Expression of CD24 as Cancer Stem Cell Marker in the Diagnosis of Oral Squamous Cell Carcinoma - A Prospective Study.

Introduction: Oral squamous cell carcinoma (OSCC) is an aggressive and recurrent malignancy. Identification of unique and overexpressed cell surface antigens is important in the diagnosis and development of cancer vaccines and various therapies for OSCC. We have used real-time polymerase chain reaction (RT-PCR) for the expression of cell surface protein CD24 in both tissue samples and in blood samples to study the clinicopathological features as well as to determine the gene expression profile of CD24 in OSCC and explore its role as a potential target of clinical therapy. Materials and Methods: In this prospective study, the expression of CD24 was evaluated in 20 blood (3 ml) and tissue samples of OSCC specimens by quantitative RT-PCR. Student's t-test was used for statistical analysis. The significance level was considered <0.05. Results: CD24 was found to be upregulated amongst the cases for both the tissue and the blood. CD24 was statistically significant with P < 0.05. Fold change was calculated to assess the quantity of the difference in expression amongst cases when compared to controls. Results were supportive of CD24 being a reliable biomarker, hence blood samples can also be used in screening and diagnosis of OSCC. Discussion: CD24 expression is significantly upregulated in blood and tissue samples in OSCC. In addition, CD24 overexpression is highly associated with adverse prognostic parameters such as lymph node involvement, advanced clinical stages and worse overall survival. Our findings have important implications in future practice, overexpression of CD24 in OSCC was associated with poor prognosis correlating to the clinical findings, large-scale comprehensive studies are needed further to confirm our findings. In addition to histological features, CD24 can be used as marker for OSCC.

Ameloblastic fibrosarcoma transformation from ameloblastic fibroma.

Ameloblastic fibrosarcoma (AFS) is an extremely rare malignant odontogenic tumor. It is composed of benign odontogenic epithelium, resembling that of ameloblastoma, and a mesenchymal part exhibiting features of fibrosarcoma. The development of this lesion in the jaws is either de novo or from preexisting ameloblastic fibroma which has been well documented. The most commonly affected site within the jaw is the posterior mandible. These tumors show local aggressiveness and a high tendency to recur. We present a case of a 33-year-old female patient with swelling of the right posterior mandible for 2 months and progressive paresthesia of the same region for the past 6 months. Patient's history revealed undergoing surgical enucleation for ameloblastic fibroma before a year in the same region as current swelling. Examination of the swelling revealed an ulceroprolifeartive Growth of 6 × 4.5 cm extending from premolar to molar region. Primary investigation involved biopsy of the swelling, which was reported as sarcoma for which resection of the right hemimandible and selective neck dissection was performed. Following surgery, the final histopathology report of the resected specimen was reported to be AFS. One year after the surgical procedure, the patient is clinically and radiologically disease-free. Considering the aggressive nature of these tumors, it is vital to give an accurate diagnosis through biopsy, which is considered as gold standard diagnostic evidence, so that the surgeon plans the appropriate therapeutic decision. Knowledge of this rare entity and its histologic features as opposed to the more common benign counterparts such as ameloblastoma or ameloblastic fibroma is crucial as the latter involves a conservative treatment approach while the former can only be treated through aggressive resections.

Modified Cupar's method for immediate diastema closure.

Anterior maxillary osteotomy or ostectomy (AMO) is a safe, reliable, and easily adaptable procedure routinely performed in orthognathic surgery for the management of the dentoalveolar segment of the anterior maxilla. The anterior segmental maxillary osteotomy was first performed in 1921 by Cohn-Stock. Several modifications were done regarding approaches for AMO; however, Cupar's method is the most preferred approach by the surgeons and in practice since several decades. A novel midline split osteotomy is performed in combination with Cupar's method for superior and posterior repositioning of anterior maxillary segment in combination with immediate closure of diastema in this case report.

Extracranial Head and Neck Schwannomas: A Case Series and Review of Literature.

Schwannomas are benign nerve tumors of schwann cell origin. Schwann cells are derived from neural crest and are therefore of neuroectodermal origin. 25-40% of all schwannomas arise in the head and neck region. The most common schwannomas are vagal schwannomas and cervical schwannomas in the head and neck region. Here we present two cases of head and neck schwannomas which were not identified as originating from any major nerve. The first patient had a schwannoma in the infratemporal region which was excised by performing transzygomatic approach, and the second patient had a schwannoma in the left lateral part of the neck which was excised using a cervical crease incision.

