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Carcinoma ex pleomorphic adenoma is not common among malignant salivary tumors and an accessory lobe of parotid gland tumor with a carcinoma ex pleomorphic adenoma histology is even rarer. Management of these tumors include a high index of suspicion, good understanding of the anatomy and a meticulous surgical access. The exceptional localization of an ossified Carcinoma ex Pleomorphic Adenoma in the accessory lobe of the parotid gland, never reported to date in the literature, has prompted us to report this case to stress the challenging difficulties related to clinical and histologic diagnosis and to analyze a minimally invasive intraoral approach. Carcinoma ex pleomorphic adenoma is not common among malignant salivary tumors and an accessory lobe of parotid gland tumor with a carcinoma ex pleomorphic adenoma histology is even rarer. Management of these tumors include a high index of suspicion, good understanding of the anatomy and a meticulous surgical access. The exceptional localization of an ossified Carcinoma ex Pleomorphic Adenoma in the accessory lobe of the parotid gland, never reported to date in the literature, has prompted us to report this case to stress the challenging difficulties related to clinical and histologic diagnosis and to analyze a minimally invasive intraoral approach.

Highlights • In COVID-19 era, the aim of our effort is to guarantee high-quality and timely oncologic care, minimizing infection risk. • Microvascular flaps, reported to be the gold standard for reconstruction, require an extended resource allocation not affordable in this period. • We are obliged to define a paradigm shift in our approach, based on propeller flap. • This surgical technique could represent a reconstructive landmark in COVID-19 era, besides head and neck reconstructive surgery is most likely heading towards a new reconstructive approach., In COVID-19 pandemic era, one major concern is related to ensure optimal management to oncologic patients, even though a context of radical uncertainty. The aim of our effort is to guarantee high-quality and timely care, minimizing COVID-19 infection risk, according to our head and neck (HN) reconstructive mission, still more challenging because of the criticality of the period. Thus, our reconstructive decision algorithm is changed. Microvascular free flaps, reported to be the gold standard for surgical reconstruction, represent extremely specialized procedures necessitating an extended resource allocation not affordable in the adversities of the period. Therefore, we are obliged to define a paradigm shift in our approach, based on free-style reconstructive surgery principles of propeller flap concept. According to our experience, we believe that this viable and feasible surgical technique could represent a reconstructive landmark in this pandemic era, since any guideline is missing, besides HN reconstructive surgery is most likely heading towards a new reconstructive approach.

Invasive local procedures are often reported in clinical history of patients suffering from Bisphosphonates-Related Osteonecrosis of the Jaws (BRONJ) but over 40% of spontaneous forms have been also described in literature. We compared age, gender, underlying bone disorders, bisphosphonate therapy, clinical features and surgical outcome of 205 cases (36.2%) of BRONJ non surgery-triggered (group 1) with 362 (63.8%) cases of surgery-triggered forms (group 2). Differences between group 1 and 2 were analysed using Mann-Whitney U and χ2 tests. Statistical analysis was performed using STATA 8. Zoledronate was the most used type of bisphosphonate (63.4% versus 69.0%) and the mandible was the most frequently involved site (63.9% versus 63.4%) in both groups. BRONJ in group 1 was more frequently multicentric (9.3% versus 5%, p < 0.05), had a lower clinical stage (45.9% versus 13.8% in stage 1, p < 0.01) and had a better outcome after surgical therapy (improvement in 74.1% versus 58.6%, p < 0.05). The high prevalence of non surgery-triggered forms of BRONJ should be considered by oncologists, haematologists and general physicians who are advised to inform their patients regarding the importance of preventive dental protocols to control the possible causes of osteonecrosis not related to dental invasive procedures. © 2010 Elsevier Ltd. All rights reserved.

The purpose of the survey was to assess through a mailed questionnaire the knowledge, attitudes, and behaviors regarding oral cancer and their relationship with different indicators in a random sample of 1000 dentists in Italy. Respondents know the major risk factors and only half identify the diagnostic procedures. One-third indicated the most common form and the early lesions and this knowledge was more likely in those graduated from dental school and attended a course on oral cancer in the previous year. Approximately two-thirds (64.8%) believed that they were prepared to perform an oral cancer examination and to palpate lymph nodes in patients' necks. Multiple logistic regression revealed that this positive attitude was significantly higher for those who graduated from medical school and for those who have attended a course on oral cancer in the previous year. Half of the dentists routinely perform an oral cancer examination on all patients and it was more likely by those graduated from dental school, those who know that squamous cell is the most common form of oral cancer and that an early oral cancer lesion usually is a small, painless red area, those who believed that they are prepared to perform an oral cancer examination and to palpate lymph nodes in patients' necks, those who have attended a course on oral cancer in the previous year, and those who claim they need information. The importance of health care professionals as communicators of public health messages should be emphasized.

a Department of Oral Sciences, University of Palermo, Via del Vespro 129, Palermo 90127, Italy b Department of Microbiology, University of Palermo, Via del Vespro 133, Palermo 90127, Italy c Department of Head and Neck Pathology, II University of Napoli Piazza Miraglia, 80100, Italy d Department of Biomedical sciences and Human Oncology, Section of Oral Medicine, School of Medicine and Dentistry, University of Turin, Corso Dogliotti, 14, Torino 10126, Italy e Department of Dentistry and Surgery, Pizza G. Cesare 11, Bari 70124, Italy