Inflammatory Pseudotumor Presenting as a Facial Swelling

We present a case of inflammatory pseudotumor (IPT) presenting as a facial swelling after an accidental hit on a right side of a face. As swelling did not resolve, dental examination and teeth extraction were done by a dentist presuming the swelling was misdiagnosed with infection of dental origin. Swelling grew even bigger and patient was referred to Department of Maxillofacial Surgery. CT scan of the face and FNA of the lesion was ordered. A homogenous tumor mass in the right infraorbital region in front of anterior wall of the maxillary sinus was seen on CT. The result of the FNA was reactive hyperplasia of the lymph node. Since the lesion was easily accessible surgical exploration and complete extirpation was done. Pathohistological analysis indicated a low grade B-cell Non Hodgkin lymphoma. PCR showed policlonality of B cells discarding the diagnosis of lymphoma. Pathohistological review showed diffuse intramuscular, perineural and perivascular infiltration with small lymphocytes without formation of germinative centers. Imunohistochemistry was positive for CD20 and CD3. Taking into account all features the diagnosis of IPT was established. Diagnosis of IPT is a diagnosis by exclusion, combining clinical, radiological and pathohistological characteristics. Lack of clear histologic criteria makes differential diagnosis extremely difficult. Our case is unique regarding localisation of head & neck IPT, no case presenting on the face in infraorbital region has been described in the literature. Although IPT is very rare in general and especially on the face, one should be aware of it when considering differential diagnosis of facial swelling

The modification of rotation - advancement flap made in 1950

The early techniques of cleft lip repair involved the straight-line technique, the triangular flap technique or some kind of geometric line (triangular, quadrangular closure). A turning point in cleft lip surgery was in 1955 when doctor. Millard presented his method: the rotation-advancement technique or flap, at the First International Congress of Plastic Surgery in Stockholm. Today, the technique, with or without some modifications, is used by more than 85% of cleft surgeons around the world. We are presenting a patient with complete unilateral cleft lip and palate who underwent surgery sixty-five years ago. The scar on his lip was similar to rotation advancement line. Cheiloplasty was performed by Professor Šercer in 1950, five years before Millard's publication. Professor Ante Šercer was an internationally recognized Croatian scholar in the area of ear, nose and throat diseases. He also gave a significant contribution to surgical management of velopharyngeal insufficiency and plastic surgery of the nose and ear

Pleomorphic Adenoma in Ectopic Salivary Gland Tissue in the Neck

A case of pleomorphic adenoma originating from ectopic salivary gland tissue (ESGT) of the upper neck is reported. A 34-year-old male patient was referred to our Department for a painless swelling in the right submandibular region. Preoperative evaluation (clinical examination, fine-needle aspiration cytology (FNAC) and imaging studies) was performed and the finding was that of a pleomorphic adenoma in ESGT. A modified »S« incision with extension to the submandibular region was performed and the tumour was extirpated. The histopathological report confirmed our initial diagnosis. No recurrence was obtained during a four-year follow-up period. Isolated neck mass may be overlooked as ectopic salivary gland tissue neoplasm (ESGTN). Proper preoperative assessment and optimal surgical treatment are the keys for successful management of these rare tumours. The distinction between metastatic lesion from a head and neck tumour and ESGTN may present considerable diagnostic problem. A review of the literature on ESGT and associated tumours with emphasis on clinical features, diagnosis and treatment is also presented

DEVELOPMENT OF A VALID AND RELIABLE INSTRUMENT FOR THE ASSESSMENT OF QUALITY OF LIFE IN ADOLESCENTS WITH CLEFTS - DETECTION OF POTENTIAL MENTAL HEALTH ISSUES

