Application of direct oral microscopy in evaluating mucosal margins around invasive oral squamous cell carcinoma.

INTRODUCTION: Direct oral microscopy constitutes a novel, non-invasive diagnostic technique, which aids clinical examination of the oral cavity. The oral mucosa is examined at multiple magnifications and features such as sub-epithelial mucosal vessels, surface patterns, colour tone, transparency and the exact demarcation of mucosal lesions are estimated. The incidence of oral squamous cell carcinoma (OSCC) oscillates between 1.9% and 3.5%, which makes it the eighth most common carcinoma occurring around the world and in Poland. The 5-year survival rates oscillate between 20% and 30%. AIM: The aim of the study was to evaluate clinically unchanged mucosal margins around OSCC by direct oral microscopy. The authors approached the question whether the borders of mucosal margins around OSCC established via direct oral microscopy differ from those established based on clinical examination. MATERIAL AND METHODS: Fifteen patients diagnosed with OSCC were enrolled. Patients were first clinically examined to evaluate the extent of the tumour and to plan resection margins. Eventually, direct oral microscopy was performed to establish the width of the subclinically unchanged mucosal margins based on a standard picture of healthy oral mucosae, followed by comparison with those established by clinical evaluation. RESULTS: Histopathologic results of biopsies from areas indicated by direct oral microscopy revealed dysplasia in 86.7% of patients, whereas biopsies from areas indicated by clinical examination revealed dysplasia only in 40% of individuals, resulting in the need for widening of mucosal margins. CONCLUSIONS: Direct oral microscopy enables detection of dysplasia within clinically unaltered mucosal margins around OSCC, which results in more precise establishing of resection boundaries, contributing to improvement of resection totality.

Clinical diagnosis of oral erosive lichen planus by direct oral microscopy.

INTRODUCTION: Direct oral microscopy is a novel, non-invasive diagnostic technique that aids clinical examination of the oral cavity. The basic principles of this method derive from colposcopy and dermoscopy. The principle is to reveal precancerous lesions of oral mucosae in their subclinical phase in order to begin their treatment as early as possible and prevent malignant transformation. Oral lichen planus (OLP) is an autoimmune, inflammatory, chronic disease affecting oral mucous membranes. Buccal mucosae are most often affected. AIM: To describe the in vivo picture of erosive OLP in direct oral microscopy in terms of the pattern and density of subepithelial blood vessels, surface texture, color, transparency and borders of the lesions. The study also demonstrates the utility of the method in the selection of the most appropriate biopsy site. MATERIAL AND METHODS: A total of 30 patients with erosive OLP were examined. Clinical examination of the oral cavity with the naked eye was performed, followed by direct oral microscopy. The most appropriate biopsy sites based on both examinations were chosen for every individual and biopsies were taken for histopathological evaluation. RESULTS: Biopsies obtained based on direct oral microscopy revealed dysplasia in 16 patients (53.3%). Biopsies obtained based on clinical examination with the naked eye revealed dysplasia in 3 cases (10%). CONCLUSIONS: Direct oral microscopy makes it possible to obtain a repeated picture of erosive OLP and constitutes an alternative to the clinical examination with the naked eye in election of the most appropriate biopsy site. Thus, introduction of the most accurate and early therapy is possible.

A Comparison of the Specific Facial Trauma Cases at the Department of Maxillofacial Surgery, Gdansk, Poland, from March 2019 to August 2023.

Background: Accidents involving the maxillofacial area are sudden and unforeseen, such as traffic accidents and physical altercations. The COVID-19 pandemic was a critical threat to the public in aspects not only involving physical health but also those affecting psychological health due to isolation, leading to a higher incidence of stress and depression among the general population and specifically in patients with OMF trauma. This study assessed the relationship between the impact of the COVID-19 pandemic and the quantity and severity of maxillofacial injuries. Methods: Data were retrieved from the Department of Maxillofacial Surgery of the University Clinical Centre in Gdansk from March 2019 to August 2023. Results: There was an increased risk of injury occurrence to the condylar process of the mandible, especially the left side, Le Fort type II/III fractures, injuries of the maxillary alveolar process, and displacement of the upper facial mass. Simultaneously, a decreased occurrence of certain injuries i.e., Le Fort type III fractures and Le Fort type I/II fractures, was recorded. Conclusions: The COVID-19 pandemic led to an increased occurrence of high-energy injuries, including displacement of the upper facial mass (p = 0.010).

