Oral squamous cell carcinoma outcome in adolescent/young adult: Systematic review and meta-analysis.

To perform a systematic review focusing on the prognosis of oral cavity squamous cell carcinoma (OSCC) in young patients (≤40 years old) compared to older (>40 years old). Four databases were used in our search strategy. First, all titles were systematically organized using the Covidence platform online. In the second phase, 118 full texts of potentially eligible studies were analyzed by reviewers independently and in pairs. Twelve studies were considered eligible for data extraction. The relapse was higher in the young than in controls (pooled relative risk (RR) = 1.31; 95% CI [1.10-1.56]). The 5-year disease-free survival (DFS) was worse in young group (pooled hazard ratio (HR) = 0.73; 95% CI [0.63-0.85]) but the 5-year overall survival (OS) estimate was similar between the groups (pooled HR = 0.84; 95% CI [0.70-1.00]). While the 5-year OS was similar between groups, the number of relapses and 5-year DFS were worse in patients with OSCC ≤40 years old.

Analysis of oral risk factors for ventilator-associated pneumonia in critically ill patients.

OBJECTIVE: This a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in intensive care units (ICU). MATERIAL AND METHODS: Data were collected from medical records, and a detailed oral physical examination was performed on 663 critically ill patients on mechanical ventilation. Data were statistically analysed using univariate and logistic regression models relating the development of VAP with the oral findings. RESULTS: At oral physical examination, the most frequent findings were tooth loss (568-85.67%), coated tongue (422-63.65%) and oral bleeding (192-28.96%). Patients with a coated tongue or oral bleeding on the first day of ICU hospitalization developed more VAP than did patients without these conditions (20.14 vs 13.69%, p = 0.02; 23.44 vs 15.50%, p = 0.01, respectively). In the logistic regression, a coated tongue and oral bleeding were considered independent risk factors for VAP development (OR = 1.61 (1.03-2.51) and OR = 1.69 (1.08-2.66), respectively). CONCLUSIONS: The presence of a coated tongue and oral bleeding in ICU admission could be considered markers for the development of VAP. CLINICAL RELEVANCE: The results of this paper reinforce the importance of proper maintenance of oral hygiene before intubation, which may lead to a decrease in the incidence of VAP in the ICU.

Widespread Sporadic Type Burkitt Lymphoma Presenting as Dental Mobility and Premature Eruption of Permanent Teeth in a Child.

Burkitt lymphoma (BL) is a rare and aggressive malignant neoplasm frequently involving the jawbones in children. The main purpose of this article is to report the case of a nine-year-old boy with widespread BL diagnosed through oral findings. The patient was referred after complaining of dental mobility for two weeks. The physical examination revealed premature eruption of permanent teeth. The periapical radiographic examination showed a diffuse bone rarefaction in the involved area. An incisional biopsy was performed, leading to the diagnosis of BL. The patient was then treated with chemotherapy and is free of disease after an 18-month follow-up. The main signs and symptoms of an oral BL could mimic a dental problem, thus it is extremely important to be knowledgeable about this disease, which can be fatal without early diagnosis and treatment.

Sclerotherapy for Extensive Vascular Malformation in the Tongue.

Vascular malformations (VMs) are benign lesions of blood vessels originated from an error in vascular morphogenesis during the embryologic phase. Generally, when located in the head and neck region VMs occurs in lips, tongue, buccal mucosa, gums, or palate. The VMs are usually asymptomatic, varies in size and may cause facial asymmetries. Different therapeutic modalities are available to treat VMs, which include surgical excision, cautery, cryotherapy, laser therapy, and sclerosing agents. The authors report 2 patients with extensive VM in the tongue treated with intralesional injection of a low-dose solution of monoethanolamine oleate (MO) and lidocaine. The first patient was a 69-year-old male patient and the 2nd a 65-year-old woman. In both patients, it were performed weekly application of 1:1 MO (Ethamolin) with Lidocaine (lidocaine 3% 1:50,000) in the amount of 0.1 mL of the solution per cm3 of lesion, with a total of 12 applications for each patient at the end of the treatment, with good results and without complications. It is important to be alert in which situation sclerotherapy should be used and that small doses of the sclerotherapeutic agent is essential for the prevention of complications after the procedure. Therefore, these patients showed that the sclerotherapy with MO may be an effective and simple treatment for extensive oral benign vascular lesions. In both patients, there was a great improvement in the clinical aspect of the lesions and patient's satisfaction.

