In-House Manufacturing of a Translucent Three-Dimensional Model and Surgical Guide for Marginal Mandibulectomy.

In recent years, intraoperative surgical guides have been widely used in oral and maxillofacial surgery to navigate the resection sites. However, most of them are designed for segmental mandibulectomy and determine only the anterior-posterior cutting sites. In the case of marginal mandibulectomy, the depth and angle of the resection need to be considered in addition to the anterior-posterior cutting site. This report describes a method for creating a translucent mandible model with a colored tumor that enables visualization of the tumor depth and a surgical guide for marginal mandibulectomy with a planned resection angle. If accurate surgical planning and intraoperative navigation are established using this method, personalized surgery is realized according to tumor features and hence avoids over- or under-resection.

A Simple Method for Creating Medical Illustrations Using Tablets.

Medical illustrations are defined as illustrations that contain and convey medical information. Illustrations in surgical records play a pivotal role not only in recording medical information but also in sharing surgical information, improving own surgical skills, and teaching young doctors. However, we believe that creating a medical illustration from a blank sheet of paper is challenging for beginners. The computer-assisted illustration technique proposed in this article not only saves time but also provides accurate and easy-to-understand medical illustrations. This technical note aims to introduce a simple and easy method for creating medical illustrations by tracing intraoperative photographs using an iPad™ and an Apple Pencil™. We believe that "anyone can draw" detailed, easy-to-understand medical illustrations using the present method, and we hope that many young doctors will actively create medical illustrations.

Feasibility of oral microbiome profiles associated with oral squamous cell carcinoma.

Objective: Recently, the possibility that oral microbiomes is associated with oral squamous cell carcinoma (OSCC) initiation and progression has attracted attention; however, this association is still unclear. Here, we comprehensively analyze the microbiome profiles of saliva samples using next-generation sequencing followed by determining the association between oral microbiome profiles and OSCC. Materials and Methods: Microbiome profiles in saliva samples from patients with OSCC, oral leukoplakia (OLK), and postoperative OSCC (Post) were analyzed. Candidate OSCC-associated bacteria were identified by comparing the bacterial diversity and relative abundance of each group based on these microbiome profiles, and their applicability as OSCC detection tools were evaluated. Results: There were significant differences in genus abundances (Streptococcus, Aggregatibacter, and Alloprevotella) among the groups from saliva samples. In the OSCC group, compared with the OLK and Post groups, abundances of the genus Fusobacterium, phylum Fusobacteria and phylum Bacteroidetes were markedly increased and that of the genus Streptococcus and phylum Firmicutes were decreased. Conclusion: The results suggested a strong association of these bacteria with OSCC. Especially, phylum Fusobacterium was significantly associated with early recurrence of OSCC. Thus, oral microbiome analysis may have a potential of novel OSCC detection and prognostic tool.

Efficacy of a deep leaning model created with the transfer learning method in detecting sialoliths of the submandibular gland on panoramic radiography.

OBJECTIVE: This study aimed to compare the performance of 3 deep learning models, including a model constructed with the transfer learning method, in detecting submandibular gland sialoliths on panoramic radiographs. STUDY DESIGN: We used data from 2 institutions (A and B) to create the models for use in institution B. In total, 224 panoramic radiographs with sialoliths were used. Model 1 was created using data from institution A only, model 2 was created using combined data from institutions A and B, and model 3 was created using the transfer learning method by having model 1 transferred and trained in various learning epochs using data from institution B. These models were tested and compared in their detection performance using testing data sets from institution B. RESULTS: Model 2 and model 3 with 300 epochs performed equally well and yielded the highest detection rates (recall: sensitivity of 85%, precision: positive predictive value of 100%, and F measure of 91.9%) for sialoliths on panoramic radiographs. CONCLUSION: The results of this study suggest that use of the transfer learning method with an appropriate number of epochs may be an alternative to sharing patient personal data among institutions.

Salivary CCL20 Level as a Biomarker for Oral Squamous Cell Carcinoma.

BACKGROUND/AIM: This study investigated the utility of C-C motif chemokine ligand 20 (CCL20) expression in saliva as a biomarker for oral squamous cell carcinoma (OSCC) and also examined the associated microbiome. MATERIALS AND METHODS: The study group included patients with OSCC or oral potentially malignant disorder (OPMD), and healthy volunteers (HVs). microarray and qRT-PCR were used to compare salivary CCL20 expression levels among groups. Data on CCL20 levels in oral cancer tissues and normal tissues were retrieved from a public database and examined. Furthermore, next-generation sequencing was used to investigate the salivary microbiome. RESULTS: A significant increase in the expression level of CCL20 was observed in both OSCC tissues and saliva from patients with oral cancer. Fusobacterium was identified as the predominant bacteria in OSCC and correlated with CCL20 expression level. OSCC screening based on salivary CCL20 expression enabled successful differentiation between patients with OSCC and HVs. CONCLUSION: CCL20 expression may be a useful biomarker for OSCC.

