Assessment of Antioxidant Enzyme Superoxide Dismutase (SOD) in Oral Cancer: Systematic Review and Meta-Analysis.

Objective: The present article aims to comprehensively review the existing literature on superoxide dismutase (SOD) levels, an antioxidant enzyme, in oral cancer. Method: An extensive literature search was conducted across various databases, including PubMed, Wiley Online Library, Science Direct, and Cross Reference, spanning 1998-2023. At the outset, 1,177 articles were initially identified, and 907 studies were excluded due to irrelevance or duplication of the research question. Subsequently, 270 articles underwent screening evaluation, resulting in the selection of 85 articles meeting the inclusion criteria. Following this, 68 articles underwent a full-text comprehensive assessment, and ultimately, 39 were chosen for data extraction. The risk of bias in the designated articles was assessed using the Newcastle-Ottawa Scale. Finally, 13 studies were meticulously selected, offering consistent data for the ensuing meta-analysis. Meta-analysis was executed using comprehensive meta-analysis (CMA) version 3 software (Bio Stat Inc., Englewood, NJ, USA). The meta-analysis findings revealed a statistically significant decrease in SOD levels in both erythrocyte samples (P < 0.001) and tissue samples (P < 0.05) among individuals with oral cancer (OSCC) compared to the normal control group. Conversely, the analysis of three studies on salivary samples demonstrated a significant increase (P < 0.05) in SOD levels in the oral cancer group compared to the healthy controls. Conclusion: This systematic review underscores a statistically significant decline in SOD levels observed across diverse bio-samples in individuals with oral cancer, indicating an excess of oxidative stress (OS). Additional research is needed to delve into the relationship between SOD levels and clinic-pathological prognostic markers within the oral cancer cohort. Such investigations have the potential to significantly contribute to the development of prognostic tools grounded in OS, thereby guiding strategies for treatment planning.

Oral Manifestation of Viral-Induced Erythema Multiforme Major: A Rare Presentation.

Erythema multiforme is an acute inflammatory mucocutaneous disease manifested as macules, vesicles, bullae, erosion, and papular lesions. In the present case, a 55-year-old female patient reported painful growth in the oral cavity and difficulty in mastication. The patient gave a history of prodromal symptoms before the onset of lesions On intra-oral examination, elevated plaque-like lesions were present bilaterally on lateral borders of the tongue and buccal mucosa near the retromolar region. Extraoral examination revealed concentric erythematous target (or) bull's eye lesions in palms, forearm, and foot. Based on history, clinical examination, and laboratory investigations, recurrent herpes-associated erythema multiforme was diagnosed. We report a rare clinical presentation of recurrent herpes-associated erythema multiforme manifesting as an extensive plaque-like lesion intra-orally.

A Large Residual Vestibular Schwannoma Following Incomplete Resection: A Case Report With Literature Review.

Vestibular schwannomas (VSs), also known as acoustic neuromas, are benign, slow-growing tumors. If not detected early or treated appropriately, these tumors can lead to complications such as pressure on adjacent intracranial structures that can affect vital functions. The present report discusses a rare case of a residual VS in a 46-year-old female patient. The patient was a known case of left-sided VS who underwent partial excision of the tumor four years ago and had complete hearing loss on the left side since then. She reported to the clinic with progressive headaches and imbalance while walking. Magnetic resonance imaging of the brain revealed a large left residual VS compressing the brainstem and cerebellum, which was completely excised, and the patient did well postoperatively. Incomplete resection of VS carries a significant risk of tumor regrowth, necessitating the importance of complete resection with periodic follow-ups.

Assessment of glutathione peroxidase enzyme response and total antioxidant status in oral cancer - Systematic review and meta-analysis.