Controversies in the Management of Temporomandibular Joint Ankylosis Using Distraction Osteogenesis - A Systematic Review.

Background: The three commonly employed sequences of distraction osteogenesis (DO) in the management of temporomandibular joint (TMJ) ankylosis with dentofacial deformities include post-arthroplastic distraction osteogenesis (PAD), simultaneous arthroplastic distraction osteogenesis (SAD), and pre-arthroplastic distraction osteogenesis (PrAD). Objective: The aim of this systematic review is to compare the effectiveness of various sequences of DO in the management of TMJ ankylosis with micrognathia/and obstructive sleep apnea syndrome (OSAS). Data Sources: A comprehensive online and manual search of English language literature with no date restrictions was done on March 2020. Eligibility Criteria: Inclusion criteria were case series and prospective and retrospective studies involving adult/paediatric human subjects with unilateral/bilateral TMJ ankylosis and micrognathia/OSAS treated with DO. Study Appraisal and Synthesis Methods: Of 73 studies identified, only 10 were included in the qualitative synthesis. The outcomes assessed were as follows: maximum mouth opening (MMO), posterior airway space (PAS), polysomnography variables, reankylosis, mandibular length, and chin and mandible position. Results: All the included studies showed high risk of bias. MMO and mandibular length increased, chin and mandibular position improved by the end of treatment in all the three sequences, and polysomnography variables and PAS significantly improved in PrAD compared to PAD and improved in SAD compared to baseline. Reankylosis was significantly less in PrAD. Conclusion: More well-designed studies comparing the three sequences of DO should be carried out to arrive at a consensus.

Odontogenic sarcoma: First report after new who nomenclature with systematic review.

Ameloblastic fibrosarcoma (AFS) now designated as odontogenic sarcoma is a malignant odontogenic tumor characteristically composed of a benign epithelium and a malignant mesenchymal component. It can arise de novo without any preexisting lesion or it can result from the malignant transformation of ameloblastic fibroma (AF). Hereby, we report an extremely rare case of odontogenic sarcoma which was transformed from AF over a period of about 2 years. This is the first case to be reported after it has been reclassified as odontogenic sarcoma. A systematic review was also done to evaluate the studies that reported AFS arising de novo and AFS arising from AF. The objective of this study is to systematically review the studies that reported AFS arising de novo and AFS arising from AF. Articles that reported AFS arising de novo and AFS arising from AF were collected from PubMed, Medline, Embase, Cochrane, Google search and manual search. The results of the systematic review showed that six studies (46.1%) reported AFS arised de novo with no previous history of AF. Seven studies (53.84%) reported that amelobastic fibrosarcoma arised from AF. A rare case of odontogenic sarcoma transformed from AF is reported here. This is the first case report to be published on odontogenic sarcoma after the World Health Organization reclassification. AF once diagnosed should be treated immediately without any delay to avoid the chances of its malignant transformation into odontogenic sarcoma.

Evaluation of Three-Dimensional Changes in Pharyngeal Airway Following Isolated Lefort One Osteotomy for the Correction of Vertical Maxillary Excess: A Prospective Study.

BACKGROUND: Orthognathic surgery involves movement of jaws in all three planes, and this being a part of airway complex, displacement of jaws can influence the dimension of airway at all levels. Lefort one osteotomy surgery with superior repositioning is a common procedure done for patients with vertical maxillary excess. PURPOSE: The purpose of this study was to evaluate the three-dimensional volumetric changes in airway after lefort one impaction surgery using three-dimensional cone beam computed tomography (3D-CBCT) in patients with vertical maxillary excess (VME). METHODS: A prospective analysis of 15 patients who underwent isolated lefort one impaction surgery was done with pre-operative (T0) and 3-months (T1) post-operative 3D-CBCT scans. Airway was divided into three segments, nasopharyngeal, velopharyngeal and oropharyngeal. Volumetric analysis of all these segments was done before and after surgery. Paired 't test' was used to assess the mean difference in airway volume and area between T0 and T1. One-way ANOVA was used to check the mean percentage difference in airway volume and area among the three segments. RESULTS: The mean percentage of nasopharyngeal volume difference was - 0.6299 ± 0.9146%, velopharyngeal volume difference was - 0.5205 ± 1.107%, oropharyngeal volume difference was - 1.492 ± 2.745%. Though volume and area of pharyngeal airway were decreased after maxillary impaction surgery in all three segments of airway studied, they were not statistically significant. CONCLUSION: Among the three segments of airway studied, oropharyngeal airway volume has shown the highest post-surgical reduction though statistically insignificant. ESS scores were within normal limits. Hence, we are of the opinion that there is lack of evidence to conclude that the patients undergoing lefort one superior repositioning for the treatment of VME might develop significant narrowing of PAS that may predispose the patient to breathing disorders.