Epstein-Barr Virus-Positive Mucocutaneous Ulcer Mimicking Peri-Implantitis in a Patient With Systemic Lupus Erythematosus.

Epstein-Barr virus-positive mucocutaneous ulcer (EBVMCU) is characterized by cutaneous and/or mucosal ulcers in patients receiving immunosuppressive medication or with age-related immunosenescence. Its microscopic appearance often leads to a diagnostic challenge, sometimes mimicking an overt lymphoma. A 47-year-old woman, with a previous diagnosis of systemic lupus erythematosus, was referred for evaluation of a gingival ulcer, present for about 2 months and located in the maxillary peri-implant mucosa around implants, resembling peri-implantitis. An incisional biopsy was performed, and the microscopic evaluation showed a polymorphic infiltrate with some Reed-Sternberg-like cells. Immunohistochemistry showed positive findings for CD20, CD30, CD45, PAX-5, MUM-1, LMP-1 and EBER1/2, establishing the diagnosis of EBVMCU. After 2 months, total regression of the lesion was noted without any intervention. We discuss the possible association between the EBVMCU and systemic lupus erythematosus; to our knowledge, this is the first report of an EBVMCU simulating peri-implantitis.

Erratum: Time-resolved fluorescence spectroscopy for clinical diagnosis of actinic cheilitis: erratum.

[This corrects the article on p. 4210 in vol. 7, PMID: 27867726.].

Automated algorithm for actinic cheilitis diagnosis by wide-field fluorescence imaging.

Actinic cheilitis (AC) is a disease caused by prolonged and cumulative sun exposure that mostly affects the lower lip, which can progress to a lip squamous cell carcinoma. Routine diagnosis relies on clinician experience and training. We investigated the diagnostic efficacy of wide-field fluorescence imaging coupled to an automated algorithm for AC recognition. Fluorescence images were acquired from 57 patients with confirmed AC and 46 normal volunteers. Three different algorithms were employed: two based on the emission characteristics of local heterogeneity, entropy and intensity range, and one based on the number of objects after K-mean clustering. A classification model was obtained using a fivefold cross correlation algorithm. Sensitivity and specificity rates were 86% and 89.1%, respectively.

Time-resolved fluorescence spectroscopy for clinical diagnosis of actinic cheilitis.

Actinic cheilitis is a potentially malignant disorder of the lips. Its first cause is believed to be UV sun radiation. The lesion is highly heterogeneous, making the choice of area to be biopsied difficult. This study exploits the capabilities of time-resolved fluorescence spectroscopy for the identification of the most representative area to be biopsied. A preliminary study was performed on fourteen patients. A classification algorithm was used on data acquired on nine different biopsies. The algorithm discriminated between absent, mild, and moderate dysplasia with a sensitivity of 92.9%, 90.0%, and 80.0%, respectively. The false positive rate for healthy tissue (specificity) was 88.8%.

Metalloproteinases 2 and 9 Immunoexpression in Periapical Lesions from Primary Endodontic Infection: Possible Relationship with the Histopathological Diagnosis and the Presence of Pain.