Bone Metabolism and Dental Implant Insertion as a Correlation Affecting on Marginal Bone Remodeling: Texture Analysis and the New Corticalization Index, Predictor of Marginal Bone Loss-3 Months of Follow-Up.

Background/Objectives: The general condition of implantology patients is crucial when considering the long- and short-term survival of dental implants. The aim of the research was to evaluate the correlation between the new corticalization index (CI) and patients' condition, and its impact on marginal bone loss (MBL) leading to implant failure, using only radiographic (RTG) images on a pixel level. Method: Bone near the dental implant neck was examined, and texture features were analyzed. Statistical analysis includes analysis of simple regression where the correlation coefficient (CC) and R2 were calculated. Detected relationships were assumed to be statistically significant when p < 0.05. Statgraphics Centurion version 18.1.12 (Stat Point Technologies, Warrenton, VA, USA) was used to conduct the statistical analyses. Results: The research revealed a correlation between MBL after 3 months and BMI, PTH, TSH, Ca2+ level in blood serum, phosphates in blood serum, and vitamin D. A correlation was also observed between CI and PTH, Ca2+ level in blood serum, vitamin D, LDL, HDL, and triglycerides on the day of surgery. After 3 months of the observation period, CI was correlated with PTH, TSH, Ca2+ level in blood serum, and triglycerides. Conclusion: The results of the research confirm that the general condition of patients corresponds with CI and MBL. A patient's general condition has an impact on bone metabolism around dental implants. Implant insertion should be considered if the general condition of the patient is not stable. However, CI has not yet been fully investigated. Further studies are necessary to check and categorize the impact of corticalization on marginal bone loss near dental implants.

New Radiological Corticalization Index as an Indicator of Implant Success Rate Depending on Prosthetic Restoration-5 Years of Follow-Up.

The new Radiological Corticalization Index (CI) is an indicator that describes bone remodeling near the dental implant's neck at the pixel level and is not visible to the naked eye. The aim of this research was to evaluate the correlation between the CI and bone remodeling using only radiographic (RTG) images. RTG samples were divided into groups depending on prosthetic restoration; the implant neck area around dental implants was examined, and texture features of the RTG images were analyzed. The study also investigated the type of prosthetic restoration and its influence as a factor on bone structure. The statistical analysis included evaluating feature distribution, comparing means (t-test) or medians (W-test), and performing a regression analysis and one-way analysis of variance or the Kruskal-Wallis test, as no normal distribution or between-group variance was indicated for the significant differences in the investigated groups. Differences or relationships were considered statistically significant at p < 0.05. The research revealed correlations between single crowns, overdenture restoration, bridge restoration, platform switching, prosthetic fracture, CI, and also marginal bone loss where p was lower than 0.05. However, the corticalization phenomenon itself has not yet been fully explored. The findings suggest that, depending on the type of prosthetic restoration, the corticalization index may correlate with marginal bone loss or not. Further research is necessary, as the index is suspected to not be homogeneous.

Epidemiology, etiopathogenesis, and management of MRONJ: A European multicenter study.

INTRODUCTION: The purpose of this European multicenter study was to describe the general characteristics and risk factors of MRONJ lesions as well as their clinical diagnosis and management at different European Oral and Maxillofacial Surgery centers, in order to minimize selections biases and provide information about the epidemiology, etiopathogenesis, and the current trends in the treatment of MRONJ across Europe. MATERIALS AND METHODS: The following data were registered for each patient: gender; age at MRONJ diagnosis; past medical history; indication for antiresorptive or antiangiogenic therapy; type of antiresorptive medication; local risk factor for MRONJ; MRONJ Stage; anatomic location and symptoms; treatment; surgical complications; recurrence. RESULTS: A total of 537 patients (375 females, 162 males) with MRONJ were included. Statistically significant associations were found between patients with metastatic bone disease and recurrences (P < 0.0005) and between advanced MRONJ stages (stages 2 and 3) and recurrences (P < 0.005). Statistically significant associations were also found between male gender and recurrences (P < 0.05), and between MRONJ maxillary sites and recurrences (P < 0.0000005). CONCLUSIONS: A longer mean duration of antiresorptive medications before MRONJ onset was observed in patients affected by osteoporosis, whereas a shorter mean duration was observed in all metastatic bone cancer patients, and in particular in those affected by prostate cancer with bone metastases or multiple myeloma. Surgery plays an important role for the management of MRONJ lesions.

