Background: Ameloblastic carcinoma (AC) is a rare malignant odontogenic tumor with limited knowledge surrounding its pathogenesis, molecular pathways, clinical behavior, treatment, and prognosis. This 40-year literature scoping review aims to enhance the comprehension of this complex condition, looking closely at how AC works at molecular and pathophysiological levels and what causes it to develop. Methods: The PUBMED, Medline, Scopus, and Cochrane central databases were searched, including articles from 1984 to date. Articles reporting epidemiological, clinical, instrumental, and histopathological data were included. Results: Out of the 375 articles examined, 52 met the inclusion criteria, yielding a total of 80 cases of AC. All cases before 1984 were excluded from the analysis, as were all that did not provide information on patient survival. Several molecular mechanisms associated with its development and progression were identified; these help in early diagnosis. Moreover, AC can spread locally, making a radical surgical approach necessary. There is still no agreement on how to manage neck dissection. Surgical removal followed by monitoring is an important part of managing AC. Conclusions: Advancements in biological and molecular insights have the potential to facilitate earlier diagnosis and treatment. These could lead to improvements in patients’ quality of life and long-term survival.

Background: Facial nerve injury (FNI) is the most common complication of parotid surgery and manifests as FN paralysis. The use of intraoperative facial nerve monitoring (IFNM) is becoming an established intraoperative aid for surgeons, assisting in the identification of the location and dissection of the facial nerve trunk or branches. The postoperative outcomes of parotid surgery with and without monitoring have been addressed in only a limited number of studies. Objective: The objective of this study is to evaluate the incidence of postoperative paralysis in patients undergoing extracapsular dissection (ED) for benign parotid tumors concerning the use or non-use of IFNM. Materials and Methods: The retrospective study was conducted at the Maxillo-Facial Department of the Magna Graecia University of Catanzaro. The patients were divided into two groups: Group 1 consisted of patients who underwent surgery without IFNM (1 January 2015 to 31 December 2018); Group 2, on the other hand, consisted of patients who underwent surgery with IFNM (1 January 2019 to 31 December 2022). Group 2 employed the Nerve Integrity Monitor (Medtronic’s NIM^®). To classify the FN function, we employed the modified House–Brackmann classification system. To evaluate the dependence between the “use of IFNM” and “postoperative paralysis”, a descriptive analysis was conducted, including applying the Chi-squared test and calculating the Pearson correlation. Subsequently, a binary logistic regression model was applied to further evaluate the correlation between the latter. The level of statistical significance was set at p < 0.05. Results: A total of 276 patients were included in the study: 120 subjects were assigned to Group 1 (43.5%, comprising 60 men and 60 women) and 156 subjects were assigned to Group 2 (56.5%, comprising 93 men and 63 women). In 91.7% of the cases (n. 253, precisely 105 in Group 1 and 148 in Group 2), no FNI occurred. In 8.33% of the cases (n. 23, specifically 15 in Group 1 and 8 in Group 2), postoperative paralysis was observed. Of these subjects, only two in Group 1 had permanent paralysis (8.69%); therefore, 91.31% had transient paralysis. As a result, 91.31% of the subjects exhibited transient paralysis. In the case of FNI, 78% of the cases involved the marginal mandibular branch (n. 18), 13% involved the temporo-zygomatic branch (n. 3), and 7% involved more than one branch (n = 2). The results of the multivariable binary logistic regression analysis demonstrated that the use of IFNM was a statistically significant influencing factor, with an estimated reduction in postoperative paralysis of approximately 62% (OR 0.378; 95% CI: 0.155–0.92). In Group 2, the occurrence of transient complications was significantly reduced (OR 0.387; 95% CI: 0.149–1.002 with p < 0.05). Discussion and Conclusions: The use of IFNM in the ED for benign parotid tumors significantly reduces the rate of FNI and, consequently, postoperative FN paralysis. On the other hand, the use of monitoring systems must not replace the experience and anatomical knowledge of the surgeon.

