The Prevalence and Treatment Costs of Non-Melanoma Skin Cancer in Cluj-Napoca Maxillofacial Center.

Background and Objectives: An increasing incidence of non-melanoma skin cancer (NMSC) is noted, as well as an increasing cost of the treatment, with NMSC becoming a public health problem. We aimed to investigate the prevalence and treatment costs of surgically treated NMSC from the Oral and Maxillofacial Surgery Department of Cluj-Napoca County Hospital. Materials and Methods: We retrospectively analyzed the clinical data and the charge data of hospitalization from the informatic system of Cluj-Napoca County Hospital. All patients benefited from standard surgical excision with the reconstruction of the post-excisional defect. A statistical analysis of the costs related to the patients' features, period and conditions of hospitalization, materials, medication, and paraclinical investigations was performed. Results: Between 2015 and 2019, 133 patients with NMSC were addressed to our department, with basal cell carcinoma (BCC) being four-fold higher than squamous cell carcinoma (SCC). Most NMSC cases were diagnosed in stage I or II, and they benefited from local reconstruction. The treatment costs progressively increased in the last five years, reaching a total cost of EUR ~13.000 in 2019. The treatment cost per episode was higher for SCC compared to BCC, while the total cost of treatment in 5 years was higher for BCC. Low income, immunosuppression, comorbidities, flap reconstruction option, long-lasting surgery, and prolonged hospitalization were associated with an increased cost of the treatment. Conclusion: The prevalence and treatment cost of surgically treated NMSC of the head and neck region increased in the last five years, with high-cost drivers being related to patients and treatment options.

Salivary Exosomal MicroRNA-486-5p and MicroRNA-10b-5p in Oral and Oropharyngeal Squamous Cell Carcinoma.

Background and Objectives: The research aimed at evaluating the capacity of salivary exosomal miR-10b-5p and miR-486-5p for oral and oropharyngeal cancer detection. Materials and Methods: The saliva samples were harvested from histopathological diagnosed oral and oropharyngeal squamous cell carcinoma patients and healthy volunteer subjects. The exosomes were isolated by differential ultracentrifugation and quantified by Nano Track Analysis. The microRNAs were extracted and quantified from salivary exosomes by quantitative Real-Time Polymerase Chain Reaction. Results: This research comprised fifty participants. When compared to healthy controls, salivary exosomal miR-486-5p was elevated and miR-10b-5p was reduced in oral and oropharyngeal squamous cell carcinoma. Moreover, miR-486-5p had a high expression level in stage II of cancer in comparison to the other cancer stages. The cancer samples presented an increased exosome dimension compared to the control samples. Conclusions: Salivary exosomal miR-10b-5p and miR-486-5p have an altered expression in oral and oropharyngeal cancer.

Platelet-Rich Fibrin Treatment Evaluation in Patients with Medication-Related Osteonecrosis of the Jaw and Osteoradionecrosis.

Background. Medication-related osteonecrosis of the jaw (MRONJ) and osteoradionecrosis (ORN) are associated with severe disability and continuous pain, both of which are very difficult to control. This study aims to evaluate the outcome of platelet-rich fibrin (PRF) treatment compared to iodoform gauze packing and the primary suture of oral mucosa in patients with both MRONJ and ORN. Methods. Patients suffering from MRONJ and ORN who were treated in the Oral and Maxillofacial Surgery Clinic of Cluj-Napoca in the last 10 years were selected for this study from the hospital database. Results. PRF treatment proved to be a reliable method to help heal the necrotic bone sites. High-ASA risk patients and immunosuppressed patients are more prone to recurrence and persistent signs and symptoms. Intravenous bisphosphonates produce more intense symptomatology compared to oral administration. The posterior mandible is more difficult to treat compared to other sites. Conclusions. The quality of life of MRONJ and ORN patients may be improved by a protocol that reduces pain and hospitalization.

Impact of the COVID-19 Pandemic on the Surgical Management of Head and Neck Non-Melanoma Skin Cancers in a Maxillofacial Center of Cluj-Napoca.

Background: The COVID-19 era has been a bleak period for both cancer and non-cancer patients, with delayed non-emergency treatments, such as for non-melanoma skin cancer (NMSC). This study aimed to evaluate how the treatment of NMSC patients was influenced by the management of the COVID-19 pandemic in an Eastern European Maxillofacial Surgery center. Materials and Methods: A total of 176 patients with a histopathological diagnosis of head and neck NMSC who were surgically treated in Cluj-Napoca Emergency County Hospital between 2016 and 2022 were included in this study, and divided into two samples, pre-pandemic (2016-2019) and COVID-19 (2020-2022) periods. Results: The pandemic presented with a decrease of 46.15% in patients' hospitalization, with wealthy and educated patients being prevalent. Even if the waiting time for surgery was increased, the stage of cancer and preference method for reconstruction did not differ. Despite the lower addressability of NMSC patients during the pandemic, there were no changes in surgical treatment. Conclusions: During COVID-19, the number of patients was reduced, with a longer waiting time for surgery, but without any changes in tumor stage and treatment preferences. However, the benefit of removing a cancer tumor is higher compared to the risk of developing COVID-19 infection during hospitalization.