A standard picture of healthy oral mucosae by direct oral microscopy.

INTRODUCTION: Direct oral microscopy constitutes a novel technique of in vivo oral mucosae examination. The basic principles of this method derive from colposcopy and dermoscopy. The main goal of direct oral microscopy is the earliest possible detection of oral precancerous lesions in order to implement their treatment as quickly as possible and prevent malignant transformation. AIM: To establish a standard picture of healthy oral mucosae with direct oral microscopy applying standard colposcopic criteria in order to create a reference point for further diagnosis of precancerous lesions. MATERIAL AND METHODS: Thirty patients of both genders with clinically unaltered oral mucosae were examined. For every individual, clinical examination with the naked eye was performed, followed by direct oral microscopy with colposcopic assessment criteria. Oral mucosae at various sites (lip, cheek, floor of mouth, ventral and lateral sides of the tongue, alveolar ridge and soft palate) were examined. RESULTS: Subepithelial blood vessel patterns, mucosal surface, colour tone and transparency were described for healthy oral mucosae. Moreover, cases with clinically unaltered oral mucosae where direct oral microscopy revealed subclinical alterations were described. CONCLUSIONS: Direct oral microscopy with colposcopic assessment criteria enables establishment of a repeated picture of unaltered oral mucosae. The standard picture of healthy oral mucosae is an essential reference point for application of this technique to early diagnose potentially malignant oral mucosal lesions as well as apply their early treatment.

Is Corticalization in Radiographs Related to a Higher Risk of Bone Loss around Dental Implants in Smoking Patients? A 5-Year Observation of Radiograph Bone-Texture Changes.

BACKGROUND: Currently, the topic of dental implants is widely researched. However, still compromising are the factors that can affect implant loss as a consequence of marginal bone loss. One of the factors is smoking, which has a devastating effect on human health and bone structure. Oral health and jaw condition are also negatively affected by smoking. The aim of this study was to evaluate the peri-implant jawbone corticalization phenomenon in tobacco smokers. METHODS: A total of 2196 samples from 768 patients with an implant in the neck area were checked, and texture features were analyzed. The corticalization phenomenon was investigated. All analyses were performed in MaZda Software. The influence of corticalization was investigated as a factor on bone structure near the implant neck. The statistical analysis included a feature distribution evaluation, mean (t-test) or median (W-test) comparison, analysis of regression and one-way analysis of variance or Kruskal-Wallis test as no normal distribution or between-group variance was indicated for the significant differences in the investigated groups. Detected differences or relationships were assumed to be statistically significant when p < 0.05. RESULTS: The research revealed that MBL was correlated with smoking after 5 years (0.42 mm ± 1.32 mm 0 mm ± 1.25 mm), the Corticalization Index was higher in the smoker group on the day of surgery, and it became higher after 5y of observation (185.98 ± 90.8 and 243.17 ± 155.47). The implant-loss frequency was higher in the group of smokers, too, compared to non-smokers (6.74% and 2.87%). The higher the torque value during the implant placement, the higher the Corticalization Phenomenon Index. CONCLUSIONS: The research revealed a correlation between smoking and changes in bone structure in radio textures near the implants. The corticalization phenomenon is important, may be detected immediately after implant placement and may be one of the indicators of the implant success rate.

Oral squamous cell carcinoma - do we always need elective neck dissection? evaluation of clinicopathological factors of greatest prognostic significance: a cross-sectional observational study.