BACKGROUND: Oxidative stress induced by free radical accumulation contributes to many pathologies, including cancer. Antioxidant defense system fails to scavenge free radicals when it is excessively accumulated. Assessing individual antioxidant enzymes and total antioxidant capacity could direct the customized therapeutic strategies. OBJECTIVE: Evaluation of total antioxidant status and enzyme glutathione peroxidase activity in the oral cancer group compared to the healthy control group. METHOD: The literature search included databases PubMed, Science Direct, Wiley Online Library, Cochrane and Cross Reference between 1999 and 2021. The database search was completed in the month of August 2022. The extracted data were analyzed by Comprehensive Meta-Analysis (CMA) version 3 software (Biostat Inc. Englewood, NJ). Based on search strategies, 1435 articles have been retrieved from the database. In the segregated articles, 1365 were excluded due to duplicated articles, animal studies, low-quality studies, articles unrelated to the research question, and with unmatched objectives. Based on inclusion criteria, 70 articles were selected for full-text valuation. However, 33 articles were found highly suitable for inclusion and data extraction. Finally, 11 articles were selected for meta-analysis. RESULTS: The meta-analysis of four included studies of tissue samples showed a significantly (p < .001) increased GPx activity in the oral cancer group, when compared to the control group, whereas three included studies of erythrocyte samples displayed a significantly (p < .001) decreased GPx activity in the oral cancer group than the control group with the pooled standardized mean difference value of -2.766 moles/min/g Hb at 95% CI (-3.297 to -2.234). The meta-analysis of the included studies depicted an insignificant (p = .947) reduction of salivary TAS levels in the oral cancer group when compared to the control group. CONCLUSION: Our systematic review and meta-analysis depict antioxidant GPx enzyme activity in the regional tissue samples of the oral cancer group differs from other systemic biological fluid samples compared to the healthy control group.

Juvenile psammomatoid ossifying fibroma of the maxilla and mandible: A systematic review of published case reports.

OBJECTIVE: The aim of this study is to evaluate recent evidence-based data that summarize the clinicopathological findings and treatment along with follow-up measures taken in terms of published cases of Juvenile psammomatoid ossifying fibroma (JPOF) of the maxilla and mandible by a systematic review. MATERIALS AND METHODS: The databases searched were PubMed, MEDLINE, Scopus, Google scholar, and Cross references. Only those case reports of JPOFs published in the English language from 2000 to 2022 were considered. All cases included confirmed JPOF lesions histopathologically. The SR-included details like clinical and radiographic data, follow-up details such as recurrence, and the presence of any adverse outcome. RESULTS: The database search produced 595 articles from 2000 to 2022, among which 22 case reports were included in the systematic review. The mean age of JPOF occurrence in patients was 18 ± 16 years. A male predilection was noted among patients younger than 14 years of age, whereas a female predilection was noted in patients older than 14 years of age. Frequent involvement of the mandible (56%) compared to the maxilla (44%) was reported. The posterior mandible was the most commonly affected site involving numerous adjacent structures. The expansile nature of the JPOF displayed 57% buccolingual expansion, 50% downward displacement or erosion of the lower border of the mandible and 81% of  involvement of the maxillary antrum/pterygoid plate/orbital floor. Among the 20 cases reported, the treatment provided included surgical excision in 45% of the patients, jaw resection in 35% of the patients, and enucleation and curettage in 18% of the patients. Follow-up details were provided in 80% of the reports that showed recurrence. CONCLUSIONS: The diagnosis of JPOF requires correlation of the clinical and radiographic features with key histopathological features. Although long-term follow-up of the case reports has been reported, the data lack information about the long-term outcomes of JPOF.

Expression of Sex Hormones in Oral Squamous Cell Carcinoma: A Systematic Review on Immunohistochemical Studies.

Oral squamous cell carcinoma (OSCC) is the most widespread oral malignancy. In the western world, smoking and alcohol remain the most common risk factors, whereas smokeless tobacco and areca nut consumption are the prevalent etiological factors in South Asia. Numerous markers were studied till date to identify the disease. However, the role of sex hormones in OSCC is poorly defined. Hormonal receptors play a role in breast cancer, prostate cancer, and human papillomavirus (HPV) driven oropharyngeal cancers. It is proven that the expression of estrogen receptor-α improved the overall survival of the patient with HPV-positive oropharyngeal cancer. Thus, this review article aims to determine the expression of sex hormones by immunohistochemistry in OSCC. This systematic review was performed with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement Criteria 2020. Relevant articles were collected from the electronic database in PubMed and Cochrane till 2021. Immunohistochemical studies on sex hormones and their role in OSCC published in English literature were included. We excluded case reports, case series, and abstract-only articles. The sample size of the selected studies varied, and these studies measured the parameters such as sex hormones and OSCC. Furthermore, all the studies used different sex hormones and their association with oral cancer through the immunohistochemical process. Thus, this review summarizes that sex hormones influence the biopathology of oral cancer and have a prognostic significance in the tumor subgroups.

Depleting levels of endogenous anti-oxidant superoxide dismutase in oral sub-mucous fibrosis: A systematic review and meta-analysis.

