Orthodontic treatment can be safely performed during pregnancy when tailored to the patient’s hormonal, physiological, psychological, and oral health changes. The study aims to establish a safe, trimester – specific orthodontic protocol that minimizes maternal – foetal risks while ensuring effective treatment. A systematic PubMed search using combined keywords and subtopic – specific queries was performed to identify relevant literature on orthodontics during pregnancy. Most studies were literature reviews, followed by various observational, survey – based, clinical, and case report designs. Orthodontic care during pregnancy must be adapted to trimester – related risks, with minimal interventions in the first trimester, elective procedures in the second, comfort focused management in the third, and treatment of complex care postpartum. This protocol requires individual adaptation, highlighting the need for personalized medicine and coordinated input from multiple specialists to address orthodontic, obstetric, and psychological factors during pregnancy.

Orthodontic treatment can be safely performed during pregnancy when tailored to the patient’s hormonal, physiological, psychological, and oral health changes. The study aims to establish a safe, trimester-specific orthodontic practical framework that minimizes maternal–foetal risks while ensuring effective treatment. A modular search on MEDLINE/PubMed (National Library of Medicine, Bethesda, MD, USA) was conducted using combined keywords and subtopic-specific queries to identify relevant literature on orthodontics during pregnancy. Most studies were literature reviews, followed by various observational, survey-based, clinical, and case report designs. Orthodontic care during pregnancy must be adapted to trimester-related risks, with minimal interventions in the first trimester, elective procedures in the second, comfort-focused management in the third, and treatment of complex care postpartum. This protocol requires individual adaptation, highlighting the need for personalized medicine and coordinated input from multiple specialists to address orthodontic, obstetric, and psychological factors during pregnancy.

Osseous microvascular reconstruction of the head and neck following oncologic or osteoradionecrotic resection remains surgically challenging. The fibular free flap is the gold standard for mandibular reconstruction, whereas the scapular free flap has emerged as a viable alternative in selected scenarios. A retrospective comparative analysis was performed on 69 adults undergoing cervicofacial reconstruction with fibular (n = 37) or scapular (n = 32) osseous free flaps (2015–2025). Surgical, functional, and patient-reported outcomes (DASH, EFAS, SHI, MDADI, EORTC QLQ-H N35, FACE-Q) were assessed. Demographics and clinical profiles were similar, though scapular recipients were older. Fibular flaps predominate in mandibular, scapular in maxillary reconstructions. Fibular reconstructions used more custom plates and had longer follow-up but exhibited higher donor-site complication (24.3

IntroductionThe surgical gold standard following mandibular resection is reconstruction with a vascular osteocutaneous free flap. However, not all patients are suitable candidates for this type of procedure due to local or systemic contraindications or the critical anatomy of the remaining healthy bone. This study aimed to evaluate the outcomes of reconstruction with an anterolateral thigh (ALT) free flap in combination with a reconstruction plate as an alternative in such situations.MethodsThis retrospective case series included 34 oncological patients treated with ALT and reconstruction plate to restore mandibular bone defect following mandibulectomy. Seven patients who experienced serious postoperative complications received additional surgery involving the replacement of titanium plates [three with custom-made plates using computer-aided design (CAD)/computer-aided manufacturing (CAM) methods]. For evaluation, the following data were collected from the patients: gender, smoking habits, information about surgery (such as type of demolition, type of reconstruction plate used, and duration), the pathological node involvement, the application of radiotherapy (pre- or postoperative), the onset of complications (type of complication, time to complication, management strategy), and follow-up data. The follow-up period of the patients ranged from 3 months to 7 years. The follow-up assessments were based on both clinical and radiological methods, with CT scans performed at 1, 3, and 6 months.ResultsThirteen out of 34 patients developed early or late complications and were candidates for reoperation. Six of them died before undergoing additional surgery. The complications that were observed included flap failure, complications related to the plate (exposure, fracture, dislocation), development of sarco-radionecrosis, and recurrence. Seven subjects received additional surgery, including the removal and replacement of the reconstruction plates (custom-made plates in three patients).ConclusionThe surgical protocol described in this paper represents a promising option mostly suitable for geriatric patients who show relatively poor health status and advanced tumor stages.