The aim of the study was to find clinical and pathological factors with the greatest prognostic significance in patients with OSCC. The analysis included 125 patients grouped according to the tumor primary site (TPS): the floor of the mouth (FOM), tongue (TC) and retromolar triangle (RMT). Grading (G), tumor size (pT), nodal metastases (NM), local recurrence (LR), nodal recurrence (NR), perineural invasion (PNI), lymphovascular invasion (LVI), extranodal extension (pENE), and nodal yield (NY) were evaluated in each group. Results: With regard to TPS, FOM appeared to be the most metastatic. However, the recurrence rate was similar to TC tumors, which were characterized by higher G than those in other locations. When analyzing G, the highest percentage of LR (40.5%) and NM (34.5%) was observed among patients with G2. As G increased, so did the number of pENE G1 - 7.4%; G2 - 31%; G3 - 35.7%; LVI: G1 - 25.9%; G2 - 50%; G3 - 57.1%; PNI: G1 - 29.6%; G2 - 47.6%; G3 - 92.9%; NR G1 - 14.8%; G2 - 32.1%; G3 - 21.4%. Grading did not affect the type of growth and did not directly affect the occurrence of NR. pT and DOI increased the frequency of NM but we did not observe any effect of pT and DOI on LR, PNI, and LVI. NY in the study group did not increase the risk of NR. Conclusion: Tumor primary sites within the FOM, TC, and pT classification are the factors that increase the risk of NM and LR. However, apart from the primary site predisposing to the occurrence of NM, the histological structure of the tumor turned out to be the most important feature affecting the patient's prognosis. The number of cases of pENE+, LVI+, PNI+, NM+, and NR+ increased with the increase in G. Although the pT, DOI increased the frequency of NM, we did not observe the effect of the pT and DOI on LR, PNI and LVI. Thus, even in the case of a small tumor of the FOM and TC with at least G2, elective neck dissection should be performed each time.

Efficacy of Computed Tomography and Magnetic Resonance Imaging in the Assessment of Depth of Invasion in Oral Squamous Cell Carcinoma: Analysis of 125 Clinical Cases.

Radiological diagnosis of oral squamous cell carcinoma (OSCC) is one of the main steps in treatment planning. T (tumor size), DOI (depth of invasion) (AJCC 8th edition), and nodal metastases (N+) were evaluated using CT and MRI to assess the most effective imaging method. The effectiveness of the radiological imaging methods was compared with histopathological results. Imaging diagnostic studies were performed and retrospectively analyzed in 125 patients with OSCC (CT n = 54 and MRI n = 71). Histopathology evaluated T, DOI, and N+. The radiological T results of CT in comparison with histopathological examination showed agreement in 62.5% of cases for T1, 56.25% for T2, 25% for T3, and 42.8% for T4 (p-value = 0.07), and regarding MRI, 52.2% for T1, 36.4% for T2, 33.3% in T3, and 33.3% for T4. The DOI results of CT and MRI juxtaposed against the histopathological findings were as follows: for CT, n = 18 for DOI ≤ 10 mm and n = 36 for >10 mm; for MRI, n = 29 for DOI ≤ 10 mm and n = 42 for >10 mm (DOI CT vs. DOI hist. pat. p-value = 0.23; DOI MRI vs. DOI hist. pat. p-value = 0.006). Regarding nodal metastasis, n = 21 for N0 and n = 32 for N+ for CT (p-value = 0.02), and n = 49 for N0 and n = 22 for N+ for MRI (p-value = 0.1). In the radiological N+ group, the histopathological findings coincided with the results of MRI and CT in 27% and 62.5% of cases, respectively (N0: 83.6% for MRI; 85.7% for CT). Upon evaluating T, a decreasing percentage of overlapping results with an increasing tumor size was observed. The accuracy of both imaging studies was at a similar level, with a slight advantage for MRI. Among the patients on whom CT was performed, DOI analysis did not show statistically significant differences. This led to the conclusion that, in most cases, the DOI results based on CT overlapped with those described via histopathological examination. However, among the group of patients with MRI as the imaging method of choice, the differences proved to be statistically significant (p-value = 0.006). The results of this study indicate that CT is a more accurate method for DOI assessment. The results of the radiologic metastasis evaluation (N+ group) overlapped more in the CT group, while the percentage of corresponding results in the radiologic N0 vs. hist. pat. N0 group was high and similar in both groups. These results indicate that it is easier to confirm the absence of a metastasis than its presence.

Difficulties in diagnosing angiomatoid fibrous histiocytoma of the head and neck region: A case report.

