Non-invasive visual tools for diagnosis of oral cancer and dysplasia: a systematic review

Background: Gold standard for the diagnosis of oral dysplasia (OD) oral squamous cell carcinoma (OSCC) and malignant lesions is the histological examination. Several adjunctive diagnostic techniques have been proposed in order to increase the sensitivity (SE) and specificity (SP) of conventional oral examination and to improve the diagnostic first level accuracy. The aim of this study is to perform a systematic review on non-invasive tools for diagnosis of OD and early OSCC. Material and Methods: Medline, Scopus, Web of Knowledge databases were searched, using as entry terms “oral dysplasia AND diagnosis” / ”oral cancer AND diagnosis”. Data extracted from each study included number of lesions evaluated, histopathological diagnosis, SE, SP, positive and negative predictive values (PPV and NPV), diagnostic accuracy (DA) and the main conclusions. Results: After title and abstract scanning of 11.080 records, we selected 35 articles for full text evaluation. Most evaluated tools were autofluorescence (AF), chemiluminescence (CL), toluidine blu (TL) and chemiluminescence associated with toluidine blue (CLTB). Conclusions: There is a great inhomogeneity of the reported values and there is no significant evidence of superiority of one tool over the other. Further clinical trials with a higher level of evidence are necessary in order to assess the real usefulness visual diagnostic tools

An Auto-Fluorescence guided surgical approach performed with Er:YAG laser and Nd:YAG Low Level Laser Therapy for Medication-Related Osteonecrosis of the Jaw

Medication-Related Osteonecrosis of the Jaw (MRONJ) therapy remains an unresolved problem. The proposed conservative and surgical treatment regimens are associated to contradictory success rates. Surgical approach with Er:YAG laser is associated to significant better results compared to medical treatment and traditional surgical approaches. Objective: To describe a new surgical approach that couples the advantages of the Er:YAG laser and the usefulness of the AF in highlighting surgical margins. One of the difficulties encountered during surgical removal of a MRONJ is the precise individuation of necrotic bone margins. Case Report: A case of Stage III mandibular osteonecrosis treated with a new surgical approach is presented. The aim is to describe an auto-fluorescence (AF) guided surgical approach performed with Er:YAG laser and Nd:YAG Low Level Laser Therapy (LLLT). After one month of follow-up, the complete mucosal healing was evident and symptoms was unobserved. Such a technique allowed a highly accurate and minimally invasive approach through the selective ablation of the non-/hypofluorescent areas. Conclusion: Taking into account the advantages of laser therapy and the possible effectiveness of the AF in highlighting surgical margins, this approach would probably achieve excellent outcomes.DOI: 10.14693/jdi.v22i2.48

THE BASAL COMPLEX STRATIGRAPHY OF THE HELMINTHOID MONTE CASSIO FLYSCH: A KEY TO THE EOALPINE TECTONICS OF THE NORTHERN APENNINES

Below the Monte Cassio helminthoid Flysch of the type locality, a well exposed basal complex outcrops in which Cenomanian turbidites of up to 200 m thickness are recognized. The bulk of these turbidites, named here Case Baruzzo Sandstone (CBS), consists of thick-bedded silty marlstones with a fine arenaceous base and represents the oldest siliciclastic input within the succession of the Cassio tectonic unit. The Case Baruzzo Sandstone lies unconformably on the Palombini shale of Hauterivian-Aptian age and on stratified packets of Jurassic-Cretaceous formations with Austroalpine affinity (Radiolarites, Aptici Shale and Maiolica). The Cenomanian CBS are unconformably overlain by Varicoloured Clay of Santonian - Campanian age and affected by soft-sediment deformations. The petrography of the CBS shows two petrofacies indicating (1) a direct provenance from their substrate and (2) an extrabasinal source similar to the terrigenous framework of the tectonically independent Coniacian-Santonian Ostia Sandstone outcropping southwest of the Cassio Unit. Because of its Cenomanian age the CBS must be considered as a siliciclastic wedge distinct from the younger Ostia Sandstone belonging to the Media Val Taro Unit and time correlative to the Varicoloured Clay of the Cassio Unit. The initiation of the turbidite sandstones terrigenous supply is Cenomanian into the Cassio Basal Complex (CBS), Coniacian into the Media Val Taro Unit (Ostia Sandstone) and Campanian into the more internal Gottero Unit (fine-grained turbidites interbedded within the Val Lavagna Formation). It is proposed that the relative positions of the highest tectonic units outcropping in the Emilian Apennines (i.e. Gottero, Media Val Taro and Cassio Units) during Late Cretaceous were not very different to the present setting, and that their tectono-stratigraphic evolution was related to Alpine-vergent accretionary wedges. The Alpine tectonic polarity should have controlled the westwards migration of the basinal depocentres and the evolution from the Adriatic-margin supply of the Cenomanian turbidites to the European-margin supply of the Maastrichtian turbidites. During the middle Eocene tectonic phase, before the counterclockwise apenninic rotation, the ophiolite-free Cretaceous Ligurian Units (i.e. Gottero, Media Val Taro, Cassio) overthrusted the Ligurian Units characterized by late Cretaceous ophiolitic detritus, known as Ottone and Caio Units, along a significant lithospheric discontinuity which acted as a transpressive fracture zone.&nbsp

