Is an Elective Neck Dissection Needed in Squamous Cell Carcinoma of the Maxillary Alveolus and Hard Palate?

Background Squamous cell carcinoma (SCC) of the maxillary alveolus and hard palate is a rare site for oral cavity carcinoma. Much controversy is there regarding the management of this site and elective neck dissection due to rarity and complex lymphatic drainage. Objective To estimate the prevalence of neck nodal metastasis in squamous cell carcinoma of maxillary alveolus and hard palate and the factors influencing the nodal metastasis. Method This retrospective cohort study includes patients diagnosed with squamous cell carcinoma of maxillary alveolus and hard palate and who underwent surgical intervention between March 2017 and March 2022. Result The study included 53 patients among them majority were men (73.6%). Prevalence of neck nodal metastasis was 36.6% and occult nodal metastasis was noted in 16%. On multivariate analysis, clinical nodal positivity increases the odds of pathological nodal positivity by 9.4 times compared to no nodal involvement (95% CI 2.07-42.57, p < 0.004). A depth of invasion (DOI) of more than 10 mm increases risk by 7.4 times for pathological nodal positivity compared to less than 10 mm invasion (95% CI 1.53- 35.27, p=0.013). Conclusion Squamous cell carcinoma of maxillary alveolus and hard palate has a high risk of nodal metastasis. Depth of invasion is an important predictor for nodal metastasis. Due to the high risk of nodal metastasis elective neck dissection would be recommended in advanced stages. Squamous cell carcinoma of maxillary alveolus and hard palate with nodal metastasis has a poor survival.

Evaluation of nasal septal deviation and maxillary bone and nasal airway dimensions and volumes using cone-beam computed tomography in patients with unilateral palatal canine displacement: a retrospective study.

OBJECTIVES: To detect any association between palatally displaced canine (PDC) and nasal septal deviation (NSD), palatal bone thickness and volume, and nasal airway dimensions and volume. MATERIALS AND METHODS: A total of 92 patients were included and subdivided into two groups: group 1, unilateral PDCs (44 patients), and group 2, normally erupted canines (NDCs) (48 subjects). The following variables were measured using cone-beam computed tomography: presence and type of NSD, nasal width, inferior conchae, hard palate and nasal septum thickness, maxillary bone and nasal airway volumes. RESULTS: NSD was detected in 77% and 50% of PDC and NDC subjects, respectively. Within the PDC subjects, significant differences between the displaced and nondisplaced sides were detected. Palate thickness was increased in the canine region and reduced in the molar region. Compared with the control group, PDC subjects had reduced palate thickness and lower nasal airway volume. Two predictors were significant for predicting the odds of PDC occurrence: NSD and maxillary bone volume. CONCLUSIONS: NSD is more frequent in PDC subjects. PDC subjects have reduced palate thickness and decreased nasal airway volume. In the presence of NSD, the odds of developing PDC increase by 3.35 times, and for each one-unit increase in the maxillary bone volume, the odds of developing PDC decrease by 20%.

Orofacial Actinomycosis Eroding Through Hard Palate: A Case Report.

INTRODUCTION: Actinomycosis is a rare, chronic, progressive bacterial infection caused by Actinomyces species with a reported incidence of 1 in 300 000. Actinomycosis has variable presentations and is commonly mistaken for malignancy and other infections, leading to delays in diagnosis and appropriate treatment. Actinomyces is a commensal bacteria found in the mouth, gut, and genitourinary tract. Actinomycosis tends to take advantage of anatomical defects for contiguous spread and can cause fistulas, sinus tracts, abscesses, and intrauterine device-associated infections. CASE PRESENTATION: A 78-year-old White male with known dental caries came to a primary care clinic 2 days after noticing a painless, nonbleeding mass eroding from his hard palate. After a tissue biopsy of the mass showed a diagnosis of actinomycosis and advanced imaging showed no intracranial involvement, he was treated with a 6-month course of antibiotics, including oral amoxicillin, oral amoxicillin-clavulanate, and intravenous ertapenem. DISCUSSION: There are several case reports of actinomycosis with variable presentations, such as cutaneous nodules and sinus tracts. These cases frequently are associated with dental infections and procedures, trauma, oral surgery, or prior head and neck radiation. The condition is often mistaken for other infections or malignancy, which can delay appropriate treatment and increase the risk of complications. CONCLUSIONS: Actinomycosis is a rare bacterial infection with variable presentations occurring throughout the body. This patient responded well to a prolonged course of intravenous and oral antibiotics and had complete healing of his hard palate defect. Actinomycosis is frequently misdiagnosed, leading to delays in appropriate treatment.

Comparison of the Effects of Different Palatal Morphology on Maxillary Expansion via RME and MSE: A Finite Element Analysis.