INTRODUCTION: The aim of this study was to evaluate the possible associations among the histopathological diagnosis, the inflammatory infiltrate profile, the presence of pain, and the immunoexpression of matrix metalloproteinases MMP-2 and MMP-9 in periapical lesions from primary endodontic infection. METHODS: Fifty-one primary periapical lesions obtained from extracted teeth were selected for this study. Patients were previously evaluated for the presence of pain and sinus tract related to the tooth to be extracted. Tissues were processed for microscopic examination and MMP-2 and MMP-9 immunoexpression. Microscopically, samples were classified as periapical granulomas or periapical cysts and the inflammatory infiltrate as chronic or mixed. The percentage of immunopositive cells for MMP-2 and MMP-9 of each case was performed based on 10 consecutive microscopic fields. The Student t or chi-square tests were used in the statistical analysis. RESULTS: Of the total, 28 cases were classified as periapical granulomas (54.90%) and 23 cases as periapical cysts (45.10%). Seventeen patients (33.33%) reported pain associated with the extracted tooth, with 12 cases of periapical granulomas (70.58%) and 5 cases of periapical cysts (29.42%). All cases showed immunopositivity for MMP-2 and MMP-9 in a high percentage of cells, mainly in the cytoplasm of the leukocytes. MMP-2 was expressed more in periapical granulomas than periapical cysts (P < .05) and in symptomatic cases (P < .05). CONCLUSIONS: According to the results, we may conclude that MMP-2 and MMP-9 are highly expressed in periapical lesions from a primary endodontic infection. Moreover, we may suggest MMP-2 is expressed more in periapical granuloma and in cases associated with pain.

Brazilian Oral pathology: a retrospective survey of 245 casesfrom a Surgical Pathology Hospital Laboratory / Patologia oral: uma pesquisa retrospectiva brasileira de 245 casos provenientes do Laboratório Hospitalar de Patologia Cirúrgica

The aim of this study was to determine the range of oral histopathological diagnoses in a Brazilian survey obtained from a surgical pathology hospital laboratory. Materials and Methods: A retrospective cross-sectional study was performed, and all histological slides from the oral and maxillofacial region during a 14-year period were reviewed. The diagnoses were grouped intofive major diagnostic categories, and age and sex were specified. Results: A total of 769 samples were collected and submitted for histopathological analysis. There were 245 oral cases, which were divided into 48 different diagnoses. There was no sex predilection, and the mean age was about 44 year sold. Proliferative non-neoplastic lesions (43.2%) and malignant neoplasms (26.5%) comprised the main two groups of diagnoses. Conclusion: The malignant neoplasms prevalence observed in this Brazilian sample may be due to the nature of the populationor, most probably, to the nature of the source, are ferral hospital center in the city...

O objetivo deste estudo foi determinar avariação de diagnósticos histopatológicos da cavidade oral em uma amostra brasileira obtida a partir de um laboratório hospitalar de patologia cirúrgica. Material e Métodos: Um estudo transversal retrospectivo foi realizado e todas as lâminas histopatológicas da região oral e maxilofacial durante um período de 14 anos foram revisadas. Os diagnósticos foram agrupados em cinco categorias principais de diagnóstico, sendo o sexo e a idade especificados. Resultados: Um total de 769 amostras foram coletadas e submetidas a análise histopatológica. Foram identificados 245 casos de lesões orais, que foram subdivididas em 48 diferentes diagnósticos. Não houve predileção por sexo, e idade média foi de 44 anos. Lesões proliferativas não-neoplásicas (43,2%) e neoplasias malignas (26,5%) representaram os dois principais grupos de diagnóstico. Conclusão: A prevalência de neoplasias malignas observada nesta amostra brasileira pode ser explicada devido a natureza da população ou, mais provavelmente, pela natureza da fonte, um hospital de referência na cidade...

Oral squamous cell carcinoma metastasizing to the skull bone: a case report and literature review.

Oral squamous cell carcinoma (SCC) is considered a primarily localized disease, and distant metastasis is not common. An increasing number of case reports involving unusual sites for distant metastasis from oral carcinoma have been reported in the literature. This is likely due to the improved control of cancer at the primary site, increasing the chance of developing a delayed metastasis. This article presents a case of a 58-year-old woman who refused surgical treatment for a very aggressive SCC on the mandibular alveolar ridge. The tumor did not respond to chemotherapy or radiotherapy, and the patient developed metastasis in the skull bone approximately 1 year after the initial diagnosis. The site of the primary tumor (next to the bone) as well as the patient's refusal of the proposed treatment, may have led to the hematological spread of the malignant cells, resulting in the distant metastasis.

Chondrosarcoma of the maxilla: report of two cases with different behaviours.