Salivary CPLANE1 Levels as a Biomarker of Oral Squamous Cell Carcinoma.

BACKGROUND/AIM: This study aimed to identify novel biomarkers for oral squamous cell carcinoma (OSCC) screening to improve the survival rate of patients with oral cancer. MATERIALS AND METHODS: We investigated differential salivary gene expression in patients with OSCC, those with oral potentially malignant disorders (OPMDs), and healthy volunteers (HVs). CPLANE1 was selected for further investigation by microarray analysis. We used quantitative reverse transcription PCR (qRT-PCR) to determine CPLANE1 expression levels in the saliva. The expression of CPLANE1 in normal and oral cancer tissues was analyzed using the Gene Expression database of Normal and Tumor tissues. RESULTS: qRT-PCR analysis of saliva samples showed that CPLANE1 expression levels were significantly higher in OSCC patients than in HVs and OPMDs patients. Furthermore, we developed a screening test for OSCC using CPLANE1 and showed that it had good accuracy. CONCLUSION: Salivary CPLANE1 could be a useful biomarker for OSCC screening and early detection.

Salivary NUS1 and RCN1 Levels as Biomarkers for Oral Squamous Cell Carcinoma Diagnosis.

BACKGROUND/AIM: Oral cancer may become advanced because of delay in diagnosis. In order to promote oral cancer screening, simple and highly reliable screening methods that can be implemented at general dental clinics are required. Herein we investigated differential salivary gene expression between oral squamous cell carcinoma (OSCC) patients and healthy volunteers (HV) to identify new biomarkers for OSCC detection. MATERIALS AND METHODS: Candidate genes were selected by microarrays, nuclear undecaprenyl pyrophosphate synthase 1 (NUS1) and reticulocalbin 1 (RCN1) were selected for further investigation. We used real-time quantitative reverse transcription PCR (qRT-PCR) to determine NUS1 and RCN1 expression levels in saliva and tissues. RESULTS: qRT-PCR analysis of clinical samples revealed that OSCC patients had significantly higher expression of salivary NUS1 and RCN1 than HV. CONCLUSION: A combination of NUS1 and RCN1 accurately distinguished patients from controls, and this combination can be implemented as a screening test for OSCC.

Helix-Sense-Selective Synthesis of Right- and Left-Handed Helical Luminescent Poly(diphenylacetylene)s with Memory of the Macromolecular Helicity and Their Helical Structures.

Symmetrically substituted poly(diphenylacetylene) (PDPA) bearing carboxy pendants was found to fold into a one-handed helix upon thermal annealing with nonracemic amines in water accompanied by chiral amplification of the helicity. The induced right- or left-handed helical PDPA was retained (memorized) after complete removal of the chiral amines, thus producing a one-handed helical circularly polarized luminescent PDPA in a helix-sense-selective manner. The helical PDPA with static helicity memory is tolerant toward modification of carboxy pendants, providing functional PDPAs with an optical activity solely due to macromolecular helicity. The PDPA and its derivatives before and after the one-handed helicity induction and its subsequent memory of the helicity exhibited well-resolved very simple 1H and 13C NMR and Raman spectra whose spectral patterns are virtually identical independent of the helical sense bias. On the basis of the 1H and 13C NMR, IR, Raman, and vibrational and electronic circular dichroism spectral measurement results combined with theoretical calculations, the key structural features (cis or trans and cisoid or transoid) of the PDPA as well as its helix inversion barrier and absolute handedness (right- or left-handed helix) and helix-sense excess of the one-handed helical PDPA and its derivatives with static helicity memory were determined. As a result, almost complete right- and left-handed helical cis-transoidal PDPAs with 98% helix-sense excess were successfully obtained using noncovalent helicity induction and memory strategy.

Secondary Squamous Cell Carcinoma of the Tongue Complicated with Bronchiolitis Obliterans as a Manifestation of Graft-versus-Host Disease following Peripheral Blood Stem Cell Transplantation.

