Adenoid Cystic Carcinoma of the Minor Salivary Glands: A Systematic Review and Meta-Analysis of Clinical Characteristics and Management Strategies.

BACKGROUND: Intraoral adenoid cystic carcinoma (ACC) arising from minor salivary glands (MSG) is a rare malignancy associated with delayed diagnosis and unfavorable outcomes. This study aimed to comprehensively review ACC of MSGs, focusing on clinical characteristics, imaging modalities, treatment approaches, and long-term outcomes. METHODS: A systematic search was conducted in PubMed, Web of Science, and MEDLINE databases to identify relevant articles reporting cases of ACC of MSGs between January 1997 and March 2023. The study was registered in PROSPERO (ID: CRD42023449478). A total of 10 studies that met the inclusion criteria were selected for critical review. In total, 902 patients were diagnosed with ACC of MSGs with an age range of 44.3 to 63 years, and an average age of 56.6 years. The female to male ratio ranges from 1:1 to 2.4:1. Regarding the primary site of ACC, the palate was the most common location, accounting for 30.5% to 83.3%, followed by the buccal mucosa, floor of the mouth, and lip and the retromolar area. For histology, the solid mass pattern was the most prevalent, seen in 95.2% of patients, followed by the cribriform pattern. Regarding treatment modalities, surgery was the most common approach, applied in 76.3% of cases, with a combination of surgery and radiotherapy used in 29.0% of cases. A smaller fraction, 3.2%, received a combination of surgery, chemotherapy, and radiotherapy, and 8.3% underwent radiotherapy alone. Local recurrence rates varied between 1% and 28.5%, and distant metastasis occurred in 18.2% to 33.3% of cases, predominantly to lymph nodes (14.5%). An analysis of overall survival across various stages and patient numbers indicated a 5-year survival rate of 68.0%. The findings of this study provide valuable insights for physicians in making treatment decisions and emphasize the need for ongoing research and collaborative clinical efforts to improve the management and outcomes of this challenging disease. CONCLUSION: ACC of MSGs is a multifaceted condition typically manifesting as asymptomatic enlargement and ulceration. This disease is marked by distinct histopathological patterns and perineural invasion (PNI). Recognizing these distinctive aspects is key in shaping the treatment plan, which can range from surgical procedures to radiation therapy, chemotherapy, and evolving targeted treatments. Continuous research and collaborative clinical efforts remain critical for ongoing progress in the treatment and management of this challenging condition.

Prevalence and Socio-Demographic Correlates of Dental Anxiety among a Group of Adult Patients Attending Dental Outpatient Clinics: A Study from UAE.

OBJECTIVES: The aims of this paper were twofold: first, to evaluate dental anxiety levels among patients undergoing oral surgery procedures; second, to assess how dental anxiety and fear are connected to age, gender, educational background, past traumatic experiences, and the frequency of dental appointments. METHODS: A cross-sectional Likert-scale questionnaire survey was conducted to collect quantitative data from 206 patients at the Oral Surgery Clinics at Dubai Dental Clinics, Dubai, United Arab Emirates. The reliability and validity of the questionnaire were tested using Cronbach's alpha. The normality of the MDAS score was tested using the Kolmogorov-Smirnov test. The chi square and Kruskal-Wallis tests were used to determine the association between categorical variables. Descriptive statistics were used to describe continuous and categorical variables. The statistical significance was set at p-value ≤ 0.05. RESULTS: The evaluation of the degree of dental anxiety among patients who visited the Dubai Dental clinics revealed that there was a considerably high level of moderate or high anxiety (72.3%). Tooth extraction and dental surgery procedures (95%), followed by local anesthetic injection in the gingiva (85%) and teeth drilling (70%), were the primary causes of anxiety, whereas scaling and polishing resulted in the lowest degree of anxiety (35%). There was no substantial difference in dental anxiety between male and female patients or among patients with different marital statuses. A total of 70% of patients preferred the tell-show-do method, whereas 65% chose communication strategies to reduce dental anxiety. CONCLUSIONS: The evaluation of the degree of dental anxiety among patients who visited Dubai Dental clinics revealed that there was a considerably high level of anxiety. Tooth extraction and dental surgery procedures, followed by local anesthetic injection and teeth drilling, were the primary causes of anxiety, whereas scaling and polishing resulted in the lowest degree of anxiety. Despite the use of a modified anxiety scale and a large and representative sample of oral surgery patients, more research is necessary to investigate the impact of various factors on dental anxiety.