Canonical Wnt pathway gene expression and their clinical correlation in oral squamous cell carcinoma.

AIM: The aim of this study is to explore the prognostic significance and clinicopathological correlations of the Wnt pathway genes in a cohort of surgically treated patients with oral squamous cell carcinoma (OSCC) patients. SETTINGS AND DESIGN: A prospective genetic study on patients with OSCC was carried out during the period from July 2014 to January 2016. Informed consent from patients and institutional ethical approval for the study was obtained and the guidelines were strictly followed for collection of samples. SUBJECTS AND METHODS: Clinical data and mRNA expression analysis of ten genes in the canonical Wnt pathway were evaluated and their relationships with clinical and demographic variables were studied in 58 tissue samples. Wnt-3a, ß-catenin, secreted frizzled-related proteins sFRP-1, sFRP-2, sFRP-4, sFRP-5, Wnt inhibitory factor 1, dickkopf-1, c-MYC, and cyclin-D1 from cancer (n = 29) and normal (n = 29) tissue samples were investigated using quantitative reverse transcription-polymerase chain reaction. STATISTICAL ANALYSIS: Descriptive statistics were used to summarize the sample characteristics and clinical variables. If the data were normal, then parametric tests were used; otherwise, nonparametric alternatives were used. All the analyses were carried out using SPSS version 23.0 (IBM SPSS Inc., USA). RESULTS: Expression of sFRP-1, sFRP-2, and sFRP-5 in control samples and expression of c-MYC and cyclin D1 in cancer samples showed statistical significance. Significant expression of Wnt3A was observed among patients who had recurrence and were deceased. CONCLUSION: Wnt3A, ß-catenin, and cyclin D1 are recognized as key components of Wnt/ß-catenin signaling. However, in this study, there was no significant expression of all the three genes in OSCC. The proto-oncogene c-MYC showed statistically significant upregulation in cancer tissue samples suggesting that the OSCC among South Indian population is primarily not mediated by the canonical Wnt signaling pathway.

Risk Factors for Post-operative Infection Following Single Piece Osteotomy.

OBJECTIVE: The aim of this retrospective study was to identify the significant risk factors that contribute towards postoperative infection in patients recovering from orthognathic surgery. METHODS: Retrospective records of 522 patients who underwent orthognathic surgery over 9 year period were evaluated for postoperative infection within 3 months of surgery and after 3 months of surgery. The variables of interest included age, gender, habits like smoking and alcohol consumption and incidence of postoperative infection. RESULTS: The overall infection rate was 4.60%. Patients who underwent bilateral sagittal split osteotomy to advance the mandible had an infection rate of 10.4%. Statistically significant predictor variables (P < 0.05) included patients who had the smoking habit, and those that received bone grafts in both the time periods. CONCLUSION: In conclusion, the occurrence of infection after orthognathic surgery is influenced by multiple factors, among which are the type of osteotomy, smoking habit and bone grafting procedures.

Efficacy of low-level laser therapy in temporomandibular disorders: A systematic review.

PURPOSE: The aim of this systematic review was to assess the efficacy of low-level laser therapy (LLLT) in patients with temporomandibular disorders (TMDs). METHODS: Medline search was done from 1997 to 2011 using search terms appropriate to establishing a relation between LLLT and TMD. Only randomized controlled trials were included in this study. Outcome variables related to pain, muscle tenderness, mandibular movements, and Electromyographic (EMG) activity were considered. Of the 242 articles examined, 13 were finally included in the critical analysis conducted as a part of the present systematic review. RESULTS: Of the 242 titles reviewed, only 13 articles were considered eligible. 7 articles showed significant improvement in the study group, whereas 5 showed no significant improvement between the study and control groups. The primary outcome of most of the studies was pain. Other variables considered were muscle tenderness, mandibular movements; EMG activity was considered. CONCLUSION: Our results have shown that LLLT seems to be effective in reducing pain in TMD's. It may be a treatment option for patients with an interest in a noninvasive, complementary therapy.