OBJECTIVES: This study aims to compare and analyze the biomechanical effect and the displacement trend of RME and MSE on the maxillofacial complex under different palatal shapes by using finite element analysis. METHODS: The three-dimensional model of maxillofacial complex was obtained from a computed tomography image of a person with a normal palate. Then, we modified the shape of the palate to obtain the model with a high palate. Additionally, two expander devices were considered. MSE and RME were created and four models were made: Model 1: Normal-palate craniomaxillofacial complex with RME expander; Model 2: Normal-palate craniomaxillofacial complex with MSE expander; Model 3: High-palate craniomaxillofacial complex with RME expander; Model 4: High-palate craniomaxillofacial complex with MSE expander. Then, lateral forced displacement was applied and the analysis results were obtained. RESULTS: The lateral displacement of the palatal suture of Model 3 is greater than that of Model 1, and the maxilla has more rotation. The crown/root ratio of Model 1 is significantly greater than that of the other three groups. Compared with Model 1, Model 3 has greater stress concentration in the superstructure of the craniomaxillofacial complex. Both of them have greater stress in the anchorage area than Model 2 and Model 4. CONCLUSION: Different shapes of the palate interfere with the effects of RME and MSE, and its influence on the stress distribution and displacement of the craniomaxillary complex when using RME is greater than MSE. The lateral displacement of the palatal suture of MSE is significantly larger than that of RME. It is more prone to tipping movement of the anchor teeth using RME under normal palate, and MSE may manage the vertical control better due to the smaller crown/root ratio than RME and intrusive movement of molars.

Morphological CBCT parameters for an accurate differentiation between nasopalatine duct cyst and the normal nasopalatine canal.

BACKGROUND: The incisive foramen width was a traditional imaging criterion for diagnosing nasopalatine duct (NPD) cysts. Recent CBCT studies demonstrated significant dimensional variations of the nasopalatine canal, which raised questions about the accuracy of this criterion. This study investigated whether nasopalatine canal diameters assessed on CBCT images can accurately differentiate NPD cysts from normal nasopalatine canals. METHODS: The study included 19 patients with NPD cysts (12 (63.2%) males, 7 (36.8%) females, mean age 44.7 ± 13.3), and a control group of 164 patients (72 (43.9%) males, 92 (56.1%) females, mean age 47.25 ± 17.74). CBCT images were retrospectively evaluated. The following nasopalatine canal diameters were measured on reference sagittal, coronal, and axial reformation images: nasal opening anteroposterior (AP) and mediolateral (ML) diameter, oral opening AP (APOO) and ML (MLOO) diameter, nasopalatine canal length, minimum ML (minML) diameter, anterior wall expansion (AWE), nasopalatine canal angle, and the mid-level AP diameter (midAP). All parameters were compared between groups. Discriminant functional analysis (DFA) was applied to detect CBCT parameters that best differentiate the NPD cyst from the normal canal. RESULTS: Patients with NPD cyst had significantly greater values of APOO (7.06 ± 2.09 vs. 5.61 ± 1.70), MLOO (6.89 ± 2.95 vs. 3.48 ± 1.24), minML (2.88 ± 1.53 vs. 2.25 ± 1.09), AWE (2.15 ± 0.65 vs. 0.41 ± 0.67), and midAP (4.58 ± 1.61 vs. 2.48 ± 0.96). DFA showed MLOO, AWE, and midAP as the most accurate in distinguishing NPD cyst from the normal canal. When combined in the discriminant function equation X = 0.390·MLOO + 1.010·AWE + 0.288·midAP (cut score 1.669), the differentiation can be performed with a sensitivity and specificity of 98.8% and 76.9%, respectively. CONCLUSION: NPD cysts can be accurately distinguished from the normal nasopalatine canal by measuring MLOO, AWE, and midAP diameter on CBCT images.

Pleomorphic adenoma of hard palate: Review of updated literature and "case report".

RATIONAL: Pleomorphic adenoma (PA) is a rare benign tumor mainly affecting the major salivary glands, known for its diverse histological appearances that can mimic malignancies. When it occurs in the hard palate it present diagnostic and management challenges compared to other sites due to the anatomical location and potential proximity to critical structures. This case reports a rare presentation PA starting as an ulcer, alongside a review of rare cases of PA reported in last 5 years. We aim to highlight clinical challenges and emphasize the need for awareness in diagnosis of this diverse entity amongst the clinicians before reaching a definitive conclusion. PATIENT CONCERNS: A 41-year-old female reported an asymptomatic large swelling on the right side of the posterior palatal region. Clinical diagnosis revealed a firm, rubbery, and non-tender swelling of approximately 4 cm × 4 cm diameter. A triangular incisional biopsy was performed to confirm the diagnosis. DIAGNOSIS: The histopathological evaluation confirmed the presence of a PA with a well-encapsulated and compressed salivary gland. A wide surgical dissection was made to remove the entire encapsulated tumor mass, including the mucoperiosteum and eroded bone of the palate. The borderline of the tumor was carefully identified in the surrounding healthy tissue. The hemostasis was obtained using a simple interrupted suture. LESSON: The diagnosis of PA is difficult as it usually involves extensive squamous and mucous metaplasia, confusing it with malignant disorders. Histopathological and clinical examinations are important for differentiating this lesion from other tumors. Complete surgical excision is reported as the first line of treatment.

