Neck dissection versus “watchful-waiting” in early squamous cell carcinoma of the tongue our experience on 127 cases

Background Early oral squamous cell carcinoma (EOSCC) represents about 90% of the oral cancers especially in older males. The etiology is multifactorial, strongly related to tobacco and alcohol abuse, but also infective agents, Human papillomaviruses (HPV16-18), genetic factors and pre-neoplastic lesions seem to be implicated. There is no consensus in the literature for the treatment of early squamous cell carcinoma of the tongue (stages I–II); both an elective neck dissection policy and a watchful-waiting policy have their proponents in the different centers. Methods The records of 127 patients with EOSCC of the tongue treated in our Department between 2007 and 2011, with cN0 neck staging, who underwent resection of the primary tumor with or without elective neck dissection, were reviewed. Results We divided the patients into two groups, in Group 1 the 66 patients who received an elective neck dissection 30 days later from the primary surgery have been included, and in Group 2 the 61 patients undergoing “watchful waiting” observation for the development of nodal metastases have been collected. Statistical calculations were performed using Chi-square and t student test. Conclusions A significant difference was found between the two groups as concerns tumor stage and pathologic tumor classification (p < 0.001). No significant differences were present between the two groups as concerns mean follow up (P = 0.2), relapse rate (p = 0.3) and relapse-free survival time (p = 0.2). In T1 stage tumors with depth of infiltration ≤4 mm, or low grade (G1-G2), the “watchful waiting” strategy for cervical metastases is appropriate, given the low regional recurrence rate (15%) and overall survival of 100%. In case of T2 lesions with depth of infiltration ≥4 mm or high grade (G3) we prefer to perform the elective neck dissection, with 13% of local recurrence and 100% of survival at 6 years

Surgical evolution in the treatment of mandibular condyle fractures

Background: In Literature fractures of the mandible that involve the condyle ranges from 20% to 35% and various possible surgical options are described according to the varying pathological situations. Up to the present, numerous techniques have been used for the surgical treatment of condylar fractures. In this article we are proposing the combination of two surgical techniques as therapy for extra-capsular condylar fractures with dislocation. Methods: From June 2003 to July 2007 30 patients were treated for condylar fractures with the application of a Rigid External Fixator under endoscopic assistance. This method includes a surgical reduction of the fracture with the aid of an endoscope, performing a transcutaneous insertion of a Rigid External Fixator to stabilize the fracture. Results: Out of the total number of patients, 28 reached an optimal result without the need for temporary immobilization of the temporal mandibular joint and pre-auricular cutaneous access, thanks to the decisive aid of the video-endoscope. Conclusions: The endoscope allows perfect control over both the positioning of the external fixator and the surgical reduction, restoring the normal movement of the mandible with a return to full anatomical functioning of the temporo-mandibular joint. This approach avoids possible damages to the facial nerve branches. The rigid external fixation system is better than an internal one, because it is less restrictive in precise anatomical reduction, since with an REF the condylar fragment is kept in the correct anatomical position but is not obliged to maintain that exact position, and therefore it is possible to carry out all the repair mechanisms listed above. Endoscopic assistance allows a good positioning control of the REF although the endoscopy permits an optimal control of the condylemeniscal complex mobility after REF application

Bilateral hypertrophy of masseteric and temporalis muscles, our fifteen patients and review of literature

OBJECTIVE: The association of bilateral hypertrophy of temporalis and masseteric muscles is a rare clinical entity. The origin of the condition is unclear, causing cosmetic problems, pain, and functional impairment. PATIENTS AND METHODS: In this paper we analyzed 15 patients treated at the Department of Maxillo-Facial Surgery of the University of Naples Federico II, from 2000 to 2013, for temporalis and/or masseteric muscle hypertrophy, and in particular, a rare case of a patient with a marked bilateral swelling of the temporalis and masseteric region, in conjunction with a review of the literature. RESULTS: Fourteen patients have not any kind of postoperatively problems. The last patient had been aware of the swelling for many years and complained of recurrent headaches. We adopted a new protocol fort these patients and the patient was very pleased with the treatment resul ts, and reported a reduct ion in headaches and a continuation of his well-being, in addition to greater self-confidence. The last follow-up was performed three years after the first treatment, and the patient showed a complete resolution of his symptoms, and just a small increase of the swelling. CONCLUSIONS: The treatment of temporalis and masseteric hypertrophy with Botulin toxin could be an effective option compared to conservative treatment or surgical intervention although the review of the literature shows that this is only a temporary treatment. In fact, surgery still remains the best option. The treatment must be repeated every 4/6 months for 2-3 consecutive years before having stable benefits. To overcome this problem, an association with a bite treatment allowed us to achieve more lasting and more stable results over time without a recurrence of symptoms between the treatments. Furthermore, this association has enabled us to obtain a more rapid reduction of the hypertrophy