Large-scale geomorphological mapping as a tool to detect structural features: the case of Mt. Prinzera ophiolite rock mass (Northern Apennines, Italy)

This paper presents a geomorphologic map of the Mt. Prinzera ultramafic rock complex (Parma Province, Emilia-Romagna Region, Italy) mapped at large scale (1:2500). The map is the first contribution to the detailed geomorphologic knowledge of the area within the framework of a multidisciplinary approach used to analyse Mt. Prinzera as a hard rock aquifer case study. The geomorphologic mapping was carried out by field survey and aerial photograph analysis. All the surface processes and landforms were considered, with particular attention to structural geomorphologic features. The mapping of linear morphologic features was considered useful for revealing the presence of sets of joints otherwise difficult to detect due to surface weathering. Sets of rock discontinuities are important for water seepage and percolation and their identification is crucial for developing the hydrogeological conceptual model of the aquifer

Lower Oligocene thrust-system in the epi-Ligurian succession: evidence from the Enza Valley (northern Apennines, Italy)

Abstract Within the lower part (Upper Eocene-Oligocene) of the epi-Ligurian succession, outcropping in the Emilian side of the northern Apennines (Enza Valley), duplications by thrust tectonics were recognized through the systematic integration of field geology with calcareous nannofossil biostratigraphy. This thrust system, derived from the overthrusting of two thrust-sheets over a footwall, is unconformably overlain by a Rupelian succession. The thrust structure of the Enza Valley, affected by a subsequent wide overturned syncline together vith the unconformable succession, shows a remarkable Lower Oligocene contractional tectonics, previously not recognized in the northern Apennines. The comparison of this thrust system with other outcropping areas of the epi-Ligurian succession makes probable the wide-spread occurrence of the Lower Oligocene tectonics in the uppermost structural levels of the chain (epi-Ligurian domain). In a regional tectonic framework, the Rupelian thrust tectonics affecting the epi-Ligurian succession can be related to the Lower Oligocene closure of the innermost portion of the Subligurian basin (Aveto-Petrignacola Formation) due to the NE-verging overthrusting of the External Ligurian Units. In this context the unconformable succession of the Enza Valley seems correlable with the basal portion of the Subligurian Eratica Sandstone (Rupelian-Chattian) which unconformably overlies a deformed substratum (Mesoalpine Phase)

Effects of zoledronic acid and dexamethasone on early phases of socket healing after tooth extraction in rats : a preliminary macroscopic and microscopic quantitative study

The exact pathogenesis of medication-related osteonecrosis of the jaw (MRONJ) is still unknown. The aim of this paper was to investigate the effects of zoledronic acid and dexamethasone on the early phases of socket healing in rats subjected to tooth extractions. Thirty male Sprague-Dawley rats were divided into 2 groups: pharmacologically treated group (T, n=20) and non-pharmacologically treated group (C, n=10). T group rats received 0.1 mg/Kg of zoledronic acid (ZOL) and 1 mg/Kg of dexamethasone (DEX) three times a week for 10 consecutive weeks. C group rats were infused with vehicle. After 9 weeks from the first infusion, first maxillary molars were extracted in each of the rats. Quantitative macroscopic and microscopic analysis was performed to evaluate socket healing 8 days after extraction. Pharmacologically treated rats showed significant inhibition of bone remodeling. Connective tissue/alveolar bone ratio, osteoclast number and woven bone deposition were significantly reduced in group T compared to group C. Conversely, the proportion of necrotic bone was higher in group T compared to group C (0.8% and 0.3%, respectively. P=0.031). ZOL plus DEX do not cause gross effects on socket healing at a macroscopic level. Our findings confirmed that exposure to ZOL plus DEX impairs alveolar wound repair. Inhibition of osteoclastic resorption of socket walls after tooth extraction and the inability to dispose of the necrotic bone may be considered the initial steps of MRONJ onset

Thermal increase in the oral mucosa and in the jawbone during Nd:YAG laser applications. Ex vivo study