Comparison of pterygomaxillary dysjunction with tuberosity separation in isolated Le Fort I osteotomies: a prospective, multi-centre, triple-blind, randomized controlled trial.

The aim of this trial was to compare two techniques of maxillary dysjunction, with 10mg/kg tranexamic acid as an adjuvant, in isolated non-segmented Le Fort I procedures. Two hundred patients were randomized to one of four groups: group A, pterygomaxillary dysjunction+saline; group B, tuberosity separation+saline; group C, pterygomaxillary dysjunction+tranexamic acid; and group D, tuberosity separation+tranexamic acid. Primary outcome measures were intraoperative blood loss and operating time, while the secondary outcome measures were surgical field assessment, need for blood transfusion, and duration of hospitalization. The data were analyzed using one-way analysis of variance (SPSS v. 17.0), and the level of significance was set at P<0.05. Results revealed that group D (tuberosity separation+tranexamic acid) had the least blood loss (mean 172 ml) and shortest operating times (mean 49 min), with the best surgical field. This group also exhibited the lowest drop in postoperative haemoglobin concentration (Hbgm/dl) and packed cell volume (PCV). Five patients, all in group A, required a blood transfusion and had an extra 24h of hospitalization. This trial revealed that the tuberosity separation technique with the use of tranexamic acid was the best protocol in producing the least blood loss, minimizing the operating time, and providing the best surgical field.

A Study on the Influence of the Osteotomy Slope on Bony Changes after Advancement Genioplasty.

INTRODUCTION: The slope of the osteotomy used for the genioplasty dictates the vertical change. The horizontal bony changes after advancement genioplasty are not identical to the intercortical bony changes, because the variety of osteotomy slopes result in different vertical changes. MATERIAL AND METHODOLOGY: Ten of these patients had additional osteotomies as follows: five maxillary, three mandibular and two both maxillary and mandibular. Pre-operative and post-operative (at least 6 months) lateral cephalograms were retrospectively analyzed to assess horizontal and vertical movements of the chin. The following landmarks were used, Hard tissue pogonion (Pog), Occlusal plane (OPL), Menton (Me), Menton plane (MePL). The following parameters were calculated: ΔH = H-H, ΔV = V-V, The ratio between ΔH and ΔV equals tangent α, Calculated α = inverse tangent α . RESULTS: The Mean Horizontal bony movements was 3.75 mm (SD 1.4 mm, range -6 to 15 mm). The Mean Vertical bony movements was 1.4 mm (SD 0.8 mm, range 0.5-2 mm). The Mean Measured Osteotomy slope angle was 82.2 (SD 7.4, range 75-91). The Calculated Mean Slope Angle based on the ΔH/ΔV ratio was 82.3 (SD 7.0, range 74-95). DISCUSSION: The slope of the osteotomy used for the genioplasty dictates the vertical change. The osteotomy slope angle was defined as the angle between the osteotomy and a line perpendicular to the occlusal plane. The measured angle was compared with the calculated angle deduced from the horizontal and vertical genial post-operative changes.

Treatment of oral submucous fibrosis using split skin graft and a polyethylene stent: a prospective study.

AIM: Aim of this study was to evaluate the split skin graft held in place with a polyethylene stent for the treatment of oral submucous fibrosis. METHODS: Fifteen prospective patients diagnosed clinically with oral submucous fibrosis, from June 2011 to 12 December 2012, were recruited for this study. All patients were treated surgically using the same surgical technique of fibrotomy followed by split skin graft along with a polyethylene stent. Preoperative and postoperative mouth opening measurements at 1 week and after a minimum of 6 months were evaluated by measuring the inter incisal distance. RESULTS: Mean follow up was 9.8 months with a minimum of 6 months. Mean preoperative mouth opening was 12.9 mm (6-20 mm). Intraoperatively mean mouth opening was 37.9 mm (36-41 mm). After 1 week mean mouth opening was 35.8 mm (31-40 mm). At 6 months follow up, mean mouth opening was 33 mm (20-40 mm). CONCLUSION: Fibrotomy followed by split skin graft along with a polyethylene sheet stent and sufficient postoperative physiotherapy is a simple, cost effective and viable treatment modality for oral submucous fibrosis.