BACKGROUND:Alternobaric facial palsy (AFP) is a rare peripheral facial nerve palsy resulting from transient neurapraxia when sudden ambient-pressure changes disrupt middle-ear equilibrium. Common precipitants include scuba diving, air travel, and altitude. AFP triggered by routine activities is exceedingly uncommon. CASE REPORT:A healthy 27 year old man developed acute right facial paresis after a prolonged yawn, while in the car. He reported ear fullness, cheek and tongue numbness, and inability to close the right eye, without other neurological sympthoms. Examination revealed a right peripheral facial palsy (House - Brackmann Grade IV), positive Bell's sign, and otherwise normal findings. CT and MRI of the brain and temporal bones showed no lesions. Other causes were ruled-out. Given the abrupt onset, absence of structural pathology, exclusion of other etiologies, AFP was diagnosed. MANAGEMENT AND OUTCOME:Prednisone (50 mg, tapered over 3 weeks), eye care, and close follow-up led to full recovery within three weeks. No recurrence occurred at 3, 6, or 12 months. CONCLUSIONS:This case highlights an atypical AFP trigger - a simple yawn - and underscores the importance of considering alternobaric mechanisms in acute peripheral facial palsy, even in everyday settings.

Since botulinum toxin (BoNT) was approved by the US Food and Drug Administration as a prophylactic treatment for chronic migraines in 2010, subsequent studies have shown that BoNT is effective in the management of chronic migraines due to its pain-relieving effects. Therefore, neurologists are increasingly utilizing BoNT as a therapeutic tool for chronic migraine. It is crucial to thoroughly understand the functional anatomy in the head, face, and neck regions to successfully administer BoNT injections in these areas. This review describes the complexity of muscles and their associated target nerves in the frontal, temporal, and occipital areas and serves as a resource for essential functional anatomy, with the goal of providing clinicians with a practical perspective on utilizing BoNT injections.

In patients with cleft lip and palate the most common associated dental problem is lateral incisor agenesis, often associated with lack of support and definition of the nasal tip. In many cases, adhesions deriving from surgical procedures and skeletal discrepancy make orthognathic surgery and rhinoseptoplasty unavoidable. In the present case report a dental rehabilitation with canine substitution and prosthetic-implant treatment in a posterior area is described. The use, during rhinoseptoplasty, of a customized titanium prosthesis, which provides projection for the tip of the nose, is also introduced. The patient was administered two questionnaires in order to assess the psychological aspects related to the cleft outcomes and the influence that the treatment conveyed.

This review aims to provide a comprehensive overview of the literature on the oral side effects caused by radiotherapy for head and neck cancers. Various treatments are examined to mitigate these sequelae, and a protocol is proposed for dentists and dental hygienists to manage oncological patients. A literature search was conducted to select relevant articles addressing the effects of radiotherapy treatments on the oral cavity, with a particular focus on the development of mucositis, candidiasis, changes in salivary pH, trismus, fibrosis, and alterations in the oral biofilm. PubMed and MedLine were used as search engines, with keyword combinations including: head and neck cancer, mucositis, candida, dental care, dental hygiene, epidemiology, oral microbiome, biofilm, trismus, fibrosis, and salivary pH. A total of 226 articles were identified, spanning the period from 1998 to 2023. Articles deemed inappropriate or in languages other than English or Italian were excluded. A management protocol for oncological patients was proposed, divided into two phases: home-based and professional. Despite the advancements in intensity-modulated radiation therapy, it is impossible to completely avoid damage to healthy tissues. Preventive education and counseling in the dental chair, ongoing motivation, and education about oral hygiene are crucial to combine a good therapeutic outcome with an improved quality of life for the patient.

IntroductionCancer metastatic to the orbit may be difficult to distinguish from idiopathic orbital pseudotumor at clinical and radiological examination. This case report describes clinical, radiological features, differential diagnosis, and treatment options for orbital neoplasms of unknown origin.Presentation of caseA 63-year-old woman presented to our Unit because of orbital swelling, ocular pain, globe displacement, conjunctival chemosis, and progressive vision loss. The patient had been seen by an ophthalmologist at another hospital. The initial diagnosis was idiopathic orbital pseudotumor. Steroid therapy did not resolve clinical symptoms. Her medical history held decisive clues: ten years before this presentation she had been diagnosed with double primary breast cancer, invasive lobular breast carcinoma, and invasive ductal breast carcinoma. Orbital biopsy was performed for differential diagnosis.DiscussionConsidering the rapid onset and severity of symptoms, the radiological features of the orbit, and the patient's medical history of breast cancer, orbital metastasis should have been the most likely diagnosis. Orbital biopsy was performed because of the history of multiple primary cancers and because metastatic origin had to be determined to define the best treatment strategy.ConclusionBiopsy is necessary under specific circumstances in the diagnosis of orbital metastasis, especially when presentation is ambiguous and when differential diagnosis is challenging. A patient's medical history may hold vital clues to correct diagnosis.

