Voltage-Dependent Anion Channel 1 Expression in Oral Malignant and Premalignant Lesions.

BACKGROUND: The voltage-dependent anion channel 1 protein (VDAC1) plays a role in cellular metabolism and survival. It was found to be down or upregulated (overexpressed) in different malignancies but it was never studied in application to oral lesions. The purpose of this study was to retrospectively evaluate the expression of VDAC1 in biopsies of oral premalignant, malignant, and malignancy-neutral lesions and to examine the possible correlations to their clinicopathological parameters. MATERIALS AND METHODS: 103 biopsies including 49 oral squamous cell carcinoma, 33 epithelial dysplasia, and 21 fibrous hyperplasia samples were immunohistochemically stained with anti-VDAC1 antibodies for semi-quantitative evaluation. The antibody detection was performed with 3,3'-diaminobenzidine (DAB). The clinicopathological information was examined for possible correlations with VDAC1. RESULTS: VDAC1 expression was lower in oral squamous cell carcinoma 0.63 ± 0.40 and in oral epithelial dysplasia 0.61 ± 0.36 biopsies compared to fibrous hyperplasia biopsies 1.45 ± 0.28 (p < 0.01 for both; Kruskal-Wallis test). CONCLUSION: Oral squamous cell carcinoma and epithelial dysplasia tissues demonstrated decreased VDAC1 protein expression if compared to fibrous hyperplasia samples, but were not different from each other, suggesting that the involvement of VDAC1 in oral carcinogenesis is an early stage event, regulating cells to live or die.

Intra-oral Acantholytic Squamous Cell Carcinoma: 55 Cases. Is this Variant more Aggressive?

We aimed to collect and analyze available cases of intraoral acantholytic squamous cell carcinoma (aSCC), that consisted of the authors' cases and cases derived from the existing literature, with an emphasis on the pathological staging and patient outcome. Our research question was whether aSCC is more aggressive than conventional SCC. The literature was searched for documented cases of aSCC involving the intra-oral mucosa, excluding those from the lips and tonsils, and seven new cases were added from our files. The authors compared the obtained aSCC data to existing data for conventional SCC. Fisher Exact or Pearson's χ2 tests were used for categorical variables. Fifty-five cases of intraoral aSCC were reviewed, of which 48 were retrieved from the literature. Analysis of the published cases was reinforced by contacting the authors of all the papers with incomplete data for further clarifications. The most common sites of aSCC were the tongue (24/55) and the maxilla/maxillary gingiva and/or palate (11/55). The overall survival rate was 36/53 (67.9%) with a mean follow-up period of 22 months against 62.5% for conventional SCC (p = 0.6). No statistically significant difference between the two variants of the tumor with respect to the oral cavity was detected. The differences in age, sex, survival rate, staging, and locations were not statistically significant. Based on the available data from 55 cases, there is no evidence to suggest that aSCC is more aggressive than conventional SCC in intraoral cases.

Surgical approach to a severe case of sodium hypochlorite accident: a case report and review of the literature.

Sodium hypochlorite (NaOCl) is the most common irrigant used in modern endodontics due to the antimicrobial properties against bacteria, the powerful oxidative activity, and the ability to dissolve organic soft tissues. When NaOCl extrudes the apex of the root, commonly referred as "sodium hypochlorite accident," it can lead to devastating outcomes leading to long-term functional and esthetic deficits. Currently, no clear guidelines exist as to how these patients should be managed. The purpose of this paper is to present a case report and a review of literature and to propose an adequate surgical treatment protocol for this unfortunate event.

Transoral Endoscopic Plating for Orbital Blowout Fractures.