Epidemiology and Management Paradigm of Head and Neck Infections, Including COVID-19 Pandemic Period: A 10-Year Retrospective Study in a Maxillofacial Center of Cluj-Napoca.

Background. The management of odontogenic infections varies across the globe. To shed light on the subject, this study delves into the practices of the Oral and Maxillofacial Department at Cluj-Napoca County Hospital. Material and Methods. This comprehensive retrospective analysis of 10 years of clinical experience covered a range of factors, including demographics, clinical and investigations factors, medical and surgical treatment approaches, and follow-up. Additionally, the study examined the change in trends over the course of the COVID-19 pandemic. Results. While head and neck infection occurrence had a decreasing trend before the COVID-19 pandemic, during the pandemic era the number of patients almost doubled. The infections were prevalent in the submandibular space, teeth being the prevalent cause. Young adults are prone to suffer from odontogenic infections. High levels of C reactive protein, ASA II-IV risk, and hepatic dysfunction indicated a longer time of hospitalization. The majority of antibiograms were negative, and the positive ones indicated Streptococcus and Staphylococcus species as prevalent pathogens. Extra- or intraoral surgical drainage and wide-spectrum antibiotics proved to be the workhorse for odontogenic infections. Conclusion. This study advances our understanding of oral and maxillofacial surgery and offers actionable strategies for improving patient outcomes in similar healthcare institutions worldwide.

Radical resection of mandibular ameloblastoma and functional reconstruction with a fibula free flap. Report of two cases and review of the literature.

INTRODUCTION: Ameloblastoma is a borderline bone tumor that origins from the residual epithelium of the teeth germs, the epithelium of the enamel organ or the epithelium of odontogenic cysts. Ameloblastoma management is challenging owing to the necessity of tumor radical excision and the functional and aesthetic reconstruction of the surgical defect. The fibula-free flap (FFF) provides a high-quality and predictable mandibular reconstruction due to the high-caliber vascular pedicle, the bone length that can reconstruct large defects, the possibility for implants-based prosthetic reconstruction, and the possibility of harvesting a composite flap that can replace the mucosa, hence protecting the underlying bone reconstruction. CASE REPORTS: We report adult female and elder male patients, who were addressed to our hospital for mandible swelling and histopathological results of ameloblastoma. The lesions were treated by segmental mandibulectomy and FFF reconstructions. Osteosynthesis plates and screws were enough for the female patient's reconstruction of the lateral mandible defect and a load-bearing plate was necessary for the male patient's reconstruction of the surgical defect that included the anterior part of the mandible. The facial artery was used in both cases, and the surgeries lasted approximately 8 hours. No recurrence was observed at the follow-up and the aesthetic function was well re-established. CONCLUSION: Radical treatment of ameloblastoma is mandatory. The aesthetic function could be properly maintained by FFF. Also, the FFF reconstruction is a reliable method for head and neck large bone and soft tissue defects, microvascular anastomosis on facial artery offering a good blood SUPPLY OF THE FLAP. KEY WORDS: Ameloblastoma, Fibula-free flap, Maxillofacial reconstruction, Radical treatment.

A New Detection Method of Oral and Oropharyngeal Squamous Cell Carcinoma Based on Multivariate Analysis of Surface Enhanced Raman Spectra of Salivary Exosomes.

Raman spectroscopy recently proved a tremendous capacity to identify disease-specific markers in various (bio)samples being a non-invasive, rapid, and reliable method for cancer detection. In this study, we first aimed to record vibrational spectra of salivary exosomes isolated from oral and oropharyngeal squamous cell carcinoma patients and healthy controls using surface enhancement Raman spectroscopy (SERS). Then, we assessed this method's capacity to discriminate between malignant and non-malignant samples by means of principal component-linear discriminant analysis (PC-LDA) and we used area under the receiver operating characteristics with illustration as the area under the curve to measure the power of salivary exosomes SERS spectra analysis to identify cancer presence. The vibrational spectra were collected on a solid plasmonic substrate developed in our group, synthesized using tangential flow filtered and concentrated silver nanoparticles, capable of generating very reproducible spectra for a whole range of bioanalytes. SERS examination identified interesting variations in the vibrational bands assigned to thiocyanate, proteins, and nucleic acids between the saliva of cancer and control groups. Chemometric analysis indicated discrimination sensitivity between the two groups up to 79.3%. The sensitivity is influenced by the spectral interval used for the multivariate analysis, being lower (75.9%) when the full-range spectra were used.