This study aims to compare a relatively novel three-dimensional rendering called Path Tracing (PT) to the Volume Rendering technique (VR) in the post-surgical assessment of head and neck oncologic surgery followed by bone flap reconstruction. This retrospective study included 39 oncologic patients who underwent head and neck surgery with free bone flap reconstructions. All exams were acquired using a 64 Multi-Detector CT (MDCT). PT and VR images were created on a dedicated workstation. Five readers, with different expertise in bone flap reconstructive surgery, independently reviewed the images (two radiologists, one head and neck surgeon and two otorhinolaryngologists, respectively). Every observer evaluated the images according to a 5-point Likert scale. The parameters assessed were image quality, anatomical accuracy, bone flap evaluation, and metal artefact. Mean and median values for all the parameters across the observer were calculated. The scores of both reconstruction methods were compared using a Wilcoxon matched-pairs signed rank test. Inter-reader agreement was calculated using Spearman's rank correlation coefficient. PT was considered significantly superior to VR 3D reconstructions by all readers (p < 0.05). Inter-reader agreement was moderate to strong across four out of five readers. The agreement was stronger with PT images compared to VR images. In conclusion, PT reconstructions are significantly better than VR ones. Although they did not modify patient outcomes, they may improve the post-surgical evaluation of bone-free flap reconstructions following major head and neck surgery.

Background: As specific flap designs performed for lower third molar extractions usually influence periodontal healing of the adjacent first and second molars, this study aimed to evaluate the periodontal conditions of these sites after 6 months post-surgery. Methods: Forty patients, aged 14–30 years, were included. Surgical extraction of the lower third molar was performed through a flap with papilla detachment (a modified envelope technique with detachment of gingival papilla between the first and second molars) or a trapezoidal flap (characterized by mesial- and distal-releasing incisions). Periodontal parameters at the first and second molar sites were assessed for visible plaque index, bleeding on probing, recession, probing pocket depth, and clinical attachment loss before surgery (T0), one month (T1), and six months after extraction (T2). Results: No statistical differences were found for the plaque and bleeding indexes between the two flaps at each observation time and considering both time intervals. For recession, no statistical differences were found between the two flaps considering the final time interval. For probing pocket depth at the second molar site, both techniques registered a significant increase between T0 and T1, followed by a decrease up to T2. For clinical attachment loss, mean values assessed for the first and second molar sites demonstrated evidently increased values between T0 and T1, followed by moderate decreases up to T2. Conclusions: Considering short (T1) and mid-term (T2) follow-ups, a specific flap design does not seem to particularly influence periodontal healing six months after surgery.