ABSTRACT: Orbital fractures account for up to 40% of craniofacial injuries. In this article, the authors present the transoral endoscopy-assisted plating technique for treating orbital blowout fractures (OBF). A retrospective analysis of 56 cases treated with transoral endoscopy-assisted approach was performed. Immediate versus delayed surgery decision-making was performed by using our 2-week algorithm. The surgical technique included only transoral incisions, forced duction and "pulse" tests, osteotomy, endoscopic inspections, the reduction with a curved elevator and an indwelling balloon, the retrieval of prolapsed fatty tissue back into the orbit, removal of sharp bony fragments, adaptation of the titanium mesh to the orbital floor and its fixation with screws to stable bony structures, reattachment of the osteotomized lateral wall, and postoperative computed tomography (CT) scan with 3D CT reconstruction. The overall success rate of surgeries was 96%. The resolution of comorbidities resulted in a normal globe position, normal eye movement, and the resolution of diplopia. Postoperative complications were insignificant with one case of surgical edema and one case of infection and sequestration that appeared six months after surgery. These results remained unchanged after 20 to 24 months of follow-up. The suggested minimally invasive transoral technique can be effectively implemented in cases of OBF as well as in cases when the medial wall of the orbit is involved. Our results presented a high success rate with minimal rate of complications, thus our technique is a safe way with minimal morbidity for treating OBF.

Oral variant of acantholytic squamous cell carcinoma-Histochemical and immunohistochemical features.

Acantholytic squamous cell carcinoma (ASCC) is an uncommon variant of squamous cell carcinoma (SCC). It is characterized by a combination of typical SCC and pseudoglandular structures, dyskeratotic cells and prominent acantholysis. The purpose of this study was to analyze the histochemical and immunohistochemical characteristics of the intraoral variant of ASCC. Cases of intraoral ASCC were retrieved from the English language literature. Four new cases from our files were added. In total, 35 cases were included and analyzed in this study. The mean age of the patients was 61.5 + 13 years (age range 38-92 years), with a male-to-female ratio of 1.7:1. According to the available data, histochemical and immunohistochemical stains for mucins were found to be consistently negative. E- cadherin, a marker of adherens junctions, was usually reported to be expressed in areas of "typical" (non acantholytic) SCC, but reduced in the acantholytic areas. We examined for the first time the expression of claudin 1, a marker of tight junctions, and found it to be reduced in the acantholytic areas, similar to E-cadherin. Several cases of oral ASCC also expressed vimentin and cytokeratin (CK) 19, markers associated with epithelial-mesenchymal transition. A wide range of non-epithelial markers yielded negative immunoreactions. In conclusion, ASCC is an uncommon variant of squamous cell carcinoma. The acantholytic process appears to involve reduced expression of molecular components of both adherens junctions and tight junctions. These findings could suggest a relation to the epithelial mesenchymal transition process and therefore further studies are needed in order to establish such a link and the subsequent possible impact on the clinical outcome of the patients.

Rare variants of head and neck squamous cell carcinoma -differential immunohistochemical profiles.

We aimed to immunohistochemically characterize the pattern of expression of epithelial markers in rare head and neck squamous cell carcinoma (HNSCC) variants: carcinoma cuniculatum (CC) and adenosquamous carcinoma (ASC). We also present an additional variant of HNSCC with concomitant basaloid and squamous components that has overlapping morphological features with odontogenic and non-odontogenic tumors, which we termed basalo-squamous carcinoma (BSC). The selected markers included CK5/6, p40, CK19, BerEP4, p16 and SOX10. All tumors were CK5/6 and p40 positive. CK19 and BerEP4 were positive in BSC and focally in ASC but negative in CC. p16 was positive in 3 (60%) of the CCs, focally positive in ASC and negative in BSC. SOX10 was negative in all three variants. Our results highlight the plasticity of the lining epithelium revealing differential profiles of immuno-expression of the selected molecular markers, possibly reflecting their diverse histopathogenesis.

Graftless sinus floor augmentation with an internal-port implant: long-term experience.

