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Objective: Hypogonadism is common in HIV-infected men. The relationship between health status, sex steroids and body composition is poorly known in HIV. The aim was to investigate the association between health status (comorbidities/frailty), body composition, and gonadal function in young-to-middle-aged HIV-infected men. Design: Prospective, cross-sectional, observational study. Methods: HIV-infected men aged

Aim: AAA (Alveolar Antral Artery) injuries are the most frequent intra-operative lesions occurring during maxillary sinus surgery. The aim of this work is to evaluate the role of preoperative CBCT and the effectiveness of piezosurgery to prevent bleeding. Furthermore, a modified Lundgren technique is presented, that can significantly reduce the risk of bleeding and of damages to maxillary sinus structures. Methods: A case of maxillary sinus lift with immediate implants placement is reported. Preoperative CBCT scan allowed to study the course in the anterior-lateral sinus wall of the AAA and the variability of its patency. Antrostomy was performed with piezosurgery device. Results: Through preoperative identification of the course of the artery and trough this modified piezosurgery technique, it was possible to preserve membrane and artery integrity. Schneider membrane therefore was detached from the sinus floor, and contextually three implants were positioned. Conclusions: In the preoperative phase, a study with CBCT scan is suggested, in order to identify intraosseous arterial course, patency variability and the distance from alveolar ridge. Furthermore, it is strongly recommended the use of piezosurgery, to preserve vascular structures and soft tissues. A modified Lundgren technique can be useful to avoid the use of round bur and thus reduce the risk of perforation of the underlying structures. Aim AAA (Alveolar Antral Artery) injuries are the most frequent intra-operative lesions occurring during maxillary sinus surgery. The aim of this work is to evaluate the role of preoperative CBCT and the effectiveness of piezosurgery to prevent bleeding. Furthermore, a modified Lundgren technique is presented, that can significantly reduce the risk of bleeding and of damages to maxillary sinus structures.Methods A case of maxillary sinus lift with immediate implants placement is reported. Preoperative CBCT scan allowed to study the course in the anterior-lateral sinus wall of the AAA and the variability of its patency. Antrostomy was performed with piezosurgery device.Results Through preoperative identification of the course of the artery and trough this modified piezosurgery technique, it was possible to preserve membrane and artery integrity. Schneider membrane therefore was detached from the sinus floor, and contextually three implants were positioned.Conclusions In the preoperative phase, a study with CBCT scan is suggested, in order to identify intraosseous arterial course, patency variability and the distance from alveolar ridge. Furthermore, it is strongly recommended the use of piezosurgery, to preserve vascular structures and soft tissues. A modified Lundgren technique can be useful to avoid the use of round bur and thus reduce the risk of perforation of the underlying structures.

Oronasal fistula can occur secondary to various pathologies, but cleft surgery is the most common. The authors propose a pedicled palatal flap technique for surgical repair of small oronasal fistula (0.5-0.8 cm), derived from their experience in the treatment of 7 patients between March 2003 and December 2007. In one case, the fistula was induced by prolonged snorting of cocaine. In the other cases, the fistulas developed after excision of a benign tumor of the palate. For the cocaine-induced fistula, failure of the repair attempt was apparent within 7 days of surgery. In all other cases, complete fistula closure was obtained, and no complications occurred. Oronasal fistula can occur secondary to various pathologies, but cleft surgery is the most common. The authors propose a pedicled palatal flap technique for surgical repair of small oronasal fistula (0.5-0.8 cm), derived from their experience in the treatment of 7 patients between March 2003 and December 2007. In one case, the fistula was induced by prolonged snorting of cocaine. In the other cases, the fistulas developed after excision of a benign tumor of the palate. For the cocaine-induced fistula, failure of the repair attempt was apparent within 7 days of surgery. In all other cases, complete fistula closure was obtained, and no complications occurred.

Background: One possible complication of implant surgery in the posterior maxilla is the displacement of implants into the maxillary sinus. Purpose: To report on clinical and radiological findings and on biological, surgical, and biomechanical considerations in cases of implant displacement. Materials and Methods: This is a retrospective study of 21 patients referred to the Department of Head and Neck Surgery, Second University of Naples, due to implants displaced into the maxillary sinus. Patient, implant, and treatment data were collected, and 1-year follow-up was made. Results: A total of 24 displaced implants were diagnosed and surgically removed through an antrostomy in the lateral sinus wall. Implant displacement occurred after functional loading in only one case; in the remaining cases, displacement occurred either perioperatively or postoperatively prior to loading. Besides the displacement, eight patients suffered from maxillary sinusitis, treated with a Caldwell-Luc operation. Healing was uneventful for all patients, and no sinusitis relapse or late postoperative complication was present at 1-year follow-up. Conclusions: It is reasonable to affirm that the major cause of displacement of implants is related, most of the time, to incorrect treatment planning and/or a poorly performed surgical procedure. When implant displacement occurs, the displaced foreign body has to be removed in order to avoid sinus pathology.

