The salivary gland disease section provides for the reader descriptions of and commentary on landmark papers covering the topics of salivary gland disease. It covers calculi, including minimally invasive options for patients with obstructive salivary gland disease; extracorporeal shockwave lithotripsy (ESWL), retrieval by basket or microforceps, and gland-preserving surgery; parotid gland anatomy, including the role of the buccinator muscle in salivary secretion; IgG4-related disease, including hallmarks of the disease, for example, tissue infiltration by IgG4-secreting plasma cells and lymphocytes resulting in tissue destruction, organ failure, and death in a small number of cases; it then looks at extracapsular dissection, as well as salivary gland malignancy.

BACKGROUND:Myofibromas (MF) are rare benign tumors primarily affecting the head and neck region, with maxillary involvement being uncommon, especially in pediatric patients. Traditional management typically involves aggressive resection. This report presents a conservative approach utilizing 3D-based technologies for treating Myofibromas affecting the maxilla and hard palate. Case presentation: A 13-year-old male with a Myofibroma of the hard palate confirmed by incisional biopsy was managed conservatively through 3D imaging, segmentation, 3D printing, local excision, and a custom-fabricated wafer to support tissue growth and rehabilitation. RESULTS:Secondary healing of the surgical area proceeded smoothly with minimal morbidity. Clinical and radiological findings at follow-ups showed soft and hard tissue rehabilitation. The patient is currently undergoing routine follow-ups and exhibits excellent healing with no signs of recurrence. CONCLUSIONS:Our case highlights the significance of conservative management in minimizing tissue resection and postoperative complications. It also emphasizes the necessity of 3D-based treatment planning for precise treatment planning and fabrication of patient-specific devices. This novel approach provides a promising alternative for managing aggressive maxillary Myofibroma in young patients.

Current trends in the management of sialolithiasis include a proper diagnosis with the help of a differential diagnosis. Cone beam computed tomography may be a good choice for detecting sialoliths because it is more sensitive than sonography. A practitioner should collect precise information about the stone in question, which includes the exact location of the calculus, its size and volume, and the number of calculi in a given case. For submandibular calculi, the orientation of the stone's location against the gonion and the inferior edge of the mandible creates the system of coordinates almost in a geographical fashion. The next step is management planning, and a proper surgical approach may be selected from a comprehensive list of available techniques. If the sialoendoscopic removal of calculi via ducts is impossible, endoscopy-assisted, ultrasound (US)-guided, or unassisted intraoral surgery, extracorporeal shock-wave lithotripsy (ESWL), a combination of the ESWL with the sialoendoscopy, and endoscopy-assisted ductal stretching procedure are our options. Measures must be taken to avoid or minimise postsurgical complications. The development of our knowledge, skills, diagnostic arsenal, and surgical approaches to sialolithiasis cases over the last hundred years is impressive. However, there is still room for further improvement. Some problems in diagnostics, calculus assessment, and surgical approaches require additional research.

Background: The voltage-dependent anion channel 1 protein (VDAC1) plays a role in cellular metabolism and survival. It was found to be down or upregulated (overexpressed) in different malignancies but it was never studied in application to oral lesions. The purpose of this study was to retrospectively evaluate the expression of VDAC1 in biopsies of oral premalignant, malignant, and malignancy-neutral lesions and to examine the possible correlations to their clinicopathological parameters. Materials and methods: 103 biopsies including 49 oral squamous cell carcinoma, 33 epithelial dysplasia, and 21 fibrous hyperplasia samples were immunohistochemically stained with anti-VDAC1 antibodies for semi-quantitative evaluation. The antibody detection was performed with 3,3′-diaminobenzidine (DAB). The clinicopathological information was examined for possible correlations with VDAC1. Results: VDAC1 expression was lower in oral squamous cell carcinoma 0.63 ± 0.40 and in oral epithelial dysplasia 0.61 ± 0.36 biopsies compared to fibrous hyperplasia biopsies 1.45 ± 0.28 (p < 0.01 for both; Kruskal–Wallis test). Conclusion: Oral squamous cell carcinoma and epithelial dysplasia tissues demonstrated decreased VDAC1 protein expression if compared to fibrous hyperplasia samples, but were not different from each other, suggesting that the involvement of VDAC1 in oral carcinogenesis is an early stage event, regulating cells to live or die.

