Accuracy of the Cone Beam Computed Tomography in the Detection of Bone Invasion in Patients with Oral Cancer: A Systematic Review.

This review article aims to analyze the diagnostic accuracy of the cone beam computed tomography (CBCT) with respect to other imaging methods in detection of bone tissue invasion by oral squamous cell carcinoma (OSCC). The review was carried out of English language studies in PubMed Search, National Library of Medicine, between 1990 and 2017. For each study, sensitivity, specificity, and positive (LR+) and negative (LR-) likelihood ratio, as well as the diagnostic accuracy, and positive and negative predictive values were calculated. Of the 62 collected articles, 7 fulfilled the inclusion criteria. Tests and respective articles included were computed tomography (CT, four studies), magnetic resonance imaging (MRI, five studies), C (two studies), single-photon emission tomography (SPECT, two studies), multi-slice computed tomography (MSCT, two studies), and panoramic radiography (PR, two studies). The analytic data show values of LR+ were 14.4 (CT), 37.9 (MRI), 27.8 (CBCT), 25.5 (SPECT), 37.0 (MSCT), 4.8 (PR), respectively. The values of LR- were 0.35 (CT), 0.24 (MRI), 0.10 (CBCT), 0.06 (SPECT), 0.31 (MSCT), and 0.36 (PR), respectively. The positive and negative predictive values for bone tissue invasion by OSCC were 90.31%-74.91% (CT), 90.63%-78.69% (MRI), 80.05%-89.83% (CBCT), 72.97%-95.53% (SPECT), 87.44%-73.74% (MSCT), and 84.245%-69.18% (PR), respectively. The level of scientific evidence available today is weak. To better define the impact of CBCT on clinical decision-making, further studies with uniform methodological approach are needed.

Diode laser surgery in the treatment of oral proliferative verrucous leukoplakia associated with HPV-16 infection.

BACKGROUND: Proliferative verrucous leukoplakia (PVL) is an oral potentially malignant disorder, characterized by multifocal expression, progressive clinical evolution, and a high rate of malignant transformation. Evidence-based information regarding optimal PVL management is lacking, due to the paucity of data. The present report describes a case of PVL associated with HPV-16 infection and epithelial dysplasia treated by diode laser surgery, and the outcome of disease clinical remission over a 2-year follow-up period. CASE REPORT: A 61-year-old Caucasian male with oral verrucous hyperkeratosis presented for diagnosis. The lesions were localized on the maxillary gingiva and palatal alveolar ridge. Multiple biopsy specimens have been taken by mapping the keratotic lesion area. Microscopic examination was compatible with a diagnosis of PVL with focal mild dysplasia, localized in the right maxillary gingiva. Polymerase chain reaction (PCR) was done for human papillomavirus (HPV) detection which revealed presence of HPV DNA, and the genotype revealed HPV 16 in the sample. The PVL in the right gingival area was treated on an outpatient basis by excision with a diode laser. This approach resulted in good clinical response and decreased morbidity over a 2-year follow-up period. CONCLUSIONS: This case illustrates the benefit of a conservative approach by diode laser treatment than wide surgical excision for management of the PVL lesions associated with mild dysplasia and HPV-16 infection.

Large oral ulcer of tongue related to dental trauma.

A 36-year-old Philippine male has a several month-history of burning pain of his tongue with lingual erythema and oral bleeding. Here we describe a classical case of oral chronic ulcer related to mechanical dental trauma. In this case, unilateral crossbite malocclusion was able to produce oral mucosal lesion that was sufficient to cause a large, chronic tongue ulcer and subsequent mild epithelial dysplasia. A specific tongue-retaining device was made. In absence of dental trauma, his chronic ulcer of the tongue resolved within a few weeks. This case suggests evidence on the direct relationship between chronic oral trauma and the potential occurrence of a dysplastic process.

Hyperpigmentation of the hard palate mucosa in a patient with chronic myeloid leukaemia taking imatinib.

BACKGROUND: Imatinib mesylate is an inhibitor of the tyrosine kinase Bcr-Abl and a first-line treatment for Philadelphia chromosome-positive chronic myeloid leukaemia (CML). Dermatological side effects include superficial oedema, pustular eruption, lichenoid reactions, erythroderma, and skin rash. Depigmentation of the skin and/or mucosa is uncommon, and hyperpigmentation is rare. CASE PRESENTATION: We present the case of a 63-year-old Caucasian male with widespread hyperpigmentation of the hard palate associated with a 9-year history of imatinib therapy to treat CML. He did not complain of any symptoms. Clinical examination did not reveal any abnormal pigmentation of the skin or other region of the oral mucosa. He did not smoke cigarettes or drink alcohol. His medication regimen was a proton pump inhibitor, a beta-blocker, cardioaspirin, atorvastatin, and imatinib 400 mg/day. Histopathologically, melanin and haemosiderin deposits were evident in the lamina propria. The lesion persisted, with no clinical change, through several follow-ups. We reviewed the literature to explore the possible relationship between oral hyperpigmentation and long-term imatinib mesylate treatment. CONCLUSIONS: We diagnosed oral pigmentation associated with imatinib intake based on the medical history and clinical features of the pigmented macules. Oral pigmentation may have a variety of causes, and differential diagnosis requires nodal analysis. Clinicians should be aware of possible oral mucosal hyperpigmentation in patients taking imatinib mesylate. Such pigmentation is benign and no treatment is needed, but surveillance is advisable.