Background: The rehabilitation of patients with cleft deformities is very complex and unique, and managed by a team of professionals. Quality of life depends on the health, and represents an instrument that examines the disease impact and treatment modalities on the health, integrating an objective assessment of the health status and its subjective experience. Children with clefts are often teased by their peers, and that is the reason why they experience different kinds of psychological distress. Patients with non-syndromic clefts may develop depression and anxiety, hyperactivity, elevated risk of suicide and increased drug abuse in adolescence. Subjects and methods: Experienced members of a cleft palate team developed a specific questionnaire divided into 2 parts: the first contains the clinical profile of adolescents, and the second part contains questions regarding quality of life. This questionnaire was administered to 73 patients between June 2015 and June 2016, who matched these criteria during their control examinations at the University Hospital Dubrava. Results: In general, the patient group showed significantly worse scores on majority of answers, specifying that their quality of life is worse compared to the control group. The principal component analysis revealed the presence of three components (factors). The interpretation of the three components was consistent with loadings indicating the component names: Component 1: The relationship with parents, success, society; Component 2: Appearance, and Component 3: Function. Conclusion: According to our results, we created a specific instrument - The Quality of Life in Adolescents with Cleft Assessment to assess aesthetic and functional results of treatment and quality of life of the operated adolescents with clefts. The adolescents in this study have no psychiatric disorders diagnosed in their medical charts, but results indicate that some of them need help in dealing with future life. Regarding these findings, it will be possible to intervene in the process of treatment and improve the overall outcome of therapy

Human DLG1 and SCRIB are distinctly regulated independently of HPV-16 during the progression of oropharyngeal squamous cell carcinomas: a preliminary analysis

The major causative agents of head and neck squamous cell carcinomas (HNSCCs) are either environmental factors, such as tobacco and alcohol consumption, or infection with oncogenic human papillomaviruses (HPVs). An important aspect of HPV-induced oncogenesis is the targeting by the E6 oncoprotein of PDZ domain-containing substrates for proteasomal destruction. Tumor suppressors DLG1 and SCRIB are two of the principal PDZ domain-containing E6 targets. Both have been shown to play critical roles in the regulation of cell growth and polarity and in maintaining the structural integrity of the epithelia. We investigated how modifications in the cellular localization and protein expression of DLG1 and SCRIB in HPV16- positive and HPV-negative histologic oropharyngeal squamous cell carcinomas (OPSCC) might reflect disease progression. HPV presence was determined by p16 staining and HPV genotyping. Whilst DLG1 expression levels did not differ markedly between HPV-negative and HPV16-positive OPSCCs, it appeared to be relocated from cell–cell contacts to the cytoplasm in most samples, regardless of HPV16 positivity. This indicates that alterations in DLG1 distribution could contribute to malignant progression in OPSCCs. Interestingly, SCRIB was also relocated from cell–cell contacts to the cytoplasm in the tumor samples in comparison with normal tissue, regardless of HPV16 status, but in addition there was an obvious reduction in SCRIB expression in higher grade tumors. Strikingly, loss of SCRIB was even more pronounced in HPV16-positive OPSCCs. These alterations in SCRIB levels may contribute to transformation and loss of tissue architecture in the process of carcinogenesis and could potentially serve as markers in the development of OPSCCs

Head and Neck Cancer Patients’ Survival According to HPV Status, miRNA Profiling, and Tumour Features—A Cohort Study

Head and neck cancers (HNC) are a heterogeneous group of tumours mainly associated with tobacco and alcohol use and human papillomavirus (HPV). Over 90% of all HNC are squamous cell carcinomas (HNSCC). Sample material from patients diagnosed with primary HNSCC (n = 76) treated with surgery as primary treatment at a single centre were assessed for HPV genotype, miR-9-5p, miR-21-3p, miR-29a-3p and miR-100-5p expression levels. Clinical and pathological data were collected from medical records. Patients were enrolled between 2015 and 2019 and followed-up until November 2022. Overall survival, disease-specific survival and disease-free survival were assessed and correlated with clinical, pathological, and molecular data. Kaplan-Meier and Cox proportional hazard regression was used to assess different risk factors. In the study, male gender, HPV-negative HNSCC (76.3%) mostly located in the oral region (78.9%) predominated. Most patients had stage IV cancer (47.4%), and the overall survival rate was 50%. HPV was found not to affect survival, indicating that in this population, classic risk factors predominate. The presence of both perineural and angioinvasion was strongly associated with survival in all analyses. Of all miRNAs assessed, only upregulation of miR-21 was consistently shown to be an independent predictor of poor prognosis and may thus serve as a prognostic biomarker in HNSCC

DNA Methylome Distinguishes Head and Neck Cancer from Potentially Malignant Oral Lesions and Healthy Oral Mucosa

