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We report a case of a 37-year-old caucasian woman presenting a 1 cm pinkish nodular asymptomatic lesion of the hard palate, slowly growing in the last years. The lesion underwent to biopsy. Histological analysis showed the nevus tissue layered under a continuous squamous epithelium. The stroma contained nests of medium-sized round cells, with regular monomorphous nuclei. The nevus cells were immunohistochemically positive for S-100 protein, while melanin, visualized by Masson-Fontana silver staining, was absent. Therefore a diagnosis of non pigmented melanocytic nevus was formulated. Because of its rarity and to avoid any risk of malignant transformation, a surgical treatment with wide excision was chosen; the surgical wound was previously covered with a membrane of fibrin and autologous platelets, and subsequently sutured, resulting in a total heal. This procedure seems to be the most reliable to approach melanocytic lesions of the oral cavity. Clinical diagnosis of non-pigmented nevi, either flat or protruding, is difficult, because the nevus shows a pinkish colour that is indistinguishable from that of the surrounding mucosa. Moreover, attention is required when similar clinical evidence occurs, because the localization inside the oral cavity may offer several problems of differential diagnosis.

Fibrolipomas are benign mesenchymal neoplasms of the fatty tissue rarely encountered in the oral cavity. They account for around 1% to 5% of all neoplasms affecting the mouth and occur as raised, slow-growing, painless lesions of normal or yellow coloration and uncertain etiology. In contrast, mucus retention cysts are epithelium-lined cavities originated from a salivary gland. They are also raised, asymptomatic, slow-growing lesions, located on the floor of the mouth, buccal mucosa and lips. This article reports a diagnostic and a surgical treatment of a rare fibrolipoma case associated with a mucus retention cyst located in the palate.

Hobnail hemangioma (HH) is a rare benign vascular neoplasm reported as a distinctive small benign, solitary vascular neoplasm of the superficial and mid-dermis occurring on the face, trunk, or extremities of young or middle-aged adults. The oral manifestations are quite uncommon, with only three cases reported in the English language literature. The following case refers to a 38-year-old woman with a small nodule on the hard palatal mucosa. Histological findings showed a biphasic growth pattern of irregularly dilated vascular structures in the superficial mucosa, lined by epithelioid endothelial cells with a hobnail appearance, with neoplastic vessels observed in deeper parts of the lesion. In the oral cavity, the differential diagnosis includes hemangioma, melanoma, and Kaposi's sarcoma, whose clinical and histological features may be confused with those of HH.

The neurofibroma is a benign tumor of neuronal origin not frequently located in the oral cavity. The possible association of this neoplasia with systemic pathologies, such as Von Recklinghausen's disease and multiple endocrine neoplasia, makes its diagnosis fundamental. The diagnosis is, in most cases, quite complex, because of the neurofibroma's strong similarities with a great number of benign neoformations of the connective tissue, of the epithelium, and of the bone. The histology represents, therefore, the fundamental diagnostic criterion, in particular, through the use of appropriate immunohistochemical analysis. This articles presents the case of a solitary neurofibroma, subtype I (common Schwann cell type), detected on the left-hand side of the posterior region of the palate in a 56-year-old woman, which presented itself as an otherwise non-symptomatic ulcerated mass. After a careful anamnesis, an incisional biopsy was performed in order to establish the histological nature of the neoformation. The immunohistochemical test, which resulted positive for S-100 and negative for the epithelial membrane antigen and keratin, allowed the diagnosis of a presumably benign lesion deriving from a neural differentiation. The surgical excision of the entire mass was accompanied by the extraction of the upper left-hand second molar, which was attached to the mass through its palatal root.

In Summer 2002, a patient with frequent epistaxis was admitted to the San Gerardo Hospital. Local examination showed a big mass in the nasal fossa. TC and RMN revealed a diffuse erosion of the palatal bone and infiltration of the maxilla. The tumor was removed and histological examination showed a gland carcinoma. The young age of the patient and the need of an adequate bone reconstruction led to use osteoperiosteal calf bone graft. Subsequently, using local anesthesia, 6 implants were positioned. After normal healing and the period of osteointegration, a Toronto bridge was made on implants that the patient wears with no problem.