Peripheral blood stem cell transplantation (PBSCT) has increasingly been used for hematologic cancer therapy, resulting in improved survival rates. However, risks include graft-versus-host disease (GVHD) and secondary solid tumors. Here, we describe a case of tongue squamous cell carcinoma (SCC) complicated by bronchiolitis obliterans (BO) following PBSCT. A 42-year-old man with a history of acute lymphocytic leukemia treated with PBSCT presented with multiple white lesions and erosions on the tongue and buccal mucosa that are compatible with oral chronic GVHD (NIH criteria: score 2). The lesions were presented for 8 years. The patient had a history of BO manifested as GVHD. During follow-up, an exophytic mass was rapidly developed on the left dorsum of the tongue. Biopsy of this lesion confirmed SCC (cT2N0M0). Pulmonary function testing for general anesthesia was almost normal. Hemiglossectomy, supraomohyoid neck dissection, and tongue reconstruction were performed. Thirteen months after surgery, the patient showed neither recurrence of tumor nor progression of oral GVHD. However, the patient died of respiratory failure due to repeated pneumothoraxes and deterioration of BO.

Changes in oral microbial profiles associated with oral squamous cell carcinoma vs leukoplakia.

AIM: Oral squamous cell carcinoma (OSCC) is the most frequently occurring cancer among head and neck SCC worldwide. The identification of novel effective biomarkers for early detection may greatly improve the survival rate and prognosis of patients with OSCC. This study aimed to identify specific oral microbial profiles associated with OSCC. METHODS: Saliva samples were collected from oral leukoplakia (OLK) and OSCC patients (N = 6 each) and healthy controls (HC; N = 4). Total bacterial genomic DNA was isolated and 16S rRNA gene survey was performed by next-generation sequencing of the V4 region. The relative distribution of abundance for phylogenetic groups was compared among the OSCC and OLK groups. RESULTS: The 448 operational taxonomic units detected from the libraries were classified into 133 genera, 69 families, 41 orders, 26 classes and 12 phyla. The abundance of phyla Bacteroidetes and genus Solobacterium was notably higher in the OSCC group when compared with the OLK group, whereas those of genus Streptococcus was significantly lower in the OSCC group when compared with the OLK. CONCLUSION: These changes in the salivary microbiome may have potential applications as a novel diagnostic tool for the early detection of OSCC.

Nasal Symptom Questionnaire: Our Proposed Scoring System and Prognostic Factors in Chronic Rhinosinusitis.

OBJECTIVES: We aimed to verify the usefulness of our proposed nasal symptom questionnaire (NSQ) scoring system and to determine predictors linked to the improvement in nasal symptoms in chronic rhinosinusitis (CRS) patients undergoing endoscopic sinus surgery (ESS). PATIENTS AND METHODS: Ninety-one CRS patients undergoing ESS and 144 volunteers with results of NSQ available were enrolled. The NSQ consists of 10 items. Receiver-operating-characteristic (ROC) curve, area under the ROC curve (AUC), internal consistency, and test-retest reproducibility of the NSQ were analyzed. The relationship of the NSQ score with the visual analogue scale (VAS) was examined. After classifying into two groups, i.e., (i) "improvement group" and (ii) "no-improvement group," factors linked to the improvement in NSQ after ESS were investigated. RESULTS: ROC-AUC (0.9318), the Cronbach α coefficient (0.8696), and the test-retest coefficient (0.8131) showed high reliability. NSQ score significantly correlated with VAS in both pre- (p < 0.0001, rs = 0.6007) and postoperative stages (p < 0.0001, rs = 0.5975). The postoperative NSQ scores significantly decreased compared with baseline levels (p < 0.0001). In multivariate analysis, the computed tomography (CT) score by the Lund-Mackay scoring system revealed to be significant (p = 0.0481). CONCLUSION: Our proposed NSQ scoring system was well verified. The CT score can be helpful for predicting the improvement in nasal symptoms after ESS in CRS patients.

Usefulness of our proposed olfactory scoring system during endoscopic sinus surgery in patients with chronic rhinosinusitis.

INTRODUCTION: The primary aim of the current study was to examine the usefulness of our proposed olfactory scoring system in chronic rhinosinusitis (CRS) patients with olfactory disorders (n = 213) receiving endoscopic sinus surgery (ESS). MATERIALS AND METHODS: Analyzed patients were divided into two groups: an eosinophilic CRS (ECRS) group (n = 153); and a non-ECRS group (n = 60). The T&T recognition threshold test was used to evaluate olfaction at baseline and at 3 and 12 months after ESS. Patients with mean recognition threshold < 2.0 at 3 or 12 months or with a decrease of ≥ 1.0 as compared with baseline were defined as showing clinical improvement. We scored mucosal conditions as normal (0 points), edema (1 point), and polyp (2 points) at the canopy of olfactory cleft (OC), middle and superior turbinates, superior nasal meatus, and sphenoethmoidal recess during ESS. The total score of OCs (SOCs) was calculated (range 0-20 points). We compared SOCs between ECRS and non-ECRS groups. Factors related to olfactory improvement were also investigated using uni- and multivariate analyses. RESULTS: SOCs in the ECRS and non-ECRS groups showed significant correlations with mean recognition thresholds at baseline and at 3 and 12 months. In the multivariate analysis for predicting improvement of mean recognition threshold, lower SOCs were significantly associated with olfactory improvement factors at 3 and 12 months postoperatively in the ECRS group. CONCLUSION: SOCs appears promising for estimating olfactory prognosis after ESS in CRS patients.