Objective: The systematic review is aimed to assess the antioxidant status by superoxide dismutase level in oral sub-mucous fibrosis using available literature. Materials and methods: A literature search was accomplished electronically in Pubmed (MeSH), Science Direct, Scopus, Web of Science core collection, Cochrane, and Cross-reference, using the keywords such as 'oral submucous fibrosis,' 'antioxidant status' and 'superoxide dismutase.' Results: Of the 352 articles identified, only 16 satisfied the selection criteria and were included in the systematic review. Among the selected, six studies were included for serum level analysis of superoxide dismutase. The assessment showed a significant reduction of serum superoxide dismutase in oral submucous fibrosis patients than in control (p < 0.004). The mean difference in serum superoxide dismutase concentration between oral submucous fibrosis and healthy subjects was -86.23 U/ml (95% CI -145.30, -27.17). The serum SOD level was significantly reduced as the disease progressed to stage I or stage II (p < 0.001) compared to the control group. Conclusion: The studies showed significantly lower levels of superoxide dismutase in various human samples of patients with OSMF. Therefore, further studies are required to estimate antioxidant status using different biomarkers of oral submucous fibrosis concerning different stages of the disease in order to augment future therapy. Clinical relevance: Assessment of antioxidant activity helps to identify the patients at risk of malignant transformation. It serves as a reliable guide to validate therapy. It serves as a marker of prognosis in patients suffering from oral submucous fibrosis.

Assessment of the anti-oxidant reduced glutathione in oral squamous cell carcinoma - Systematic review and meta-analysis.

Background: The excess reactive oxygen species or free radicals reaction leads to oxidative injury to the biological components such as cells and tissues, which would result in the initiation and progression of carcinogenesis. The magnitude of oxidative damage depends primarily on the balance between free radicals (pro-oxidants) and antioxidant system activity. Aim: To assess antioxidant status by evaluating the reduced glutathione (GSH) levels in various biological samples of patients with oral squamous cell carcinoma (OSCC) using available literature. Materials and Methods: An electronic literature search was carried out in PubMed (MeSH), Science Direct, Scopus and Cross Reference by using specific keywords. Results: The systematic electronic search identified 704 articles. After studying the articles' titles and abstracts, 657 articles were excluded for the following reasons; duplicated articles, animal studies, studies of low quality and not relevant to the research question. The remaining 47 articles were selected for full-text assessment. After eliminating the articles that did not match the objectives, the present qualitative synthesis finally included 27 articles for evaluation. The ten studies, which showed coherent data, were included in quantitative analysis. The GSH levels in OSCC groups are significantly decreased (P < 0.001) in plasma and erythrocyte samples compared to healthy controls. Conclusion: The selected studies showed significantly lower levels of GSH in various biological samples of OSCC. Hence, future studies are required to validate the expression of GSH as a prognostic biomarker in oral cancer.

A Meta-analysis of Oral Squamous Cell Carcinoma in Young Adults with a Comparison to the Older Group Patients (2014-2019).

BACKGROUND: The oral squamous cell carcinoma (OSCC) often affects elderly aged adults, who had long-term tobacco exposure. In the recent past decade, there is an increasing incidence of OSCC in younger individuals, who had less tobacco association. AIM: The aim of this study is to examine the risk factors and to assess and compare the clinicopathological features and prognosis of OSCC in young patients with the older group patients. MATERIALS AND METHODS: We included studies that addressed the OSCC involving young patients during the period between 2014 and 2019. Initially, we found 679 articles; after refined evaluation, 92 works had their titles matching to the present work. After extraction of case reports, reviews, and studies with un-matched objectives or inadequate data, we have chosen only 24 presentations matching to the abstract. The statistical analysis performed by Chi-square tests using SPSS 20.0 version for windows. RESULTS: Of the total OSCC, 10% of patients belonged to the younger age group, and 90% were the older aged group. Both the groups showed male gender predominance and tongue as the predominant site of involvement. The younger patients tend to have significantly reduced tobacco exposure. The highly reported tumors were advanced staged and moderately differentiated tumors in both groups. There was a statistically evident high recurrence reported in the younger group. The overall survival seems to be similar for both groups. CONCLUSION: The identification of the potential risk factors, along with unique molecular mechanisms, and biological behavior of the disease is mandatory to control the incidence of OSCC in young adults.

Malondialdehyde, an Oxidative Stress Marker in Oral Squamous Cell Carcinoma-A Systematic Review and Meta-Analysis.