Immunoexpression of cytokeratin-19 in the oral lichen planus and related oral squamous cell carcinoma.

AIMS: Cytokeratin 19 (CK-19) is an epithelium-specific intermediate filament protein that has been investigated in oral lichen planus (OLP) lesions but has not been compared with the expression of CK-19 in the OLP-related oral squamous cell carcinoma (OSCC). The aim of the present study has been to objectively compare the immunohistochemical expression of the CK-19 in OLP lesions and subsequent OSCC lesions that developed over time, to evaluate the change of the staining pattern among OLP and the grades of differentiation in OSCC. METHODS: Thirty-six formalin-fixed tissues of 18 OLP patients (18 samples from OLP lesion and 18 samples from OLP-related OSCC lesion) were included. The monoclonal antibody for CK-19 was used at 1:100 dilution for the immuno-staining on 4-µm thick sections. Staining pattern of CK-19 was graded into a 4-point scale: (1) no staining, (2) only few cells staining, (3) less than 50% of the cells stained, and (4) 50% or more of the cells stained. Microslides were examined under the light microscope using objective lenses magnifications of 4×, 10×, and 20×. RESULTS: The CK19 positive rate in OLP tissues was 33% (6 out of 18) and 56% (10 out of 18) in OSCC tissues. The CK19 positive score in OSCC tissues was significantly higher than that in the corresponding OLP tissues (Mann-Whitney test, P=0.02). Well-differentiated OSCC showed significantly lower of C-K19 scores than those moderately differentiated grades (Mann-Whitney, P=0.007). CONCLUSIONS: The quantity and distribution of CK-19 staining in OSCCs showed relevant difference in comparison with OLP lesions. The increased of CK19 protein expression in OSCC tissues correlates significantly with the pathologic differentiation grade.

Trichoadenoma of the upper lip.

BACKGROUND: Trichoadenoma of Nikolowski, who describe the first cases in 1958, is a rare and benign tumor of the hair follicle. It is well-differentiated and slowly-growing. The clinical appearance of Trichoadenoma (TA) can be similar to basal cell carcinoma or epidermal cyst. RESULTS: We describe a 44-year-old male who was referred for nodular lesion on the upper lip and a TA was diagnosed. Oral examination showed exophytic yellow mass located between mucous membrane of the upper lip and vestibular gingiva, 1.2 per 0.8 cm. Anamnestic data was non-contributory. An excisional biopsy of the lesion was performed. Microscopically, the lesion consisted of multiple keratinous cysts lined with stratified squamous epithelium and intermingled with solid islands of basaloid cells lying within sclerotic stroma. The pathological diagnosis was TA. The surgical wound healed uneventfully. CONCLUSION: Because the lesion is unique, it is uncertain how aggressive or indolent the tumor might be. Therefore, the microscopical analysis is mandatory. At the best of our knowledge, this is the second case of trichoadenoma of the lip.

Nerve sheath myxoma of the tongue.

Nerve sheath myxoma (NSM) of the oral mucosa is a slow-growing, benign, often asymptomatic submucosal mass. We report on a case of classical NSM of the tongue, with diagnostic and therapeutic approach to the case. Many NSM arise within the endoneurium of a peripheral nerve. It is a rare condition with no apparent differences between sexes in its prevalence. It can occur at any age.

Allergological and toxicological aspects in a multiple chemical sensitivity cohort.

BACKGROUND: Multiple chemical sensitivity (MCS) is a chronic condition characterized by an exaggerated response to toxicants. We ascertained the prevalence of allergy to metals and toxicological aspects in MCS patients. METHODS: We conducted a retrospective review of medical records of 41 patients with MCS. We performed patch testing (n = 21) for dental series and did lymphocyte transformation test (n = 18) for metals. We measured mercury in samples of blood (n = 19), urine (n = 19), saliva (n = 20), and scalp hair (n = 17) to investigate the association between mercury levels and cases of MCS. RESULTS: The prevalence of metal immune hypersensitivity in a subset of 26 patients was 92.3 percent. Elevations of mercury occurred in 81.2 percent (26 of 32). The mean (±SD) in blood concentrations of mercury was 7.6 ± 13.6 µg/L; mean in urine was 1.9 ± 2.5 µg/L; mean in scalp hair was 2.2 ± 2.5 µg/g; mean in saliva was 38.1 ± 52.1 µg/L. Subgroup analyses showed that elevation of mercury levels in biological matrices were associated with mercury amalgams in patients with MCS (22 patients), compared with controls (8 patients) (odds ratio 11 : 95 percent confidence interval 1.5 to 81.6; P = 0.023). CONCLUSIONS: Our data show an increased prevalence of metal allergy and elevation of mercury levels in bioindicators among patients with MCS.