OBJECTIVE: The objective was to assess the outcome of graftless sinus floor augmentation associated with dental implant placement performed with an implant system that has an internal port and screw, combined with the osteotome technique. METHOD AND MATERIALS: Between 2012 and 2018, 722 titanium-aluminum-vanadium implants (Ti-6Al-4V ELI, diameter 3.75/4.20 mm) were placed in 331 patients. Implants 11.5 mm in length were inserted in maxillae with bone level ≤ 5 mm, and 13.0-mm-long implants were inserted in maxillae with bone level of > 5 to 8 mm. In all cases, no graft materials or bone substitutes were used for the sinus elevation. Implant condition was assessed at three different centers and the follow-up period ranged from 6 months to 7 years. RESULTS: In total, 412 11.5-mm-long implants and 310 13-mm-long implants were inserted. Implantation was successful in 689 implants (95.4%), based on cone beam computed tomography and clinical evaluation as well as the patients' experience, with no statistically significant difference between the 11.5-mm and 13.0-mm implants. The complication rates were comparable between cases with bone levels from 3 to 5 mm and the > 5- to 8-mm bone level cases. CONCLUSIONS: The port and screw implant system may allow maxillary sinus augmentation without grafting or bony substitute. This can simplify relatively major surgery, such as a sinus augmentation procedure, to a less invasive procedure and potentially reduce the risk of complications.

Transimplant antral lavage as minimally invasive treatment of chronic rhinosinusitis: Preliminary report of 11 consecutive cases.

OBJECTIVE: The present article reports how a dental implant with an internal port dental implant valve approach (DIVA) can be utilized as oroantral port to treat chronic rhinosinusitis (CRS) in a minimally invasive manner. METHOD AND MATERIALS: Eleven patients (age mean 68.1 years) with CRS were subjected to the transimplant lavage technique. For three patients the CRS treatment was performed via previously installed dental implants, and for another eight patients the implantation procedure was combined with the CRS treatment. The moment the implant was fully installed, the sinus membrane was punctured via the implant channel. Upon completion of the pus drainage the sinus was irrigated with normal saline, followed by the injection of a steroid solution (100 mg hydrocortisone). RESULTS: Patients began to report symptomatic improvement from the first day after the first-session procedure. Nine patients had complete relief of most of their symptoms (nasal obstruction/discharge, anosmia/hyposmia) at day 30. The follow- up nasal endoscopy demonstrated no evidence of active sinus disease. All the implants used were found to be well-osseointegrated and still in use for prosthetic purposes. Clinical and radiologic results showed stability and no recurrence in the follow-up period. CONCLUSION: The dental implant with an internal central port and integral dedicated sealing screw may be used for irrigation, observation, and further treatment of the maxillary sinus in cases of CRS.

Four-years' experience with dynamic implants with internal port for minimally invasive sinus elevation.

OBJECTIVE: The purpose of this article is to describe long-term results of the dynamic implant valve approach (DIVA) for the dental implant procedures when the implant system with internal ports was used. METHOD AND MATERIALS: During 2012 to 2015, 378 titanium-aluminum-vanadium implants (Ti6Al4V ELI; diameter 3.75 mm; length 11.5 and 13 mm) were implanted in 172 patients (one to nine implants per patient) using the DIVA technique. The DIVA implants were used in cases when sinus membrane and/or nasal floor elevation procedures were needed. The condition of the implants was assessed during the follow-up period up to 60 months. RESULTS: Out of 378 inserted implants, 257 implants were inserted in the maxilla with the bone level < 5 mm, and 121 implants were inserted in the maxilla with the bone level > 5 mm. In 357 cases (94.5%), the implantation was totally successful both from objective CBCT clinical and subjective patients' viewpoints. The comparison of complication rates between the cases with the bone level < 5 mm and the cases with the bone level > 5 mm indicated no significant difference (P = .32). CONCLUSION: Preliminary results that the DIVA simplifies the dental implantation procedure and augmentation treatment were confirmed. The implant with an inner sealing screw can be used in cases with elevation of the maxillary sinus membrane, and simplifies the surgery and secures optimal dental implant placement. This new type of implant simplifies the maintenance phase of implant dentistry and helps to overcome possible complications.

