Transient hepatic attenuation difference (THAD) or fat sparing? Aberrant right gastric vein (ARGV) determining a pseudolesion at the border of the IInd/IIIrd liver segments. Review of developmental concepts

The aberrant right gastric vein (ARGV) is a rare anatomical variation. It can be responsible for unexplained hyperdensities in the hepatic parenchyma on CT scans, also known as third inflow effects. We present two cases sharing similar vascular pattern and slightly different imagistic findings on ultrasound and computer-tomography performed studies. Both ultrasonographies showed a nodular-geographic hypoechoic area within a hyperechogenic fatty liver. Further CT evaluation showed in both cases a hyperattenuating homogenous area clearly visible on all four phases at the border of the IInd/IIIrd hepatic segment, that enhance especially on the portal venous phase, with no slow-fill, wash-out, central scar or rim-like features. The areas were considered to be focal fat sparing areas in diffuse fatty liver or a perfusion disorder due to the presence of an aberrant right gastric vein. The aim of this paper is to discuss the embryological aspects which are the groundwork for this vascular anomaly and to correlate the findings with imagistic aspects. These two ARGV produced pseudolesions, understood as focal fat sparing areas within diffuse fatty livers. These pseudolesions mimic liver tumours, therefore it is important to look for such an aberrant vessel in order to rule out other diagnoses

Prognostic Potential of Tumor-Infiltrating Immune Cells in Resectable Oral Squamous Cell Carcinoma

(1) Background: The immune microenvironment plays an important role in carcinogenesis and has prognostic potential in many types of cancer. In this study we assess the prognostic character of tumor-infiltrating immune cells CD4+, CD8+ and CD56+ in resectable oral squamous cell carcinoma (OSCC); (2) Methods: We have evaluated the densities of CD4+, CD8+ and CD56+ in two distinct compartments, intratumor and invasion front, in 90 patients with OSCC; (3) Results: Significant differences were found between the tumor compartments for the CD4+ and CD8+ lymphocytes. An improved outcome (OS) was seen in patients with high densities of intratumor CD8+ lymphocytes (p = 0.0086), CD8+ lymphocytes at the front of invasion (p = 0.0011) and for intratumor CD56+ cells (p = 0.0016). Multivariate analysis confirmed the independent prognostic role of CD8+ at the front of invasion (OR = 3.75, CI95% 1.17–12.35, p = 0.026) and for intratumor CD56+ cells (OR = 3.669, CI95% 1.09–15.37, p = 0.035); (4) Conclusions: Tumor-infiltrating CD8+ lymphocytes at the front of invasion and CD56+ in the intratumor compartment display predictive traits in OSCC. A reach immune infiltration with these types of cells is associated with an improved patient outcome

Assessment of Histological Features in Squamous Cell Carcinoma Involving Head and Neck Skin and Mucosa

Background: squamous cell carcinoma (SCC) is the second most common type of malignancy worldwide. Skin and mucosa of the head and neck areas are the most frequently affected. An aggressive behavior in SCC is not easily detected, and despite all efforts, mortality in these types of cancer did not show major improvements during recent decades. In this study, we aim to determine the role of histological features available through standard pathology assessment in SCC and their relation with tumor behavior and patients’ survival. Method: in a group of one hundred patients diagnosed with SCC involving the head and neck areas, we assessed the presence of four histological features (tumor/stroma ratio, immune infiltration at the front of invasion, tumor-budding activity, and tumor necrosis), their correlations with tumor type (mucosal or cutaneous), tumor clinicopathological characteristics, and their prognostic potential. Results: the comparison between histological features in cutaneous versus mucosal SCC reveals no significant differences for any of the four parameters assessed. We found significant correlations between tumor/stroma ratio and lymphatic metastasis (p = 0.0275), perineural invasion (p = 0.0006), and clinical staging (p = 0.0116). Immune infiltration at the front of invasion revealed similar correlations with lymph node involvement (p = 0.002), perineural invasion (p = 0.0138), and clinical staging (p = 0.0043). Tumor budding and tumor necrosis correlated with the size of the tumor (p = 0.0077 and p = 0.0004) and the clinical staging (p = 0.0039 and p = 0.0143). In addition, tumor budding was significantly correlated with perineural invasion (p = 0.0454). In mucosal SCC, patients with improved outcome revealed high values for the tumor/stroma ratio (p = 0.0159) and immune infiltration at the front of invasion (p = 0.0274). However, the multivariate analysis did not confirm their independent prognostic roles. Conclusions: extended histological assessments that include features such as tumor/stroma ratio, immune infiltration at the front of invasion, tumor budding, and tumor necrosis can be an easy, accessible method to collect additional information on tumor aggressiveness in skin and mucosa SCC affecting the head and neck areas