We aimed to collect and analyze available cases of intraoral acantholytic squamous cell carcinoma (aSCC), that consisted of the authors’ cases and cases derived from the existing literature, with an emphasis on the pathological staging and patient outcome. Our research question was whether aSCC is more aggressive than conventional SCC. The literature was searched for documented cases of aSCC involving the intra-oral mucosa, excluding those from the lips and tonsils, and seven new cases were added from our files. The authors compared the obtained aSCC data to existing data for conventional SCC. Fisher Exact or Pearson’s χ2 tests were used for categorical variables. Fifty-five cases of intraoral aSCC were reviewed, of which 48 were retrieved from the literature. Analysis of the published cases was reinforced by contacting the authors of all the papers with incomplete data for further clarifications. The most common sites of aSCC were the tongue (24/55) and the maxilla/maxillary gingiva and/or palate (11/55). The overall survival rate was 36/53 (67.9%) with a mean follow-up period of 22 months against 62.5% for conventional SCC (p = 0.6). No statistically significant difference between the two variants of the tumor with respect to the oral cavity was detected. The differences in age, sex, survival rate, staging, and locations were not statistically significant. Based on the available data from 55 cases, there is no evidence to suggest that aSCC is more aggressive than conventional SCC in intraoral cases.

ABSTRACT:Orbital fractures account for up to 40% of craniofacial injuries. In this article, the authors present the transoral endoscopy-assisted plating technique for treating orbital blowout fractures (OBF). A retrospective analysis of 56 cases treated with transoral endoscopy-assisted approach was performed. Immediate versus delayed surgery decision-making was performed by using our 2-week algorithm. The surgical technique included only transoral incisions, forced duction and "pulse" tests, osteotomy, endoscopic inspections, the reduction with a curved elevator and an indwelling balloon, the retrieval of prolapsed fatty tissue back into the orbit, removal of sharp bony fragments, adaptation of the titanium mesh to the orbital floor and its fixation with screws to stable bony structures, reattachment of the osteotomized lateral wall, and postoperative computed tomography (CT) scan with 3D CT reconstruction. The overall success rate of surgeries was 96%. The resolution of comorbidities resulted in a normal globe position, normal eye movement, and the resolution of diplopia. Postoperative complications were insignificant with one case of surgical edema and one case of infection and sequestration that appeared six months after surgery. These results remained unchanged after 20 to 24 months of follow-up. The suggested minimally invasive transoral technique can be effectively implemented in cases of OBF as well as in cases when the medial wall of the orbit is involved. Our results presented a high success rate with minimal rate of complications, thus our technique is a safe way with minimal morbidity for treating OBF.

Sodium hypochlorite (NaOCl) is the most common irrigant used in modern endodontics due to the antimicrobial properties against bacteria, the powerful oxidative activity, and the ability to dissolve organic soft tissues. When NaOCl extrudes the apex of the root, commonly referred as "sodium hypochlorite accident," it can lead to devastating outcomes leading to long-term functional and esthetic deficits. Currently, no clear guidelines exist as to how these patients should be managed. The purpose of this paper is to present a case report and a review of literature and to propose an adequate surgical treatment protocol for this unfortunate event.