Objective: Literature reports bactericidal and biostimulant effects for Nd:YAG laser procedures on bone and oral mucosa but the possible overheating can cause damage to anatomical structures. The aim of the study is the evaluation of thermal increase in different levels of oral tissues: mucosa, periosteum and bone during defocused application of Nd:YAG laser at different parameters. Study Design: Superficial thermal evaluation was performed in pig jaws with a thermal camera device; deep thermal evaluation was realized by 4 thermocouples placed at a subperiosteal level and at 1,2 and 4 mm depth in the jaw bone. Laser applications of 1 minute were performed 5 times (with a pause of 1 minute) on a surface of 4 cm 2 with a Nd:YAG laser (VSP mode, 320 micrometer fiber, defocused mode) with different parameters. Temperatures were recorded before and after laser applications and after each pause in order to evaluate also the thermal relaxation of tissues. Results: At submucosal level, mean thermal increase was between 1.1°C and 13.2°C, at 1 mm depth between 1.1°C and 8.5°C, at 2 mm depth between 1.1°C and 6.8°C, at 4 mm depth between 1.0°C and 5.3°C. Temperature decrease during the rest time period was variable between 0°C and 2.5°C. Conclusions: Temperatures reached during clinical procedures with parameters reported in the literature in biostimulation protocols (1.25-2 Watts) for the five minutes of application are not dangerous for biological structures. The decrease in temperature during the rest time period is less considerable in the bone in comparison to oral mucosa

Pain and Health-Related Quality of Life After Oral Soft Tissue Surgical Interventions: The Advantages of Nd:Yag Laser

The new technology such as the neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has been used for oral soft tissue surgery. Previous study shown that laser surgery resulted in lower morbidity and complication rates. Objective: This study aims to evaluate the differences in the post-operative course associated to the use of Nd:YAG laser and to cold blade after oral soft tissue surgery. Methods: One-hundred and eighteen comparable surgical interventions were evaluated. Group 1 (G1) included 77 interventions performed with Nd:YAG laser; group 2 (G2) 41 with cold blade. Acute post-operative pain was evaluated with visual analogue scale (VAS), numeric rating scale (NRS) and verbal rating scale-6 (VRS-6) on the same day of surgery, and at 1, 3 and 7 days after surgery.The HRQoL was evaluated on day 7 using a 0-45 score range questionnaire. Data were analyzed using the software STATA 12 (StataCorp LP, College Station, Texas, USA). Results: No statistically significant differences could be highlighted in VAS and NRS scores. The VRS-6 scores resulted statistically significant at days 1 and 3. At day 1, 47.14% of patients in G1 and 13.16% in G2 had no pain; at day 3, 62.86% in G1 and 21.05% in G2 had no pain. The HRQoL in G1 was statistically higher than G2. Conclusion: The better HRQoL and the lower post-operative pain observed in laser-treated patients may be associated to the possible bio-modulating effect of the laser

Surgical Approach and Laser Applications in BRONJ Osteoporotic and Cancer Patients

Bisphosphonates-related Osteonecrosis of the Jaw (BRONJ) has been reported with increasing frequency in literature over last years, but its therapy is still a dilemma. One hundred ninety patients affected by BRONJ were observed between January 2004 and November 2011 and 166 treated sites were subdivided in five groups on the basis of the therapeutical approach (medical or surgical, traditional or laser-assisted approach, with or without Low Level Laser Therapy (LLLT)). Clinical success has been defined for each treatment performed as clinical improvement or complete mucosal healing. Combination of antibiotic therapy, conservative surgery performed with Er:YAG laser and LLLT applications showed best results for cancer and noncancer patients. Nonsurgical approach performed on 69 sites induced an improvement in 35 sites (50.7%) and the complete healing in 19 sites (27.5%), while surgical approach on 97 sites induced an improvement in 84 sites (86.6%) and the complete healing in 78 sites (80.41%). Improvement and healing were recorded in 31 (81.5%) and 27 (71.5%) out of the 38 BRONJ sites treated in noncancer patients and in 88 (68.75%) and in 69 (53.9%) out of the 128 in cancer patients

Large-sized pleomorphic adenoma of the cheek treated with Nd:Yag laser : report of a case and review of the literature

Pleomorphic adenoma (PA) mostly involves parotid glands, while extra-parotid localizations are relatively uncommon. Particularly, PAs of the cheek minor salivary glands with a size larger than 4 cm are exceedingly rare, with only few cases reported. Surgical treatment of PA usually consists in radical excision. However, despite a presumptive radicality, recurrences, sometimes followed by malignant transformation, may occur. Here we report a case of a large-sized (6 cm) PA of the cheek minor salivary glands in a 70 year-old female patient, successfully treated through a conservative approach, based on the use of Nd:YAG Laser (?=1064 nm). No recurrences were observed after a 2-year follow-up. A concise review of the literature, describing the features of 14 cases is also provided. Advantages of laser treatment include a precise cut, reduction of trauma on surrounding tissues, the possibility of a very good intraoperative hemostasis. Such features may sometimes allow to avoid general anesthesia, even for removal of big lesions. Post-operative course, in terms of pain and swelling, is usually better for intervention performed with laser, when compared to traditional surgery