ANATOMO-MORPHOLOGICAL STUDY AND NEW ORIGINAL CLASSIFICATION OF CONCHA BULLOSA

Introduction. The pneumatized cavities of the skull are characterized by the presence of numerous anatomical variants. Among these, the aberrant pneumatization of the middle turbinate is noteworthy, both in terms of prevalence and in terms of clinical resounding. The identification of this anomaly can be achieved clinically through anterior or posterior rhinoscopy, but the diagnostic gold standard is represented by spiral computer tomography (CT) and cone-beam computed tomography (CBCT) scans. Our study aims to determine the prevalence of concha bullosa (CB) in the Romanian population and to observe the distribution of the anomaly according to sex and age groups. Secondarily, we propose a new clinical classification based on the morphological appearance of concha bullosa. The selected cases will be distributed according to this new classification. Thirdly, we will study the association of concha bullosa with rhinosinusitis. Materials and methods. Our retrospective randomized study included 105 CT scans of non-traumatic patients (mean 60.34 ± 20.48 years) who underwent cranio-cerebral examinations between 01.07.2023 – 31.12.2023 in the Iasi Clinical Rehabilitation Hospital. Results. Concha bullosa was identified in 57 patients out of 106 (53.77%). Among them, 30 (28.3%) had the bilateral form and 27 (25.47%) the unilateral form. The applied statistical tests demonstrated a uniform distribution by age and gender groups. Within the classification proposed by us, we have identified all nine subtypes. Between subtypes I (A, B, C) and subtypes II (A, B, C), we recorded statistical significance (p = 0.00092), with the predominance of the lamellar type over the bulbous type. Conclusions. Concha bullosa has a high prevalence in the studied cohort. It does not show variations related to age or sex, which supports the malformative origin. The classification proposed by us ensures a better picture of the local mass effect determined by CB

MIDDLE TURBINATE PNEUMATIZATION – “CONCHA BULLOSA”. A NARRATIVE LITERATURE REVIEW AND COMPREHENSIVE DEVELOPMENTAL CONCEPTS

Abnormal pneumatization of the middle nasal turbinate, also named concha bullosa, is one of the most frequent anomalies of the ethmoid-osteomeatal complex. Clinical studies have demonstrated a prevalence between 14% and 53% in the general population. Apart from the high frequency, the importance of this anomaly resides in the loco-regional changes it produces. First, it modifies the airflow at the level of the nasal passages both through the mass effect and through the irritating action on the adjacent nasal mucosa. Therefore, congestion of the nasal mucosa occurs. Secondly, it is a predisposing factor for the installation of rhinosinus infections, especially with chronic rhinosinusitis and fungal sinus infections. Thirdly, concha bullosa can cause rhinogenic pain through the same irritating phenomenon at the level of the mucosa. Our paper aims to address the anatomic-clinical, diagnostic and therapeutic aspects of the pneumatization of the middle nasal turbinate, paying special attention to the concepts of development and etiological factors. Finally, yet importantly, we propose an original anatomical-morphological classification that includes semiological computer tomographic aspects highlighted both in the sagittal plane and in the axial plane

THE ADVANTAGE OF THE ALL-ON-SIX AND ALL-ON-EIGHT TECHNIQUE COMPARED TO THE ALL-ON-FOUR TECHNIQUE

Edentulism is a prevalent oral health issue that has a detrimental social and psychological impact on patients ‘quality of life. The treatment option adopted has a significant impact on the level of quality with the goal can be achieved. For edentulous patients, implant-supported fixed restorations are a well-established treatment modality. Implant dentistry philosophies and procedures have evolved and changed over the time to give esthetics and functional outcomes. Immediate loading has various advantages over traditional loading without sacrificing the quality of the output. An immediate fixed provisional promotes a high level of patient satisfaction with respect to esthetics, phonetics, mastication and psychological comfort, enabling patients to return to their normal routine and maintain quality of life within a short period of time. Without question, the optimal solution for any edentulous patient from whom it is still clinically viable to place implants is all-on-X dental implant solution. Whether All-on-four All-on-five, All-on-six or any variation of a full implant supported design, there is a best option for quality of life, long term durability, bone maintenance, health improvement and frankly happiness

OUR EXPERIENCE REGARDING PERI-IMPLANTITIS

Although dental implants are most common prosthetic treatment used to replace missing tooth, it gained considerable importance over a decade owing to the availability of advanced techniques that can help in achieving a greater success rate and much better osseointegration. The chances that the implanted tooth can be rejected due to inflammation caused by oral microflora still persist. The term peri-implantitis is used to describe a destructive inflammatory process affecting the soft and hard tissues around osseo integrated implants, leads to the formation of a peri-implant pocket and loss of supporting bone. Predisposing factors are poor plaque control, inflammation, infection, smoking, diabetes and occlusal overload. It is diagnosed on the basis of clinical and radiographic interpretation and still no definitive criteria have been proposed for the diagnosis and treatment of peri-implantitis. However treatment can be both conservative and surgical. The cumulative interceptive supportive therapy protocol serves as good guide for the treatment of the peri-implantitis. Radiological examination it is very important pre- and post-operative assessment of implant surgery. Among all radiological methods, periapical radiography (PA) and cone beam computer tomography (CBCT) are common to asses post-operative peri-implant bone defects

MANAGEMENT OF ORAL HEALTH CHALLENGES IN PREGNANT WOMEN

Pregnancy is a dynamic state leading to several physiological transient changes in the body system including the oral cavity. In order to maintain good oral health, the dental treatment should not be avoided. The dental management of pregnant patients involves special consideration as otherwise a hypersensitive vomit reaction in the third trimester of pregnancy can influence the eating behavior of the patient as well as oral hygiene influencing the appearance of dental erosion and tooth decay. Once pregnant women suffer an unpleasant gag reflex in a dental office, they may become phobic, delaying or postponing their dental treatment. The dental management of pregnant patients involves special considerations