Adenoid cystic carcinoma of accessory parotid gland: A case report and review of the literature

Abstract Accessory parotid gland (APG) is a small salivary gland tissue ranging from 0.5 to 1 cm diameter in size, located almost 7 mm anterior to the main parotid gland. APG is a common anatomical variant, but accessory parotid gland tumors are very rare, accounting for only 1%–7.7% of all parotid gland tumors. We present a case of adenoid cystic carcinoma involving accessory parotid gland, a very rare condition with only, to the best of our knowledge, other 7 cases described in literature. Surgical excision was performed and eventful postoperative recovery, without severe surgical complications and no signs of recurrence at 12 months of follow-up was obtained, with a good cosmetic result. An extensive review of the literature has been performed and the results are presented in order to establish a correct diagnostic-therapeutic protocol for these oncologic patients

Open reduction and internal fixation of extracapsular mandibular condyle fractures: a long-term clinical and radiological follow-up of 25 patients

Background: During the last 2 decades, many studies on the treatment of mandibular condyle fracture have been published. The incidence of mandibular condyle fractures is variable, ranging from 17.5% to 52% of all mandibular fractures. This retrospective study evaluated the long-term clinical and radiological outcomes after surgical treatment of 25 patients with a total of 26 extracapsular condyle fractures. Methods: We used 2 types of surgical approaches, the retromandibular retroparotid or preauricular approach. Three kinds of rigid internal fixation plates were used—single plate, double plate, and trapezoidal plate. The following post-operative clinical parameters were evaluated: dental occlusion, facial nerve functionality, skin scarring, and temporomandibular joint functionality. All patients underwent post-operative orthopanoramic radiography and computed tomography. The patients were also monitored for complications such as Frey’s syndrome, infection, salivary fistula, plate fracture, and permanent paralysis of the facial nerve; the patient’s satisfaction was also recorded. Results: Of the 25 patients, 80% showed occlusion recovery, 88% had no facial nerve injury, and 88% presented good surgical skin scarring. The patients showed early complete recovery of temporomandibular joint functionality and 72% of them were found to be asymptomatic. The postoperative radiographs of all patients indicated good recovery of the anatomical condylar region, and 80% of them had no postoperative complications. The average degree of patient satisfaction was 8.32 out of 10. Our results confirm that the technique of open reduction and internal fixation in association with postoperative functional rehabilitation therapy should be considered for treating patients with extracapsular condylar fractures. Conclusion: The topic of condylar injury has generated more discussion and controversy than any other topic in the field of maxillofacial trauma. We confirm that open reduction and internal fixation is the treatment of choice for patients with neck and sub-condylar mandibular fractures

Le libertà economiche in Internet: competition, net neutrality e copyright

Può l’impiego delle nuove tecnologie – in particolare, di Internet – alterare il regime giuridico previsto in Costituzione per la tutela delle libertà economiche? Esistono degli obblighi aggiuntivi rispetto a quelli tradizionalmente catalogati nell’ambito del c.d. statuto generale dell’imprenditore quando l’iniziativa economica è esercitata in Internet? E, dunque, è utile introdurre una lex specialis che sia applicabile alle sole società operanti sul world wide web? L’Autore analizza le questioni appena poste ripercorrendo il dibattito sulla competition online, sul principio della network neutrality e sulla tutela del copyright in Internet. In particolare, il primo capitolo è incentrato sulla ricostruzione della disciplina antitrust applicabile alle imprese operanti nella web economy. La soluzione proposta esclude la configurazione di una zona franca per gli operatori economici, nella misura in cui suggerisce di regolare Internet tenendo ben presente la ratio giustificatrice del diritto della concorrenza; inoltre, essa consente all’Autore di sviluppare – in una prospettiva de jure condendo – una più ampia riflessione sulle categorie generali del diritto antitrust. I capitoli centrali del lavoro sono dedicati al delicato tema della neutralità della rete. Tutta la ricostruzione ruota attorno ai seguenti interrogativi: cui prodest una rete a più velocità, che consenta ai grandi operatori economici di discriminare gli utenti e i content provider in ragione di valutazione economiche? Negare la neutralità della rete conduce, forse, a una sorta di contradictio in adjecto rispetto alle finalità perseguite con lo sviluppo di Internet? Infine, nell’ultimo capitolo, si affrontano i problemi posti dalla tutela del diritto d’autore sulle reti di comunicazione elettronica. Dopo aver ricostruito i principali problemi tecnici connessi alla diffusione telematica delle opere di ingegno, l’Autore conclude sostenendo l’inopportunità e illegittimità di un sistema normativo che, in virtù di sanzioni meramente repressive, sia fonte di (irragionevoli) compressioni delle libertà fondamentali interessate dal tema