AIM: The aim of this study was to examine the psychological state of 30 patients subjected to corrective orthognathic surgery and their expectations, as well as the influence of an in-depth psychological evaluation on the success of the operation. METHODS: The study was performed by giving 30 patients (12 men, 18 women), affected by dental-skeletal facial abnormalities and treated with orthognathic surgery, a questionnaire with 19 questions aimed at examining their preoperative emotional state (desired esthetic and functional improvements) and postoperative emotional state (expectations after surgery and associated psychological state of anxiety and depression). RESULTS: All patients (100%) expressed a clearly positive reaction to their experience. Approximately 70% of the patients observed an improvement in their masticatory function following surgery and 96.6% an improvement in esthetic appearance. Almost none of the patients (96.6%) experienced difficulty in adapting to a change in appearance, while as a result of the surgery 66.6% experienced an increase in self-esteem and confidence. In addition, the opinion of relatives and friends of the patients was favorable in most cases (76.6%). CONCLUSIONS: In order to enable the patients to face their therapeutic program with greater confidence, a team of orthodontists, surgeons and psychologist observe the patients from the beginning of treatment, having them interact with other patients who have already experienced the same situation and by showing them pre- and postoperative pictures of other patients subjected to orthognathic surgery.

IN PRESS

Sialolithiasis is characterized by the obstruction of salivary gland secretion by a calculus. It is associated with swelling, pain, and infection of the affected gland. More than 80% of all salivary calculi occur in the submandibular gland. One reason for this is the makeup of the saliva in the submandibular gland, which includes a higher mucus content, a greater degree of alkalinity, and greater concentrations of calcium and phosphate salts compared with the saliva of the parotid and sublingual glands. Other factors are that its duct is longer and its saliva flows against gravity. Sialoliths that reach several centimeters in diameter (megaliths, or giant calculi) are rare. Perforation of the floor of the mouth by a giant calculus is extremely rare. We report such a case in a 56-year-old man who presented with a 2-day history of severe pain in the left sublingual area and painful swelling in the left submandibular area. Removal of the stone and the left submandibular gland was performed via an extraoral incision. On gross examination, the sialolith measured 5.6 cm.

Chondroid syringoma is a rare tumor arising from the major and minor salivary glands. The incidence of chondroid syringoma is reported to be0.01% among the primary skin tumors. Eighty percent of the chondroid syringomas are seen in older patients , commonly on head and neck region and mostly on the cheek and nose. The authors report a case discussing the surgical management of a chondroid syringoma and pointing out the importance of including this tumor in the differential diagnosis of small subcutaneous nodules in the head and neck region, in middle-age male patients.

Purpose: To assess vascular endothelial growth factor (VEGF) expression and microvessel density (MVD) by immunohistochemistry and to relate them to the inflammatory status in a sample of radicular cysts. Methods: Specimens of 24 human radicular cysts were examined by immunohistochemistry using antibodies anti-VEGF and anti-CD34 and to evaluate vascular density. Integrity of the epithelium and inflammatory state of the connective tissues were evaluated and related with the immunohistochemical findings. A Spearman correlation test was utilized to compare the means of each parameter. Results: VEGF immunoreactivity was detected in both epithelial and connective tissues of radicular cysts. Stromal cells showed higher levels of VEGF expression when compared to epithelial cells. MVD proved to be related to VEGF expression levels (P

After an extensive review of the literature regarding maxillary sinus lift procedures, the authors report the results of a retrospective study carried out by the Institute of Oral and Maxillofacial Surgery at the Second University of Naples.A group of 9 patients aged between 18 and 50 years old, including two females, were enrolled in this study. At the preliminary evaluation, the sites to be analysed showed a bone height between the residual crest and the sinusal membrane not exceeding 8 mm. All patients responded positively to specific preimplantation requisites. Commercially pure titanium fixtures were used as well as demineralised freeze-dried bovine bone and autologous bone graft from the retromolar region.All patients were followed for at least 15 months and no clinical check-ups were missed during that time. No implant was lost and no cases of spire exposure were reported. Postoperative vertical bone resorption was within normal values.Summers technique and its variations with bone grafts of various kinds represents a valid aid for edentulous maxillary rehabilitation with scarce osseous resources in the postero-superior sectors. It offers a number of advantages compared to the traditional technique using an invasive lateral approach and is more acceptable to patients. However, in spite of this positive experience, the follow-up in the literature still appears to be too short. The authors, are therefore cautious in expressing their absolute preference for Summers technique and stress the need to wait for further long-term results.

To make a clinical evaluation of patients with squamous carcinoma of the oral cavity.The clinical condition of 72 patients with squamous carcinoma of the mouth, hospitalized at the Institute of Oral and Maxillo-Facial Surgery, 2nd University of Naples, Italy, between 1992 and 1996, were examined. The patients were evaluated system by system, staged by TNM-UICC and classified by ASA and by the Karnofsky and Burchenal and the Zubrod et al. Performance status methods.Evaluation by the two methods produced different results. Of the patients examined, 34.5% showed more than one systemic disorder. 51.4% were in ASA classes 3-4.The presence of a disease with poor prognosis associated with advanced neoplastic stage (stages III-IV; 69.4% of the total) precluded radical surgery in 32% of patients, who were treated with chemotherapy and/or radiotherapy.