This paper illustrates the clinical findings and aims at report surgical matters observed in 2 patients affected by neurofibromatosis type I with a rare palatal localization. By means of retrospective analysis 2 cases of neurofibromatosis type I with a palatal mass are selected. Both cases were surgically treated and underwent 12 months follow-up. Patients underwent surgical removal of the palatal neurofibroma. At 12 months follow-up a good local condition without any recurrence was observed. Malignant transformation was very rarely reported in oral neurofibromata and can follow incomplete removal. Surgical treatment of neurofibromata requires the sacrifice of the nerve trunk from where they originate, together with the complete removal of the mass with security margins. Therefore, risks and benefits from surgery should be carefully weighted in each patient and where surgery is not performed clinical and radiographic trials are advisable.

Surgical functional reconstruction after partial maxillectomy with fibula free flap. A bilateral upper alveolar bone, gingival and palatal defect after tumor resection, has various problems originating from reconstruction with prosthesis or temporalis muscle flap. We report a secondary reconstructive procedure using the fibula osteocutaneous free flap. The combined bone segments created the upper alveolar arch, and the skin paddle closed the palatal defect. This procedure restored the patient to masticatory function of the upper jaw, intelligible speech and natural facial appearance. As a result quality of life of patient was extremely improved.

Unlabelled: Warthin's tumor (papillary cystadenoma lymphomatosum) primarily involves the parotid gland, whereas localization in the palate has been reported by a few authors. A new case of true Warthin's tumor arising from the hard palate is here presented and histogenesis and differential diagnosis are briefly discussed., Case Report: A 50 year-old woman who was referred to us because of the presence of multiple contiguous bluish cyst-like lesions involving both sides of the hard palate mucosa. The lesion was removed with a wide excision involving almost all the soft tissues of the hard palate. Histologic diagnosis (E.E stain) was: papillary cystadenoma lymphomatosum., Discussion and Conclusion: The histogenesis of Warthin's tumor is still controversial. The most widely accepted theory is that the tumor represents a neoplastic proliferation of salivary gland ducts entrapped in pre-existing lymph nodes. In fact, immunohistochemical analysis and cell-surface markers studies have shown that the lymphoid component is predominantly formed by T-lymphocytes, with a relatively small number of polyclonal B-lymphocytes. On the contrary, other authors found opposite relationship between T and B lymphocytes. These findings supported the concept that lymphoid tissue in Warthin's tumor represented a reactive cellular infiltrate in a pattern similar to that seen in reactive lymph nodes. Similar results have been found in this report; moreover, the hard palate does not usually contain lymphatic tissue. This could support the idea that the lymphoid tissue associated with this case is reactive and a direct origin from the ductal epithelium with secondary lymphocytic infiltration is more likely to occur in this area.

Oral malignant melanoma is a rare lesion; overall prognosis remains poor despite more radical surgery with adjuvant radiotherapy chemotherapy and immunotherapy. This article describe the therapeutic approach in two cases of malignant melanoma of the hard palate. The surgical treatment provides an "en bloc" resection of the palate and of the upper alveolar crest with clear margins. The use of orthognatic surgical procedures with an oral access avoids cutaneous incisions and affords conservative but complete resection.

Having analysed the causes which lead to the loss of substance from the palatal vault, the different types of communication which then result, their evolution and the consequent functional defects are identified. By describing a complex clinical case, and having taken into consideration both aims and materials, the techniques of prosthetic rehabilitation are illustrated using obturator devices. The results of the various phases are examined.

A review of the literature showed statistical data that were not always in agreement because of the different disciplines--stomatological and oncological--of the authors. A clinical case of mixed tumour of the palate of unusual dimensions is reported. This brought problems in removal and plastic surgery of the palate.