OBJECTIVE: To qualitative and quantitatively review published literature assessing the oxidative stress marker malondialdehyde (MDA) in oral squamous cell carcinoma (OSCC). METHODOLOGY: Pubmed (MeSH), Science Direct, Scopus, Web of Science, Willey Online Library, Cochrane, and Cross Reference were searched for studies assessing MDA levels in OSCC samples. RESULTS: From the 1008 articles identified, 849 were excluded based on title and abstract screening due to duplication and irrelevance to the topic of interest. Full-text assessment of the remaining 159 articles led to the inclusion of only 46 articles that satisfied the selection criteria. Of these, only 26 studies had data compatible for quantitative analysis. The MDA levels in OSCC groups are significantly increased (p < 0.00001) in plasma, serum, and saliva samples in the majority of the studies evaluated. In contrast, MDA levels in OSCC tissue samples are significantly attenuated (p < 0.00001) compared to healthy controls, supported by fewer studies. CONCLUSIONS: The augmented MDA levels in plasma, serum, and saliva samples of the OSCC reflect the heightened oxidative stress level accurately. Further studies are required to understand the attenuated MDA levels in the tissue samples of OSCC. Correlation analysis between MDA levels with established clinicopathological prognostic markers could aid in formulating oxidative stress-based prognostication and treatment planning.

Meta-analysis on risk factors of squamous cell carcinoma of the tongue in young adults.

Tongue squamous cell carcinoma (TSCC) generally affects the older age group exposed to tobacco for an extended period. However, recent research points out that there is an increased incidence of TSCC in the younger age group without any traditional risk factors making TSCC as a distinct biological entity in this group. This study aims to assess the prevalence and risk factors of tongue carcinoma in the younger group of patients. This article included studies that addressed the TSCC involving young patients and that which are PubMed indexed. Initially, 390 articles were considered; but after refined evaluation, 123 articles had their titles and abstracts matching to this present work. After the extraction of the case reports, review articles and the articles without the assessment of the parameter of harmful habits, we have included only 23 articles in the sample matching the title. The statistical analysis was formed by using chi-square tests using IBM SPSS ver. 20.0. The cohort of the younger population in these studies was mostly in the 35- to the 45-year age group. The majority of reports (64%) classified the patients below 40 years of age as a young group. Though male predominance is reported to be 55%, female patients are also more affected (40%) in the younger age group compared with, the more typical and usual group of head and neck carcinoma patients. TSCC in older adults predominantly reported in tobacco users (70%) whereas in young adults, TSCC was associated with a higher incidence in nonsmokers (53%); the causes of these cancers in young adults remain unclear. The identification of the potential risk factors aside from traditional factors is vital to control the incidence of TSCC in young patients.

Autofluorescence based diagnostic techniques for oral cancer.

Oral cancer is one of the most common cancers worldwide. Despite of various advancements in the treatment modalities, oral cancer mortalities are more, particularly in developing countries like India. This is mainly due to the delay in diagnosis of oral cancer. Delay in diagnosis greatly reduces prognosis of the treatment and also cause increased morbidity and mortality rates. Early diagnosis plays a key role in effective management of oral cancer. A rapid diagnostic technique can greatly aid in the early diagnosis of oral cancer. Now a day's many adjunctive oral cancer screening techniques are available for the early diagnosis of cancer. Among these, autofluorescence based diagnostic techniques are rapidly emerging as a powerful tool. These techniques are broadly discussed in this review.

The role of myofibroblasts in wound healing, contraction and its clinical implications in cleft palate repair.

Myofibroblasts after its discovery in 1971 as the principal cell for wound healing has come a long way as far as research is concerned. The primary focus of research has been regarding preventing certain unwanted effects of this cell such as wound contraction and scarring. As far as the oral and maxillofacial region is concerned, the primary concern of this untoward effect is during repair of cleft palate surgically which results impaired development of palate and the dentoalveolar structures. This review focuses on the basic aspects of myofibroblasts such as its origin, formation, function in wound healing, role in wound contraction and ways by which its unwanted effects can be overcome to improve the quality of the post surgical complications of cleft palate surgery.

Cherubism combined with epilepsy, mental retardation and gingival fibromatosis (Ramon syndrome): a case report.

Cherubism is an inherited, autosomal dominant disorder that characteristically affects the jaws of children. The disease typically manifest as a bilateral swelling with associated submandibular lymph node enlargements and usually regresses as age advances. The disease is microscopically indistinguishable from other giant cell lesions and is essentially a clinical diagnosis. The association of cherubism with gingival fibromatosis, epilepsy, mental retardation, stunted growth, and hypertrichosis is referred as Ramon syndrome. We report a case of Ramon syndrome in an 8 year old girl.