Photodynamic therapy to treat periimplantitis.

AIM: : Periimplantitis is a bacterial complication after dental implants implantation. Photodynamic therapy (PDT) implies the use of low-power laser in combination with appropriate photosensitizer to increase the detoxification of the implant surfaces. Little information exists about PDT in the treatment of periimplantitis. A randomized comparative case-control study has been conducted with 20 patients and 20 controls to compare the efficacy of antimicrobial PDT versus surgical therapy in patients with periimplantitis, who have received dental implants with rough surfaces. MATERIALS AND METHODS: In the surgery group, mucoperiosteal flap surgery was used with scaling on implant surfaces and debridement of granulation tissue. Microbiologic testing was evaluated before and after intervention treatment, at 12 and 24 weeks in the study subjects. DISCUSSION: Total anaerobic counts of bacteria did not differ significantly between patients assigned to receive PDT and those assigned to receive surgical therapy (mean, 95.2% and 80.85%, respectively). PDT was associated with a significant decrease in bleeding scores (P = 0.02) as well as inflammatory exudation (P = 0.001). CONCLUSION: Treatment with PDT in patients with periimplantitis was not associated with major reduction of total anaerobic bacteria on the rough surfaces of dental implants as compared with surgical therapy. A significantly lower proinflammatory index of periimplantitis was observed in the PDT group at 24 weeks of follow-up.

Mucosa-associated lymphatic tissue lymphoma of the lower lip in a child.

Mucosa-associated lymphatic tissue lymphoma of the lip in a child is a very rare clinical entity whose cause is poorly understood. We describe an 11-year-old boy who presented with a 5-month history of an asymptomatic nodule on the lower lip with the clinical appearance of a benign mucocele. After surgical excision of the lower lip lesion, lymphocyte phenotypic analysis and histologic examination of the specimen disclosed an extranodal marginal zone B-cell lymphoma of mucosa-associated lymphatic tissue type of the buccal minor salivary glands. Mucosa-associated lymphatic tissue lymphoma of the lip may clinically resemble a large mucocele. To prevent a delayed detection of lip mucosa-associated lymphatic tissue lymphoma, an incisional biopsy of large mucous cysts of the oral mucosa before marsupialization is recommended.

Oral lichen planus and malignant transformation: a longitudinal cohort study.

OBJECTIVE: Oral lichen planus (OLP) is associated with risk for developing oral squamous cell carcinoma (OSCC). We performed a 7-year prospective study to assess the incidence of malignant transformation of OLP among adults. STUDY DESIGN: Three hundred twenty-seven OLP patients, 229 women (70.0%) and 98 men (30.0%), were observed during the follow-up period. RESULTS: During a mean follow-up of 81.7 months, 8 of 327 patients developed an OSCC in OLP areas (0.36%/y), yielding the high overall standardized incidence ratio of 17.7 (95% confidence interval [CI] 8.8-35.3). The standardized incidence ratio for OSCC was significantly higher in women [27.0 (95% CI 11.2-64.8)] than in men [11.2 (95% CI 3.6-34.9)]. Six OSCCs were well differentiated (75%) and 2 moderately differentiated (25%). Three subjects (37.5%) developed recurrences within 2 years (mean 16.1 ± 3.5 months). Disease-free survival rate after 69.8 months was 97.3%. CONCLUSIONS: OLP was associated with a significant increase in the risk for OSCC. Close surveillance may help to reduce the morbidity of OSCC arising from OLP at 24 months.

Photoletter to the editor: Exfoliative cheilitis associated with titanium dental implants and mercury amalgam.

Exfoliative cheilitis is an uncommon chronic inflammatory condition that generally affects the vermilion of the lips. Its cause is still largely unknown an there is no effective treatment. Here we report of a case of exfoliative cheilitis possibly caused by mercury-containing dental amalgam in close proximity to dental titanium implant in a 41-year-old woman. By patch-testing, she was tested positive to thimerosal, palladium, gold, nickel, and copper. There was a strong temporal relation between last titanium dental implant and the onset of exfoliative cheilitis. Clinicians should be aware that exfoliative cheilitis might be associated with an allergy to intraoral dental metals and that titanium dental implant should not be implanted in the vicinity of the mercury-containing dental amalgam filling, even in presence of mercury amalgam as rootend filling material.