Evidence-Based Protocol for Ophthalmology Consult for Orbital Fractures.

PURPOSE: Previous retrospective studies demonstrate that urgent evaluation by an ophthalmologist for orbital fractures is not required in visually asymptomatic patients, although a consult is often seen as a necessity in many hospital institutions. To determine when an ophthalmology consult is indicated for a surgical patient, the oral and maxillofacial and ophthalmology departments at 1 institution collaborated for an evidence-based approach utilizing retrospective and prospective data. PATIENTS AND METHODS: The retrospective arm looked at patients from 2012 to 2017, who had an isolated, surgically repaired orbital fracture without preoperative ophthalmology consultation. A prospective arm was then created from August 2019 to July 2020 with a designed protocol that determined which patients required an ophthalmology consult preoperatively. Extra-ocular movements, visual acuity, and diplopia were examined in the preoperative and postoperative setting to determine if the lack of an ophthalmology consult adversely affected patient outcome. RESULTS: Of the retrospective patients who met criteria, 82 of the 84 (98%) patients had a normal postoperative examination: baseline visual acuity, intact extra-ocular movement, and no diplopia. The 2 of the 84 (2%) patients had postoperative diplopia consistent with preop examination. In the prospective group, 10 of the 39 patients required a preop ophthalmology consult while 29 of 39 did not require one. A normal postoperative examination was present in 26 of the 29 patients (90%). Of those 3 remaining patients, 2 patients (7%) had postoperative diplopia consistent with preoperative while 1 patient (3%) had postoperative diplopia without preoperative diplopia. CONCLUSIONS: The authors conclude that a routine ophthalmology consult is not warranted in visually asymptomatic patients with orbital fractures requiring surgical repair.

MicroRNAs-208b-3p, 204-5p, 129-2-3p and 3065-5p as predictive markers of oral leukoplakia that progress to cancer.

Leukoplakia is the most common precursor lesion of oral squamous cell carcinoma (OSCC). Currently, the risk of progression to OSCC is assessed based on histopathologic examination alone. However, this method fails to identify the subset of microscopically innocuous leukoplakia that ultimately transforms to OSCC. The aim of this study was to determine if microRNAs (miRNAs) can be utilized to identify non- and low-grade dysplastic oral lesions at risk for cancer progression. A retrospective study of genome-wide miRNA expression level analyses was performed in the training cohort (n=20) using deep sequencing formalin-fixed paraffin embedded incisional biopsy tissues from patients with oral leukoplakic lesions diagnosed with non- or low-grade dysplasia and known clinical outcome. The promising miRNA candidates were then evaluated in the validation cohort (n=80) using quantitative real-time PCR (qRT-PCR). Four promising miRNAs-208b-3p, 204-5p, 129-2-3p and 3065-5p were identified. Combining these four miRNAs as a panel with age and histologic diagnosis (p<0.004), our final model had a predictive value for the area under the receiver operating characteristic (ROC) curve (AUC) of 0.792, sensitivity of 76.9% and specificity of 73.7% to accurately identify non- and low-grade dysplastic lesions at risk of cancer progression, which is a significant improvement over histopathologic examination alone (AUC of 0.645). While further investigation is needed, discovery of predictive markers that can accurately identify histologically innocuous oral lesions at high risk for progression to OSSC will significantly improve clinical outcome by means of early intervention.

Pregnancy Tumor in a 31-Year-Old Female with a Facial Port-Wine Stain.

Pyogenic granuloma is a type of inflammatory hyperplasia often seen in the oral cavity and occurs in response to stimuli such as local irritants and hormonal factors. Pyogenic granulomas associated with pregnancy are referred to as pregnancy tumors. This report describes the presentation and surgical management of a large pregnancy tumor occurring in a patient with an overlying isolated facial port-wine stain.

Oral ulcerations as a sequela of tacrolimus and mycophenolate mofetil therapy.

Medication-induced ulcerative stomatitis can be a complication of immunosuppressive therapy in a post-transplant patient. A 54-year-old African-American female patient presented with significant, recalcitrant oral ulcers 5 months after renal transplant as a result of mucosal toxicity and severe leucopenia caused by her immunosuppressive maintenance regimen of tacrolimus (US Pharmacopeia, Rockville, MD) and mycophenolate mofetil (Santa Cruz Biotechnology, Santa Cruz, CA). The patient was also prescribed fluconazole as an antifungal, which likely contributed to the patient's increase in tacrolimus blood levels. Altering the medication dosages ultimately reduced blood tacrolimus levels, allowing for resolution of her oral ulcers. This report indicates that medication-induced oral ulcerations are a potential sequela of post-transplant immunosuppressive therapy.