in the period 1990–2012 were retrieved; the original histological preparations were reviewed to confirm the diagnosis and from selected cases, showing exclusive intra-cystic neoplastic components, additional sections were cut at three subsequent 200 m intervals and stained with Hematoxylin–Eosin, PAS, Mucicarmine and Alcian Blue, to possibly identify tumor invasion of the adjacent tissues, which could have been overlooked in the original histological preparations. Additionally, pertinent findings collected from the clinical charts and follow-up data were analyzed. Results: We identified 14 intraoral mucoepidermoid carcinomas treated by conservative surgery and with a minimum follow up of five years. The neoplasms were located in the hard palate (nine cases), the soft palate (two), the cheek (two) and the retromolar trigone (one). In all instances, histological examination revealed the presence of a single cystic space, containing clusters of columnar, intermediate, epidermoid, clear and mucous-producing cells, the latter exhibiting distinct intra-cytoplasmic mucin production, as confirmed by PAS, Mucicarmine and Alcian Blue stains. The cysts were entirely circumscribed by fibrous connective tissue, and no solid areas or infiltrating tumor cell clusters were detected. Conservative surgical resection was performed in all cases, and no recurrences or nodal metastases were observed during follow up. Conclusions: Mucoepidermoid carcinomas showing prominent (>20%) intra-cystic proliferation currently are considered low-grade tumors. In addition, we also unveil the possibility that mucoepidermoid carcinomas, at least in their early growth phase, may display an exclusive intra-cystic component and might be considered as in situ carcinomas, unable to infiltrate adjacent tissues and metastasize. [ABSTRACT FROM AUTHOR]

Metastases to orofacial tissues are infrequent, their incidence being 1%–8% of malignant oral tumors, sometimes manifesting as the first clinical sign of an occult cancer. Renal cell carcinoma (RCC) is the second most common metastatic carcinoma to the oro-facial tissues, involving the jawbones, gingiva, oral mucosa, tongue or salivary glands. Also, RCC frequently displays a prominent clear cell component, which may predominate in the clear cell renal cell carcinoma subtype (CCRCC) and histologically mimic many other clear cell tumors, both benign and malignant, which can be epithelial (from keratinizing epithelia, cutaneous adnexa, salivary glands and odontogenic epithelium), melanocytic or mesenchymal in origin. In view of the necessity for prompt and accurate diagnosis of such unusual neoplasms, we report on the salient clinico-pathological features of 7 CCRCC metastatic to the oro-facial tissues, and highlight their immunohistochemical profile, to more accurately discriminate this neoplasm from other tumors of the oral cavity with a prominent clear cell component. [ABSTRACT FROM AUTHOR]