Background: The use of intraoperative facial nerve monitoring (IFNM) is becoming more and more frequent, an established intraoperative aid in parotid gland surgery. To date, there are no scientific studies in the literature on the post-operative outcomes of submandibular gland surgery, in particular on post-operative injury of the marginalis mandibulae branch (MMB) that represents the most frequent and feared complication of this surgery, with an incidence of 1-7% of cases . Objective: In this retrospective study, the authors evaluated the incidence of postoperative paralysis of the MMB of the facial nerve (FN )in patients undergoing submandibular sialodenectomy for benign diseases, such as benign tumors and sialolithiasis, from 2014 to 2023, with particular attention to the role of IFNM in this context. Materials and Methods: The retrospective study was conducted at the Maxillo-Facial Department of Magna Graecia University of Catanzaro. The patients were divided into two groups: Group 1 (G1) consisted of subjects who underwent surgery without the use of IFNM and identification and clamping of facial vessels (1 January 2014 to 31 Dicember 2018); Group 2 (G2), consisted of subjects who underwent surgery with IFNM and without identification and clamping of facial vessels (1 January 2019 al 31 Dicember 2023). In G2 employed the Nerve Integrity Monitor (NIMR di Medtronic) and to classify the FN function we used the modified House-Brackmann classification. A descriptive analysis was performed, and univariate and multivariate logistic regression were used to examine the impact of IFNM on surgical timing and the association between deficit of G2 (vs. G1) adjusted for age, sex, smoking status for age, sex, smoking status. The level of statistical significance was set at p value<0.05. Results: A total of 101 patients were included in the study: 50 subjects were assigned to G1 (49.5%, comprising 24 female and 26 male, and 51 subjects were assigned to G2 (50.5%), comprising 21 men and 30 women, the mean age was 55 ± 16 years in the entire patient cohort. In 77% of the cases (n. 78, precisely 38 in G1 and 40 in G2), no facial nerve injury occurred. In 23% of the cases (n. 23, specifically 12 in G1 and 11 in G2), postoperative paralysis of MMB was observed. Of these subjects, nobody had permanent paralysis but only transient dysfuction (of the 12 patients of G1 four demonstrated grade I dysfunction while eight exhibited grade II dysfunction, of the 11 subjects of G2, eight exhibited grade I dysfunction, while three demonstrated grade II dysfunction). After six months the dysfuction of grade II persisted only in five patients of G1. The results of univariate and multivariable linear regression demonstrated that the surgical timing was found to be 99 ± 44 minutes considering the entire cohort of patients, 110 ± 43 minutes for G1 and 92 ± 42 minutes for G2 (Beta = -19, 95% CI -37 to -0.16 and p = 0.048). A longer surgical timing was observed compared to non-smokers (always statistically significant with a p-value of 0.008), suggesting that smoking status may influence the duration of the intervention (Beta = -0,32, 95% CI -0,08 to -0.55 and p = 0.008) . Discussion and Conclusions: MMB paralysis represents one of the most frequent complications that can occur also in submandibular gland surgery and IFNM offers to the surgeon a valuable support in identifying the MMB in submandibular sialadenectomy. T he use of IFNM can be a valid aid, but its effectiveness always depends on the competence but its effectiveness always depends on the competence of the surgeon.

Background: Intraoperative facial nerve monitoring (IFNM) is becoming increasingly prevalent as an established intraoperative aid in parotid gland surgery. To date, however, there are few scientific studies on the postoperative outcomes of submandibular gland surgery, particularly on the postoperative injury of the marginalis mandibulae branch (MMB) of the facial nerve (FN). This branch represents the most frequent and feared complication of this surgery, with an incidence of 1–7% of cases. Objective: This retrospective study aims to evaluate the incidence of postoperative MMB paralysis in patients undergoing submandibular sialoadenectomy for benign conditions from 2014 to 2023, focusing on the role of IFNM. Materials and Methods: The patients were divided into two groups: the subjects of Group 1 (G1) had undergone submandibular sialoadenectomy after identification and clamped facial vessels, without the aid of IFNM (from 1 January 2014 to 31 December 2018). Conversely, subjects in Group 2 (G2) underwent IFNM procedures (from 1 January 2019 to 31 December 2023). The classification of any FN malfunctions was conducted following the House–Brackmann grading system. A descriptive analysis was performed, and univariate and multivariate logistic regressions were used to examine the impact of IFNM on surgical timing and the association between G2 deficit (vs. G1) corrected for age, sex, and smoking status. Results: The study population comprised a total of 101 patients with a mean age of 55 ± 16 years. The sample population comprised 50 subjects assigned to Group 1 (49.5%, 24 females and 26 males) and 51 subjects assigned to Group 2 (50.5%, 21 males and 30 females). Postoperative paralysis of the MMB occurred in 23 subjects (22.77%), including 12 of G1 (4 had a grade II and 8 grade III dysfunction) and 11 of G2 (8 had a grade II and 3 grade III dysfunction). A six-month evaluation revealed that only five patients in G1, previously diagnosed with grade II dysfunction, exhibited a residual deficit. The mean surgical time for the entire patient cohort was 99 ± 44 min: 110 ± 43 min for Group 1 and 92 ± 42 min for Group 2 (Beta = −19; 95% CI −37 at −0.16; p-value = 0.048). Furthermore, a longer operative time was observed in smokers than in non-smokers (p-value = 0.008), suggesting that smoking affects the length of surgery (Beta = 0.32; 95% CI −0.08 to −0.55). Discussion and Conclusions: MMB paralysis is one of the most prevalent complications that may arise in submandibular gland surgery. IFNM provides surgeons with a valuable tool for identifying MMB in submandibular sialoadenectomy. The efficacy of IFNM as an aid is contingent upon the expertise of the operating surgeon.