Complications of sialendoscopy: personal experience, literature analysis, and suggestions.

PURPOSE: This article describes our experience combined with analysis of the emerging literature, presenting suggestions of how to avoid the complications that may arise during or after endoscopic or endoscopy-assisted surgery of the salivary glands. MATERIALS AND METHODS: In a retrospective study, the surgical data of 498 consecutive patients who underwent surgery for calculus removal from the parotid, submandibular, and sublingual glands from 2010 to 2012 were collected and analyzed. The analysis was concentrated on specific complications of endoscopic or endoscopy-assisted operations. RESULTS: The patients were operated on by various sialendoscopy-involved techniques that included intraductal endoscopy and an endoscopy-assisted extraductal approach. The total percentage of complications associated with endoscopy was 3.23% (n = 17). In 1 case (0.2%) (submandibular gland surgery), severe bleeding occurred that required immediate gland resection. CONCLUSIONS: At present, sialendoscopic and endoscopy-assisted techniques produce a minimal number of postsurgical endoscopy-related complications, but they are not complication-free operations. Strictures, ranulas, and lingual nerve paresthesias are the most frequent of these complications. Further reduction of the number of complications is possible with careful preprocedural imaging analysis and correct endoscopic techniques.

Dynamic implant valve approach for dental implant procedures.

OBJECTIVE: To present the results of our current research involving the dynamic implant valve approach (DIVA) in cases with human patients. METHODS: The new kind of implant was designed with an internal sealing screw that might serve for drug delivery system and possible endoscopic direct observation via its channel. The DIVA was used in cases when the implant insertion should be combined with the maxillary sinus floor lifting and/or bone augmentation procedure. A total of 63 patients (female n = 31, male n = 32, age range 33-67 years old, mean age 49 years old) were treated with DIVA and 218 new type implants were inserted. RESULTS: Out of 218 inserted implants, 146 implants were inserted in the maxilla with bone level < 5 mm, and 72 implants were inserted in the maxilla with bone level > 5 mm. The number of implants per patients varied from one to eight. The failure consisted of seven implants (3.2%) in five patients. No correlation was found between failure cases and the bone density or quality. Follow up (4 to 18 months) showed that in 211 cases (96.8%), the implantation was totally successful both from objective clinical, imaging (cone beam computed tomography) and subjective patients' viewpoints. CONCLUSION: The new dynamic implant valve approach simplified dental implantation procedure and postoperative treatment. The implant with an inner sealing screw could be considered for use in cases when elevation of the maxillary sinus membrane is needed, as well as in cases when bone augmentation procedures or future treatment might be suspected.

A novel dental implant system with an internal port for endoscopic closed sinus augmentation: a feasibility study in pigs.

PURPOSE: This study describes the use of an innovative dynamic implant valve approach (DIVA) for dental implant placement and sinus augmentation procedures. MATERIALS AND METHODS: The DIVA implant system was tested in vitro for leakage and mechanical fatigue. A closed sinus elevation procedure with a gel-type bone substitute was performed using the DIVA implant in a swine model (n = 6). Implants were placed and evaluated radiographically and histologically. RESULTS: Elevation of the maxillary sinus membrane and augmentation were performed in a simple, minimally invasive fashion. Histologic analyses demonstrated complete sealing of the DIVA implant and excellent osseointegration. CONCLUSION: The DIVA can be used as a simplified viable option for dental implantation and augmentation procedures. Hermetic sealing of this implant system, which features an inner screw, renders it safe.

Preserving formerly impaired salivary gland function in radioiodine-treated thyroid papillary carcinoma.