Necrotizing Ulcerative Gingivitis, a Rare Manifestation as a Sequel of Drug-Induced Gingival Overgrowth: A Case Report.

PURPOSE: The purpose of this case report is to present a rare case of amlodipine-induced gingival overgrowth with a secondary formation of necrotizing ulcerative gingivitis involving the upper and lower arches of a 68-year-old female patient with a chief complaint of "swollen gums and pain on mastication which has been recurring for the past 5 years." MATERIALS AND METHODS: The treatment plan of this case was divided according to quadrants of the mouth. Each week, one quadrant was surgically excised, and the remaining quadrants were observed for any changes. The gingival overgrowths were excised using a 15 blade, and debris/plaque was removed with Gracey curettes. RESULTS: Although full-mouth exodontia was performed, the patient unfortunately suffered with recurrences in GO. These results are suggestive of idiopathic causes of GO. CONCLUSION: Careful examination, physician referrals, and biopsy to rule out any specific anomalies and to assist in proper diagnosis are followed by sequential management of the case results in productive outcomes.

Oral epithelial dysplasia in non-users of tobacco and alcohol: an analysis of clinicopathologic characteristics and treatment outcome.

Oral epithelial dysplasia (OED) is a histopathological diagnosis that is associated with an increased risk of oral cancer. The purpose of this study was to compare the clinical features and long-term outcome of OED between users and non-users of tobacco and alcohol. The hospital records of 456 patients diagnosed as having OED were reviewed. Two groups of patients were selected based upon tobacco and alcohol usage: 37 patients who had neither smoked tobacco nor drank alcohol and 419 patients who both smoked tobacco and drank alcohol. OED in non-users of tobacco and alcohol was uncommon, accounting for only 8.1% of all OED. There was a male to female ratio of 1:1 in the group. The tongue and buccal mucosa were the most commonly affected sites. An erythro-leukoplakic-type lesion with mild dysplasia was the common presenting feature. Mixed type lesions with severe dysplastic changes, particularly of the gingiva, may progress to malignancy. These findings support the notion that OED may also develop in persons who have never used tobacco or alcohol. Lesions more commonly occurred in women, especially in the tongue and buccal mucosa, and were mostly of the erythroplakic type. The presence of OED in patients who do not smoke tobacco or drink alcohol suggests that risk factors other than alcohol and tobacco may exist.

The pattern of maxillofacial fractures in Sharjah, United Arab Emirates: a review of 230 cases.

OBJECTIVE: Maxillofacial injuries constitute a substantial proportion of cases of trauma. This descriptive analytical study assesses the cause, type, incidence, demographic, and treatment data of maxillofacial fractures managed at Al Qassimi Hospital in Sharjah, United Arab Emirates, during a 4-year period and compares them with the existing body of literature on the subject. STUDY DESIGN: The medical records and radiographs of 230 patients treated for maxillofacial fractures at the Al Qassimi General Hospital over a 4-year period (from 1999 to 2002) were reviewed. A number of parameters, including the patient's age, gender, race, occupation, and mechanism of injury, type of facial injuries, treatment modality, and postoperative complications were recorded and assessed. RESULTS: Men 20 to 29 years of age sustained the most maxillofacial fractures. The ratio of males to females was 11:1. Most fractures were caused by motor vehicle crashes (75%), followed by falls (12%) and violent assaults (8%). There were 150 (51%) mandibular, 102 (34%) maxillary, and 22 (7.4%) zygomatic fractures. Regarding distribution of mandibular fractures, the majority (25%, 38/150) occurred in the condyle, 23% (35/150) in the angle, and 20% (30/150) in the body. The distribution of maxillary fractures were 49.0% (50/102) dentoalveolar, 29.4% (30/102) Le Fort I, and 10.7% (11/102) were Le Fort II fractures. More than half of all cases were treated by closed reduction (67%). Complications occurred in 5.6% of patients. CONCLUSION: The findings of this study, compared with similar studies reported in the literature, support the view that the causes and incidence of maxillofacial injuries vary from one country to another and, as such, can provide a guide to the design of programs geared toward prevention and treatment.