Objetivos: Los objetivos fueron evaluar el resultado de un aumento del suelo sinusal sin injerto asociado a la colocacion de un implante dental, realizado con un sistema de implantes que posee un puerto interno con tornillo en combinacion con la tecnica de osteotomo. Materiales y metodos: Entre 2012 y 2018, se colocaron 722 implantes de titanio-aluminio-vanadio (Ti-6Al-4V ELI, diametro 3,75/4,20 mm) en 331 pacientes. Los implantes de 11,5 mm de longitud se colocaron en maxilares con un nivel oseo ≤ 5 mm, mientras que los implantes de 13,0 mm se colocaron en maxilares con un nivel oseo > 5 a 8 mm. En ninguno de los casos, se utilizaron materiales de injerto o sustitutos oseos para la elevacion del seno. La situacion de los implantes se evaluo en tres centros diferentes, y el periodo de seguimiento oscilo entre 6 meses y 7 anos. Resultados: En total, se colocaron 412 implantes de 11,5 mm de longitud y 310 implantes de 13 mm de longitud. La implantacion fue satisfactoria en 689 implantes (95,4%), conforme a la tomografia computarizada de haz conico y la evaluacion clinica, asi como a la experiencia de los pacientes. No se observaron diferencias estadisticamente significativas entre los implantes de 11,5 mm y de 13,0 mm. Las tasas de complicaciones fueron comparables entre los casos con niveles oseos de 3 a 5 mm y de > 5 a 8 mm. Conclusiones: El sistema implantarlo con puerto y tornillo puede permitir un aumento sinusal maxilar sin necesidad de injertos o sustitutos oseos. De este modo, una intervencion quirurgica de cierta envergadura, como un procedimiento de aumento sinusal, puede simplificarse a un procedimiento menos invasivo. Ademas, se reduce potencialmente el riesgo de complicaciones.

Aim: Inflammatory myofibroblastic tumors (IMTs) are uncommon neoplasms of intermediate biologic behavior that typically present in the lungs of children and young adults but may occur elsewhere in the body. The head and neck is an unusual site of involvement and in the jaws these are even less common. The purpose of this study is to present a central IMT arising within the mandibular bone of a seven year old female and to analyze the available literature of intrabony/central IMTs of the jaws.

Background Sonoelastography (SEG) is a non-invasive, relatively new imaging modality that maps the elastic properties through stiffness of soft tissue. Pathological conditions such as inflammation and neoplasia can change tissue elasticity; as a result, when used in the major salivary glands, this non-invasive modality may provide information that could be useful for diagnosis. Objective Two preliminary studies are presented; both assess the diagnostic utility of SEG: the first in primary Sjogren's syndrome (pSS) and the second concerns major salivary gland tumors. Methods and materials The first study included fifteen patients with pSS that underwent SEG of the major salivary glands before starting pilocarpine treatment versus diffused sialadenitis and normal glands. The second study included nineteen benign and malignant tumors, just before ultrasound-guided needle aspiration for cytology and excisional biopsy. Quantitative indices of the shear elastic modulus were compared with cytological and histopathological results. Elastography was scored on color-scaled elastograms. Results Mean elasticity/stiffness values for pSS were not significantly different from those of diffused sialadenitis and normal salivary gland tissue. As for salivary gland tumors, scores showed clustering according to pathological condition. For example, pleomorphic adenomas were firmer than Warthin's and adenoid cystic carcinoma was firmer than polymorphus adenocarcinoma. Conclusions SEG did not show a diagnostic advantage in regard to the assessment of pSS. Nevertheless, it might serve as a tool in the evaluation of benign and malignant major salivary glands tumors. Our studies should be continued to confirm these preliminary observations.

OBJECTIVE:The objective was to assess the outcome of graftless sinus floor augmentation associated with dental implant placement performed with an implant system that has an internal port and screw, combined with the osteotome technique.METHOD AND MATERIALS:Between 2012 and 2018, 722 titanium-aluminum-vanadium implants (Ti-6Al-4V ELI, diameter 3.75/4.20 mm) were placed in 331 patients. Implants 11.5 mm in length were inserted in maxillae with bone level ≤ 5 mm, and 13.0-mm-long implants were inserted in maxillae with bone level of > 5 to 8 mm. In all cases, no graft materials or bone substitutes were used for the sinus elevation. Implant condition was assessed at three different centers and the follow-up period ranged from 6 months to 7 years.RESULTS:In total, 412 11.5-mm-long implants and 310 13-mm-long implants were inserted. Implantation was successful in 689 implants (95.4%), based on cone beam computed tomography and clinical evaluation as well as the patients' experience, with no statistically significant difference between the 11.5-mm and 13.0-mm implants. The complication rates were comparable between cases with bone levels from 3 to 5 mm and the > 5- to 8-mm bone level cases.CONCLUSIONS:The port and screw implant system may allow maxillary sinus augmentation without grafting or bony substitute. This can simplify relatively major surgery, such as a sinus augmentation procedure, to a less invasive procedure and potentially reduce the risk of complications.