There is a strong need to find new, good biomarkers of head and neck squamous cell carcinoma (HNSCC) because of the bad prognoses and high mortality rates. The aim of this study was to identify the potential biomarkers in HNSCC that have differences in their DNA methylome and potentially premalignant oral lesions, in comparison to healthy oral mucosa. In this study, 32 oral samples were tested: nine healthy oral mucosae, 13 HNSCC, and 10 oral lesions for DNA methylation by the Infinium MethylationEPIC BeadChip. Our findings showed that a panel of genes significantly hypermethylated in their promoters or specific sites in HNSCC samples in comparison to healthy oral samples, which are mainly oncogenes, receptor, and transcription factor genes, or genes included in cell cycle, transformation, apoptosis, and autophagy. A group of hypomethylated genes in HNSCC, in comparison to healthy oral mucosa, are mainly involved in the host immune response and transcriptional regulation. The results also showed significant differences in gene methylation between HNSCC and potentially premalignant oral lesions, as well as differently methylated genes that discriminate between oral lesions and healthy mucosa. The given methylation panels point to novel potential biomarkers for early diagnostics of HNSCC, as well as potentially premalignant oral lesions

Manual versus rigid intraoperative maxillo-mandibular fixation in the surgical management of mandibular fractures:A European prospective analysis

Purpose: Intraoperative stabilisation of bony fragments with maxillo-mandibular fixation (MMF) is an essential step in the surgical treatment of mandibular fractures that are treated with open reduction and internal fixation (ORIF). The MMF can be performed with or without wire-based methods, rigid or manual MMF, respectively. The aim of this study was to compare the use of manual versus rigid MMF, in terms of occlusal outcomes and infective complications. Materials and methods: This multi-centric prospective study involved 12 European maxillofacial centres and included adult patients (age ≥16 years) with mandibular fractures treated with ORIF. The following data were collected: age, gender, pre-trauma dental status (dentate or partially dentate), cause of injury, fracture site, associated facial fractures, surgical approach, modality of intraoperative MMF (manual or rigid), outcome (minor/major malocclusions and infective complications) and revision surgeries. The main outcome was malocclusion at 6 weeks after surgery. Results: Between May 1, 2021 and April 30, 2022, 319 patients-257 males and 62 females (median age, 28 years)-with mandibular fractures (185 single, 116 double and 18 triple fractures) were hospitalised and treated with ORIF. Intraoperative MMF was performed manually on 112 (35%) patients and with rigid MMF on 207 (65%) patients. The study variables did not differ significantly between the two groups, except for age. Minor occlusion disturbances were observed in 4 (3.6%) patients in the manual MMF group and in 10 (4.8%) patients in the rigid MMF group (p &gt; .05). In the rigid MMF group, only one case of major malocclusion required a revision surgery. Infective complications involved 3.6% and 5.8% of patients in the manual and rigid MMF group, respectively (p &gt; .05). Conclusion: Intraoperative MMF was performed manually in nearly one third of the patients, with wide variability among the centres and no difference observed in terms of number, site and displacement of fractures. No significant difference was found in terms of postoperative malocclusion among patients treated with manual or rigid MMF. This suggests that both techniques were equally effective in providing intraoperative MMF.</p

Epidemiology of maxillofacial trauma in the elderly: a European multicenter study

ABSTRACT Introduction: The progressive aging of European population seems to determine a change in the epidemiology, incidence and etiology of maxillofacial fractures with an increase in the frequency of old patients sustaining craniofacial trauma. The objective of the present study was to assess the demographic variables, causes, and patterns of facial fractures in elderly population (with 70 years or more). Materials and Methods: The data from all geriatric patients (70 years or more) with facial fractures between January 1, 2013, and December 31, 2017, were collected. The following data were recorded for each patient: gender, age, voluptuary habits, comorbidities, etiology, site of facial fractures, synchronous body injuries, Facial Injury Severity Score (FISS). Results: A total of 1334 patients (599 male and 735 female patients) were included in the study. Mean age was 79.3 years, and 66% of patients reported one or more comorbidities. The most frequent cause of injury was fall and zygomatic fractures were the most frequently observed injuries. Falls were associated with a low FISS value (p<.005). Concomitant injuries were observed in 27.3% of patients. Falls were associated with the absence of concomitant injuries. The ninth decade (p <.05) and a high FISS score (p <.005) were associated with concomitant body injuries too. Conclusions: This study confirms the role of falls in the epidemiology of facial trauma in the elderly, but also highlights the frequency of involvement of females, and the high frequency of zygomatic fractures.Peer reviewe