BACKGROUND: Angiomatoid fibrous histiocytoma (AFH) is a rare, slow-growing soft tissue tumor. It appears mostly on the limbs and trunk in children and young adults. The biology of AFH remains unclear because of the small number of reported cases. Diagnostic testing does not provide definitive results. It has two clinical forms, that differ in terms of gene expression and clinical prognosis. It is important to inform the laboratory which specific gene testing is necessary. Here, we describe a case of rare AFH in the submandibular region using a full genetic panel. CASE SUMMARY: A 13-year-old boy who had been misdiagnosed in the past 6 mo by his dentist visited our clinic because of a lesion in the submandibular area on the right side. The lesion was homogeneous and painless upon palpation. No skin discoloration was observed. Due to the non-specific radiological picture computed tomography (CT), magnetic resonance imaging (MRI), cone-beam CT (CBCT), and ultrasound-guided biopsy were performed. A venous malformation was suspected on the MRI. None of the tests provided a definitive diagnosis. Owing to the non-specific radiological findings, the patient qualified for surgical treatment. The surgical procedure included an excisional biopsy. The diagnostic testing was extended using gene rearrangements. The most distinctive gene translocation in diagnosing AFH is within the EWS RNA-binding protein 1 (EWSR1)-CREB-binding protein. However, in this case, the diagnosis was confirmed by a rearrangement within the EWSR1 gene testing. CONCLUSION: AFH in the submandibular location is rare, and surgical treatment with genetic evaluation defines AFH type that affects subsequent procedures.

Intra-Articular Local Anesthetics in Temporomandibular Disorders: A Systematic Review and Meta-Analysis.

This systematic review with meta-analysis was conducted to evaluate the effectiveness of local anesthetic administration into temporomandibular joint cavities in relieving pain and increasing mandibular mobility. Randomized controlled trials were included with no limitation on report publication dates. Final searches were performed on 15 October 2023, using engines provided by the US National Library, Bielefeld University, and Elsevier Publishing House. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Articular pain and mandible abduction values and their mean differences were summarized in tables and graphs. Eight studies on a total of 252 patients evaluating intra-articular administration of articaine, bupivacaine, lidocaine, and mepivacaine were included in the systematic review. None of the eligible studies presented a high risk of bias in any of the assessed domains. An analgesic effect of intra-articular bupivacaine was observed for up to 24 h. In the long-term follow-up, there were no statistically significant changes in quantified pain compared to both the baseline value and the placebo group, regardless of the anesthetic used (articaine, bupivacaine, and lidocaine). There is no scientific evidence on the effect of intra-articular administration of local anesthesia on the range of motion of the mandible. Therefore, in the current state of knowledge, the administration of local anesthetics into the temporomandibular joint cavities can only be considered as a short-term pain relief measure.

Tobacco smoking alters the number of oral epithelial cells with apoptotic features.

Tobacco smoking is a global problem associated with the occurrence of many systemic diseases and tumors. Oral cavity tumors are common tobacco-related cancers, and of all the anatomical structures that are exposed to the effects of smoking, the oral cavity remains the least-explored area. Changes that occur in the biology of oral epithelial keratinocytes under the influence of the components of tobacco smoke often go unnoticed, if they are asymptomatic. The proper functioning of the oral epithelium is determined by the proliferation and differentiation of the cells in keratinization - the process of programmed cell death, which extends through to the mechanisms of apoptosis. Due to incomplete knowledge of the impact of tobacco smoke on the biology of keratinocytes, an evaluation of the cell cycle was conducted and the apoptosis of oral epithelial keratinocytes was analyzed. The study involved 77 patients divided into four groups according to their intensity of smoking, ranging from 0 to 27 pack-years. There were no differences in the cell count between nonsmokers and smokers in the proper cell-cycle phases. The percentage of proliferating cells in the oral epithelium is about 11%. A reduction in the number of early-apoptotic cells (caspase positive/propidium iodide negative) and an increase in the number of late-apoptotic cells (caspase positive/annexin V positive/propidium iodide positive) were observed to occur with increasing pack-years. The present study demonstrates that smoking does not affect the oral keratinocyte cell cycle, but does modify the number of cells with early and late apoptotic features. An intensification of the impact of tobacco smoke components on the biology of the oral keratinocytes is clearly noticeable at approximately 6 pack-years. This indicates that the biology of the first organ exposed to tobacco smoke - the oral epithelium - is altered by tobacco smoking.