Salivary gland impairment after radioiodine therapy (RIT) is a well-known iatrogenic artifact that includes recurrent episodes of sialadenitis, hyposalivation, dysgeusia, and dysphagia. Several therapy modalities have been suggested over the years to decrease these effects on the salivary glands. However, in cases where the salivary gland system is impaired prior to RIT, preserving its function becomes more challenging. We present three patients who underwent RIT with pre-existing insult to the salivary glands and discuss the treatment modality employed. A protocol for treating patients with pre-existing salivary gland impairment prior to RIT is proposed. The dental professional personnel should be aware of RIT insult to the salivary glands in order to preserve more maliciously the oral health in these patients. Management of impaired salivary glands subjected to additional RIT is mandatory to reduce further damage to the glands' function primarily by combining interventional sialoendoscopy for recurrent sialadenitis and sialogogues for hyposalivation.

Sialendoscopy for the management of obstructive salivary gland disease: a systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review with meta-analysis to determine the efficacy and safety of sialendoscopy in the treatment of obstructive diseases of the salivary glands in adults. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Library (no lower limit to October 2010). Reference lists were searched for identification of relevant studies. STUDY SELECTION: Prospective or retrospective studies of adult patients treated with interventional sialendoscopy for the management of salivary gland obstruction were selected. Outcome measures included rates of success (symptom-free and absence of residual obstruction), sialadenectomy, and complications. Non-English publications were excluded. DATA EXTRACTION: Two independent review authors screened eligible studies, extracted relevant data, and resolved discrepancies by consensus when applicable. Weighted pooled proportion, 95% confidence intervals, and test results for heterogeneity are reported. DATA SYNTHESIS: Twenty-nine studies were included in the analysis. The weighted pooled proportion of success rates were 0.86 (95% CI, 0.83-0.89) for studies involving 1213 patients undergoing sialendoscopy alone and 0.93 (95% CI, 0.89-0.96) for the 374 patients undergoing sialendoscopy with a combined surgical approach. Outcomes following interventional sialendoscopy for radioiodine-induced sialadenitis were reported in 3 studies, and success rates were variable. Rates of sialadenectomy were low, and few major complications were reported. CONCLUSION: Findings from the present systematic review and meta-analysis suggest that sialendoscopy is efficacious, safe, and gland preserving for the treatment of obstructive major salivary gland disease.

Minimally invasive options for salivary calculi.

The aim of this study was to review the advantages, limitations, and international interdisciplinary expert perspectives and contrasts of salivary gland endoscopy and transoral techniques in the diagnosis and management of salivary gland calculi and their adaptation in North America. The transition from transcervical approaches to strictly sialendoscopic approaches is a broad chasm and often not feasible. Sialendoscopy, sialendoscopy-assisted, intraoral, and transcervical approaches all have surgical value. Diagnostic sialendoscopy, interventional sialendoscopy, sialendoscopy-assisted, and transoral techniques have been a major step forward, not only in providing an accurate means of diagnosing and locating intraductal obstructions, but also in permitting minimally invasive surgical treatment that can successfully manage blockages precluding sialoadenectomy in most cases. A flexible methodology is required. Multiple or combined measured may prove effective.

Endoscopy in endodontics.

A successful outcome of endodontic treatment depends to a large extent on accurate intraoperative findings. Conventionally, micromirrors and microprobes have been used for this purpose. The dental operating microscope (DOM) has been implemented to enhance visibility during dental procedures. However, the microscope, a sizable tool, remains between operating field and the dental practitioner, making his ability to manipulate more complicated. Also, the interference of the hands and the handpiece with the visualization of the surgical field and inaccurate observation of the endodontic instruments during the procedure. Endoscopy reportedly provides the dentist with excellent vision and ease of use. It also provides a better intraoperative visualization in comparison with micromirrors. Further development of endoscopy made it possible to combine magnification, light, irrigation/suction and surgical microinstruments in one device. This combination could lead to an advanced root canal treatment technique.