Osseous eustachian tube and peritubal cells in patients with unilateral cholesteatoma comparison between healthy and diseased sides using high-resolution cone-beam computed tomography.

OBJECTIVES: We investigated the factors that may possibly cause primary acquired cholesteatoma. SETTING: University-affiliated hospital. SUBJECTS AND METHODS: In 20 adult patients with unilateral cholesteatoma, the sizes of the osseous eustachian tubes (ETs) and the extent of peritubal and mastoid cell development in healthy and diseased ears were examined using high-resolution cone-beam computed tomography. The height and width of the ET were measured at the tympanic orifice, the isthmus, and the midpoint, as was the length of its axis. We also assessed the extent of development of peritubal and mastoid cells. RESULTS: There were no significant differences in the size of the osseous ET between the healthy and cholesteatoma sides, but significant correlations were found in height and width between the sides at the tympanic orifice and at the isthmus. In 80% of ears with cholesteatoma, the development of both peritubal and mastoid cells was poor and, in 5% more, one or the other was poor. Mastoid and peritubal cell development was good in 60% of healthy ears and poor in 20%. In the remaining 20%, only peritubal cell development was poor. CONCLUSION: There were no significant differences in the size of the osseous ET between the healthy and diseased sides of patients with unilateral cholesteatoma. Our results indicate that inhibition of air cell development in not only the mastoid region but also the peritubal region may contribute to cholesteatoma development.

Methotrexate-associated lymphoproliferative disorders of the tongue developing in patients with rheumatoid arthritis: a report of 2 cases and a review.

Incidences of lymphoproliferative disorders (LPDs) in patients with compromised immune systems associated with immunosuppressants such as methotrexate (MTX) administered for the treatment of rheumatoid arthritis (RA) are reportedly increasing. Although extranodal lesions develop in half of the patients with MTX-associated LPDs, only a few studies have reported on intraoral lesions. We evaluated 2 elderly women with MTX-associated LPDs who had received MTX for the treatment of RA and presented with atypical ulceration of the tongue. Biopsy specimens demonstrated polymorphous B-cell LPD, probably associated with MTX. Epstein-Barr virus (EBV) was identified by immunohistochemistry for latent membrane protein 1 and by EBV-encoded RNA in situ hybridization. After MTX withdrawal, in both cases, ulcers showed complete regression at 8 weeks, and no subsequent treatment was required. Close monitoring of LPDs is mandatory, because recurrence within 10 months has been reported in half of the patients in whom LPDs had initially regressed.

Difficulty of diagnosing Wegener's granulomatosis in the head and neck region.

OBJECTIVE: The objective of this study was to review the various clinical features associated with Wegener's granulomatosis (WG) in the head and neck region and to discuss the difficulty of diagnosing patients with early stage WG. METHODS: Between January 1998 and August 2007, WG was diagnosed and treated in 16 patients at the Department of Otolaryngology, Hyogo College of Medicine. Clinical and operating records of these patients were analyzed retrospectively. Diagnosis was based on the Japanese criteria proposed by the Japanese Ministry of Health and Welfare in 1998. RESULTS: Ten patients (62.5%) had a definite diagnosis of WG, and the other six patients (37.5%) had a probable diagnosis of WG. The period from the onset to diagnosis was between 1 month and 30 years. The generalized form of WG was observed in three patients (18.8%), and the limited form of WG was observed in the other 13 patients (81.2%). Nasal, aural, and ophthalmic symptoms were initially presented in 10, 3, and 3 patients, respectively. Cytoplasmic pattern antineutrophil cytoplasmic antibodies (cANCAs) and perinuclear pattern ANCA (pANCA) were positively detected in 68.8% (11/16) and 27.2% (3/11) of the patients, respectively. Five of 14 patients (35.7%) had pathologic features of WG in biopsy samples from the head and neck region. Three patients in whom a diagnosis of WG was difficult are presented, and immediate lessons of our experience were discussed. CONCLUSIONS: This study emphasized the difficulty of diagnosing WG, particularly at an early stage and when limited to the head and neck region. The biggest challenge faced in diagnosing WG is that it requires a high index of suspicion. When WG was suspected, we should obtain an accurate medical history from patients and repeat serologic and histopathologic examinations.