Manejo cirúrgico de ferimento auto-infligido por arma de fogo em região maxilofacial / Surgical management of self-inflicted injury by gun in the maxillofacial region

INTRODUÇÃO: O manejo dos pacientes vítimas de PAF possui vertentes divergentes a respeito do tratamento cirúrgico, que pode ser realizado de forma imedata ou tardia. Em lesões auto-infligidas, a distância entre a arma e a região acometida é menor, causando consequências estéticas e funcionais mais devastadoras. Aliado ao fato desse tipo de trauma criar uma ferida suja devido à comunicação com a cavidade oral e seios paranasais, o manejo das lesões representam um desafio mesmo à cirurgiões experientes. OBJETIVO: Estre trabalho relata o manejo cirúrgico de uma ferida auto-infligida por arma de fogo que resultou em avulsão dos tecidos moles na região maxilofacial. DESCRIÇÃO DO CASO: Paciente do sexo masculino, 35 anos, vítima de projétil de arma de fogo auto-infligido em região maxilofacial, cursando com extenso ferimento em região de língua e mento. Clinicamente, o paciente não apresentava sinais de fratura em ossos da face. Ambos os ferimentos apresentavam secreção purulenta e o paciente manifestava disfonia devido a grande destruição tecidual. CONSIDERAÇÕES FINAIS: O tratamento de ferimentos por arma de fogo não só é um grande desafio para o cirurgião, como para toda a equipe multidisciplinar requerida para tais casos, visto que não há protocolos bem definidos para o tratamento dessas lesões(AU)

INTRODUCTION: The management of patients who are victims of FAP has divergent aspects regarding surgical treatment, which can be performed immediately or late. In self-inflicted injuries, the distance between the weapon and the affected region is smaller, causing more devastating aesthetic and functional consequences. Allied to the fact that this type of trauma creates a dirty wound due to the communication with the oral cavity and paranasal sinuses, the management of injuries represents a challenge even for experienced surgeons. OBJECTIVE: This paper reports the surgical management of a self-inflicted gunshot wound that resulted in soft tissue avulsion in the maxillofacial region. CASE DESCRIPTION: Male patient, 35 years old, victim of a self-inflicted firearm projectile in the maxillofacial region, coursing with extensive injury in the region of the tongue and chin. Clinically, the patient did not show signs of facial bone fractures. Both wounds had purulent secretion and the patient had dysphonia due to extensive tissue destruction. FINAL CONSIDERATIONS: The treatment of gunshot wounds is not only a great challenge for the surgeon, but also for the entire multidisciplinary team required for such cases, since there are no well-defined protocols for the treatment of these injuries(AU)

Gender-Specific Variations in Greater Palatine Foramen Anatomy: Insights from CBCT Scans in the North Cyprus Population.

BACKGROUND The greater palatine foramen (GPF) is anatomically located distal to the third maxillary molar tooth, midway between the midline of the palate and the dental arch. The GPF contains the major palatine artery, vein, and nerve, traversing the palatine sulcus. This study aimed to evaluate the anatomical position of the GPF in 93 women and 67 men at a single center in Cyprus using cone beam computed tomography (CBCT). MATERIAL AND METHODS A retrospective analysis was conducted on 160 CBCT scans. Measurements of the GPF's horizontal and vertical diameters, distances from GPF to the incisive foramen, posterior nasal spine, anterior nasal spine, and midaxillary suture, and positional relationships to molars were recorded. Statistical analyses compared these measurements between males and females. RESULTS The study included 93 females and 67 males with an average age of 46.6 (±11.6) years. Significant sex differences were observed in most GPF measurements, with males showing larger dimensions such as the anterior nasal spine, posterior nasal spine, mid-maxillary suture, and incisive foramen to the GPF. The GPF was predominantly located in the third molar region (96.25% on the right, 96.9% on the left). The left GPF showed a significantly larger horizontal diameter than the right (P<0.05). CONCLUSIONS There was a significant difference in the average distances from the anterior nasal spine, posterior nasal spine, mid-maxillary suture, and incisive foramen to the GPF, as well as in the size of the GPF, between males and females. Recognizing these variations enhances clinical planning and reduces the risk of complications.

Microsecretory adenocarcinoma of the hard palate: a case report and literature review.

Microsecretory adenocarcinoma (MSA) is a new type of salivary gland neoplasm identified in the 2022 World Health Organization Classification of Head and Neck Tumour (Skalova et al., Head Neck Pathol 16:40-53, 2022) and is characterized by a unique set of histomorphologic and immunohistochemical features and a recurrent MEF2C::SS18 fusion. MSA was initially misdiagnosed as another salivary gland tumour due to its similar morphology; until recently, only fewer than 50 cases were reported. We present a case of MSA of the hard palate with diverse architectural growth patterns, bland cytological features, abundant basophilic intraluminal secretions and fibromyxoid stroma. The tumour cells were positive for the SOX10, S100, and p63 protein and negative for the p40 protein according to immunohistochemistry. SS18 gene rearrangement was demonstrated via break-apart fluorescence in situ hybridization. We also provided a comprehensive literature review and integrated the clinicopathological features, immunophenotype, and molecular alterations of the disease. A comprehensive understanding of MSA enables us to accurately distinguish and categorize MSA from other salivary gland tumours with analogous morphologies.