Background: The surgical plan to reconstruct the palate must be carefully prepared given the morphological peculiarity of the soft palate forming both the roof of the mouth and the floor of the nasal cavity. This article focuses on the use of folded radial forearm free flaps to manage isolated defects of the soft palate in the absence of tonsillar pillar involvement. Methods: Three patients affected by squamous cell carcinoma of the palate underwent resection of the soft palate and immediate reconstruction with a folded radial forearm free flap. Results: All three patients showed good short-term morphological-functional outcomes as far as swallowing, breathing, and phonation were concerned. Conclusions: The folded radial forearm free flap seems to be an efficacious way to manage localized defects of the soft palate, given the positive outcomes of the three patients treated, and in accordance with other authors. In general, the radial forearm free flap was confirmed to be a versatile solution for those intraoral defects of the soft tissue requiring a limited quantity of volume as in the case of the soft palate.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial disease that significantly impacts patients’ quality of life. New therapeutic strategies and in particular biologic treatments are now available for these patients. It has been demonstrated that Dupilumab (an anti IL-4/IL-13 biologic drug) is effective in reducing the size of nasal polyps and in improving patients’ symptoms and thus, quality of life. No real-world studies examining Dupilamab’s efficacy in the elderly with respect to other adult age groups have as yet been carried out. The aim of this multicentric study was to evaluate Dupilumab’s efficacy in young–middle adults as opposed to an older adult population affected by severe, uncontrolled CRSwNP. Of the 96 patients included in the study, 22 were 65 years old or older. Significant improvements were observed in all the parameters considered in both age groups after treatment was begun (T0 mean values for SNOT-22 = 58.5 ± 20.3, VAS NO = 7.6 ± 2.2, VAS smell = 8.6 ± 2.1, NPS = 5.6 ± 1.4, PNIF = 101.6 ± 59.4, S’S = 5.1 ± 3.1), T4 mean values for SNOT-22 = 15.1 ± 12.7, VAS NO = 1.7 ± 1.8, VAS smell = 2.4 ± 3, NPS = 1.7 ± 1.7, PNIF = 162.4 ± 43.2, S’S = 10.4 ± 3.7) (p < 0.0001). No differences in the variables considered were observed between the two age groups during the study, with the exception of the Peak Nasal Inspiratory Flow (PNIF), which was marginally higher; this was also the case according to multivariate analyses (p = 0.008) in the young–middle adult group with respect to the elderly one (p = 0.07). At multivariate analyses, asthma and the female sex negatively influenced the PNIF values (p = 0.001 and p = 0.012, respectively). Age negatively influenced the Visual Analog Scale (VAS) for nasal obstruction (p = 0.0032) and Endoscopic Sinus Surgery (ESS) negatively influenced the patents’ olfactory performance (p = 0.028) to the same degree in both groups. Dupilumab was found to be effective to the same degree in both age groups. It can be considered a safe and reliable option for the treatment of elderly patients with severe, uncontrolled CRSwNP.

A secretory carcinoma with NTRK3 break-apart molecular rearrangement: A case report on a tumor initially diagnosed as a mucoepidermoid carcinoma.Authors declare no conflict of interestData are available from the digital archieves and laboratories of Policlinico G.B. Rossi, Verona, Italy.Key points: Secretory Carcinoma, Salivary Glands, Mucoepidermoid Carcinoma, Oral Oncology, NTRK3

A woman presented a right submandibular gland lesion with cytologic diagnosis of mucoepidermoid carcinoma. Patient underwent sialoadenectomy en bloc with supraomohyoid neck dissection. Positivity for ETV6-NTRK3 genes fusion on surgical sample led to final diagnosis of secretory carcinoma (SC). Secretory carcinoma has been renamed by WHO in 2017 from mammary-analogue-secretory carcinoma (MASC). Only 649 have been reported until 2019. While cytologic alteration are shared with other neoplasms as the acinic cell and mucoepidermoid carcinomas, ETV6-NTRK3 rearrangement is pathognomonic of SC. Although usually indolent and with low-stage presentation, SC has higher rate of local recurrences and nodal involvement than ACC. Surgical treatment represent the gold standard. Real prevalence of SC is probably underestimated due to the recent WHO 2017 reclassification. While cytologic analysis does not allow to discriminate SC from other malignancies, chromosomal examination is recommended. When low-grade SC is diagnosed, complete surgical resection assures good prognosis.

Craniofacial tissue reconstruction still represents a challenge in regenerative medicine. Mesenchymal stem cell (MSC)-based tissue engineering strategies have been introduced to enhance bone tissue repair. However, the risk of related complications is limiting their usage. To overcome these drawbacks, exosomes (EXOs) derived from MSCs have been recently proposed as a cell-free alternative to MSCs to direct tissue regeneration. It was hypothesized that there is a correlation between the biological properties of exosomes derived from the dental pulp and the age of the donor. The aim of the study was to investigate the effect of EXOs derived from dental pulp stem cells of permanent teeth (old donor group) or exfoliated deciduous teeth (young donor group) on MSCs cultured in vitro. Proliferation potential was evaluated by doubling time, and commitment ability by gene expression and biochemical quantification for tissue-specific factors. Results showed a well-defined proliferative influence for the younger donor aged group. Similarly, a higher commitment ability was detected in the young group. In conclusion, EXOs could be employed to promote bone regeneration, likely playing an important role in neo-angiogenesis in early healing phases.