Učestalost visokorizičnih tipova humanoga papiloma virusa u karcinomima usne šupljine u bolesnika bez rizičnih čimbenika

Oral cavity cancer is usually the result of heavy smoking and longstanding alcohol consumption. Only around 10% of oral cancer patients neither smoke nor drink. In western countries, there is a rising trend in oral cancer in those who neither smoke nor drink alcohol. Human papilloma virus (HPV) has already been linked to oropharyngeal cancer, especially in those who neither drink nor smoke. This relationship between HPV and oral cancer has not yet been established, with previous results being controversial. We have hypothesised that the frequency of high risk HPV types, especially types 16 and 18, is increased in non smokers non drinkers (NSND) who develop oral cancer. This would therefore link HPV involvement in oral carcinogenesis in this population. Only patients with oral squamous cell carcinoma treated primarily with surgery in the Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, from 1995 to 2010 were included in the study. Patients were divided into two groups. The first group consisted of smokers of more than 10 pack/year who were also daily drinkers. The second group consisted of NSND and included those of less than 10 pack/year active smokers. HPV status, age, gender, anatomic locations of the tumour, stage, second primary tumours, recurrence and survival were compared between the two groups. HPV was detected directly with PCR method and indirectly with p16INK4a immunohistochemistry. There were 77 non smokers non drinkers and 77 controls (smokers and drinkers, SD). Women were more frequent among NSND group (75%) versus more males among SD (90%), p<0,001. The age range was greater among NSND, with the youngest patient 24 years old and the oldest one 90 years old. More than half of the patients were younger than 45 or older than 70 years. The SD group were middle aged (45-69 years) in 79%. The tongue was the most frequent tumour site in oral cavity among NSND (42%) followed by the sublingual region (17%), upper gum (13%) and lower gum (12%). In the control group (smokers and drinkers), sublingual cancer was the most frequent site (39%), followed by tongue cancer (34%) and then retromolar cancer (17%). The NSND group had smaller cancers (T1 and T2) without regional metastasis (N0), although there was no statistical significance. No difference in recurrence or second primary tumour (SPT) was observed between the two patient groups. HPV detected by PCR was less frequent among the NSND group. Only 22% of NSND were positive for HPV, compared with 31% of SD. HPV was positive in 27% of all oral cancer patients which is similar to previous published results. Men were more frequently HPV positive (68%) than women. HPV positive patients tended to be younger than HPV negative patients (56 years vs 60 years) but without statistical significance. Regional metastasis (N) correlated significantly more with HPV positivity (39% vs 23%) although there was no difference in primary tumour (T) or stage. Similar rate of SPT was observed between the two groups. HPV positive patients had a greater incidence of recurrences and worse survival, but this was not statistically significant. If p16INK4a expression is considered as surrogate marker of HPV infection, we have confirmed the hypothesis of the study that high risk HPV groups are more frequently seen in NSND oral cancer patients than in SD patients with oral cancer. p16INK4a was positive in 27% of NSND and only 10% of SD (p=0,0064). However, PCR results did not support the above hypothesis and the overall correlation between p16INK4a and HPV was weak. All p16INK4a positive patients should be HPV positive if it is sensitive as a surrogate marker, but this was the case in only 7 out of 29 patients. 22 out of 29 patients were p16INK4a positive and HPV negative. Based on our findings and those of other studies, we cannot support the use of p16INK4a immunostaining as the only test for HPV in oral cancer. No statistically significant difference was observed between p16INK4a positive and negative patients according to age, sex, anatomic tumour locations, stage, SPT or HPV status. A higher rate of recurrences was associated with stronger p16INK4a expression, and this trend was also observed in survival curves. Stronger p16INK4a expression had worse survival outcomes, particularly among tongue cancers. Both HPV PCR and p16INK4a may be extrapolated for survival and prognostic purposes. When both are positive, survival outcomes are worse while best survival is associated with negative HPV PCR and p16INK4a. NSND that is HPV positive has 2.8 hazard ratio and strong p16INK4a expression carries 2.9 hazard ratio for the same population. According to this study, correlation between HPV and p16INK4a is very weak. In clinical practice, patients should be routinely tested for HPV using PCR and p16INK4a immunohistochemistry in order to give us valuable information regarding their prognosis