We aimed to immunohistochemically characterize the pattern of expression of epithelial markers in rare head and neck squamous cell carcinoma (HNSCC) variants: carcinoma cuniculatum (CC) and adenosquamous carcinoma (ASC). We also present an additional variant of HNSCC with concomitant basaloid and squamous components that has overlapping morphological features with odontogenic and non-odontogenic tumors, which we termed basalo-squamous carcinoma (BSC). The selected markers included CK5/6, p40, CK19, BerEP4, p16 and SOX10. All tumors were CK5/6 and p40 positive. CK19 and BerEP4 were positive in BSC and focally in ASC but negative in CC. p16 was positive in 3 (60%) of the CCs, focally positive in ASC and negative in BSC. SOX10 was negative in all three variants. Our results highlight the plasticity of the lining epithelium revealing differential profiles of immuno-expression of the selected molecular markers, possibly reflecting their diverse histopathogenesis.

Acantholytic squamous cell carcinoma (ASCC) is an uncommon variant of squamous cell carcinoma (SCC). It is characterized by a combination of typical SCC and pseudoglandular structures, dyskeratotic cells and prominent acantholysis. The purpose of this study was to analyze the histochemical and immunohistochemical characteristics of the intraoral variant of ASCC. Cases of intraoral ASCC were retrieved from the English language literature. Four new cases from our files were added. In total, 35 cases were included and analyzed in this study. The mean age of the patients was 61.5 + 13 years (age range 38-92 years), with a male-to-female ratio of 1.7:1. According to the available data, histochemical and immunohistochemical stains for mucins were found to be consistently negative. E- cadherin, a marker of adherens junctions, was usually reported to be expressed in areas of "typical" (non acantholytic) SCC, but reduced in the acantholytic areas. We examined for the first time the expression of claudin 1, a marker of tight junctions, and found it to be reduced in the acantholytic areas, similar to E-cadherin. Several cases of oral ASCC also expressed vimentin and cytokeratin (CK) 19, markers associated with epithelial-mesenchymal transition. A wide range of non-epithelial markers yielded negative immunoreactions. In conclusion, ASCC is an uncommon variant of squamous cell carcinoma. The acantholytic process appears to involve reduced expression of molecular components of both adherens junctions and tight junctions. These findings could suggest a relation to the epithelial mesenchymal transition process and therefore further studies are needed in order to establish such a link and the subsequent possible impact on the clinical outcome of the patients.

Formation of stones, or calculi, can occur in various organs of the body. Two treatment approaches are possible: either to remove the stone in one piece or to crush it and remove the fragments. The term lithotripsy is applied to the second approach.

Objective: The present article reports how a dental implant with an internal port dental implant valve approach (DIVA) can be utilized as oroantral port to treat chronic rhinosinusitis (CRS) in a minimally invasive manner. Method and Materials: Eleven patients (age mean 68.1 years) with CRS were subjected to the transimplant lavage technique. For three patients the CRS treatment was performed via previously installed dental implants, and for another eight patients the implantation procedure was combined with the CRS treatment. The moment the implant was fully installed, the sinus membrane was punctured via the implant channel. Upon completion of the pus drainage the sinus was irrigated with normal saline, followed by the injection of a steroid solution (100 mg hydrocortisone). Results: Patients began to report symptomatic improvement from the first day after the first-session procedure. Nine patients had complete relief of most of their symptoms (nasal obstruction/discharge, anosmia/hyposmia) at day 30. The follow- up nasal endoscopy demonstrated no evidence of active sinus disease. All the implants used were found to be well-osseointegrated and still in use for prosthetic purposes. Clinical and radiologic results showed stability and no recurrence in the follow-up period. Conclusion: The dental implant with an internal central port and integral dedicated sealing screw may be used for irrigation, observation, and further treatment of the maxillary sinus in cases of CRS.