Effectiveness of tranexamic acid on intraoperative blood loss in isolated Le Fort I osteotomies--a prospective, triple blinded randomized clinical trial.

The aim of this triple blinded randomized clinical trial was to evaluate the efficacy of tranexamic acid when used in conjunction with hypotensive anaesthesia exclusively for Le Fort I osteotomies. 49 patients undergoing Le Fort I osteotomy for correction of dentofacial deformity were divided into two groups; Group 1 received a placebo of saline 5 ml and Group 2 received 10 mg/kg body weight of tranexamic acid. The operating surgeon, anaesthetist and investigator were blinded. The variables of interest recorded in this study included the change in Hb%, PCV, total blood loss, total operating time and quality of the surgical field using Fromme's Ordinal Scale. Statistically significant differences between the two groups were found between the following variables: post-operative Hb%, drop in Hb%, post-operative PCV, drop in PCV, total surgical blood loss, total operating time and quality of surgical field (P < 0.05). Group 2 patients exhibited a smaller drop in Hb% and PCV, with a lower Fromme's Ordinal Scale value and decreased total blood loss and operating time. In conclusion single preoperative administration of tranexamic acid in the dose of 10 mg/kg, when combined with hypotensive anaesthesia is effective in controlling blood loss with regards to single piece Le Fort I surgery.

Open versus closed treatment of unilateral subcondylar and condylar neck fractures: a prospective, randomized clinical study.

PURPOSE: The purpose of the present study was to compare closed treatment with open reduction and internal fixation for displaced unilateral subcondylar and condylar neck fractures. MATERIALS AND METHODS: A total of 32 patients with displaced unilateral condylar fractures were included in the present study. Of the 32 patients, 27 were men and 5 were women. The patients were divided into 2 groups. The group I patients were treated with closed treatment and rigid maxillomandibular fixation, and group II patients were treated with open reduction and internal fixation. The patients were assessed for maximal interincisal opening, protrusive movements, lateral excursion movements on the fractured and nonfractured sides, anatomic reduction of the condyle on radiography, pain in the temporomandibular joint, and malocclusion. Parameters such as the maximal interincisal opening, protrusive movements, and lateral excursion movements on the fractured and nonfractured sides between the 2 groups were compared statistically using an independent t test. Parameters such as anatomic reduction of the condyle, pain in the temporomandibular joint, and malocclusion between the 2 groups were compared statistically using the chi(2) test. RESULTS: No significant difference was found between the 2 groups in the maximal interincisal opening, protrusion, lateral excursion movement, malocclusion, and temporomandibular joint pain; however, a statistically significant difference was seen in the anatomic reduction of the condyle. CONCLUSIONS: The results of the present study have shown that no significant clinical difference exists between patients undergoing closed treatment and rigid maxillomandibular fixation or open reduction and internal fixation. However, a radiographically better anatomic reduction of the condylar process was seen in the patients treated with open reduction and internal fixation.

Hypotensive anaesthesia and blood loss in orthognathic surgery: a clinical study.

OBJECTIVES: To find out whether hypotensive anaesthesia minimized blood loss during orthognathic surgery. DESIGN: A prospective randomized clinical study. SUBJECTS AND METHODS: 53 consecutive patients, 15-33 years old, who were to have orthognathic operations were admitted to the study. They were randomly allocated to either normotensive or hypotensive anaesthesia. RESULTS: Median (range) blood loss/operation (ml) under hypotensive anaesthesia was 200 (90-400)ml and under normotensive anaesthesia was 350 (130-1575)ml (P= 0.01), and those for maxillary segmental osteotomy under hypotensive anaesthesia were 85 (40-240)ml and, under normotensive anaesthesia, 175 (100-190)ml (P= 0.05). CONCLUSION: There was pronounced reduction in blood loss during orthognathic operations done under hypotensive anaesthesia compared with those done under normotensive anaesthesia.