Head and neck chondrosarcomas are rare and potentially lethal tumours, which are even more uncommon in the head and neck region. The diagnosis of chondrosarcoma is based on the histopathological pattern of malignant chondroid tissue proliferation. The grade of malignancy and the histological surgical margins are some of the most important prognostic factors for this group of tumour. In the present report we described two cases of chondrosarcoma affecting the maxilla, which presented different behaviours. The first patient, with a high-grade tumour, died of local recurrence and the second patient, with a low-grade tumour, is alive and free of disease 60 months after the treatment. These two cases emphasize the importance of histological tumour grade and appropriate treatment for the prognosis.

Comparison of two prognostic scores for patients with parotid carcinoma.

BACKGROUND: Salivary glands present a wide diversity in histopathologic types and biologic behaviors, thus complicating the search for prognostic factors. METHODS: We compared 2 prognostic scores that were previously published for patients with parotid carcinoma in a retrospective series of 175 patients treated in a single institution. RESULTS: Cox multivariate analysis indicated clinical skin invasion, facial nerve function, and perineural growth as the most significant recurrent disease-related prognostic factors. According to the Vander Poorten score, 148 patients were divided into 4 groups, with the 5-year disease-free survival of 76%, 81%, 69%, and 35%, respectively. In the Carrillo's score, the patients were divided into 3 groups: low-risk, intermediate-risk, and high-risk, with the 5-year disease-free survival of 84%, 73%, and 34%, respectively. CONCLUSION: Carrillo's score showed more distinct survival curves, and determination of groups with a more favorable prognosis was difficult for both scores. Therefore, both scores were not totally reproducible for our group of patients.

Oral traumatic neuroma with mature ganglion cells: A case report and review of the literature.

Traumatic neuromas are characterized by the presence of pain, burning, or paresthesia, associated with a history of trauma, normally surgery, in the same site. In the oral cavity, the most commonly affected sites are the lip, tongue, and mental nerve area. Pressure on the suspected area usually provokes pain. They microscopically consist of a proliferation of nerve fascicles embedded in a background of collagen. We present a case of a 42-year-old Latin American female patient complaining of a painful solitary nodule erupting on the lingual surface of the mandibular body. Histopathological analysis showed a traumatic neuroma associated with mature ganglion cells, which is an extremely unusual finding. After complete removal of the lesion the symptoms disappeared. To the best of our knowledge, this is the first case of a unique lesion with unusual clinical and histopathological features reported in the English language literature.

Nonlymphoid mesenchymal tumors of the parotid gland.

Salivary gland tumors are uncommon and most of them are of epithelial origin. Mesenchymal tumors affecting the parotid are extremely rare, and we present a series of 19 cases. All parotid tumors (600 cases) treated at the Department of Head and Neck Surgery from A.C. Camargo Hospital, Brazil from 1953 to 2003 were reviewed and 19 cases of nonlymphoid mesenchymal origin were selected. The histological characteristics were reviewed and clinical features were obtained from the medical charts. 15 out of 19 were benign tumors, including 5 lymphangiomas, 5 neurofibromas, and one case each of schwannoma, lipoma, solitary fibrous tumor, meningioma and giant cell tumor. Four malignant tumors were classified as rhabdomyosarcoma, fibrosarcoma, Langerhans cell histiocytosis and endodermal sinus tumor. From the malignant cases, only the patient with fibrosarcoma died due the tumor, the other three are alive with no signs of recurrence. In our series of 600 cases of parotid gland tumors, nonlymphoid mesenchymal tumors corresponded to 3.16% (19 cases; 15 benign and 4 malignant). All cases were treated by surgery with no recurrences, except one case of fibrosarcoma whose patient died of distant metastasis.

Giant pleomorphic adenoma of the parotid gland.

Pleomorphic adenoma is the most common type of all benign and malignant salivary gland tumors, involving more frequently the parotid gland. It is a benign tumor with a slow and continuous growth that without treatment can reach an enormous size. We present a case of a giant pleomorphic adenoma in a 78-year-old man with a history of more than 30 years of a growing lesion in the parotid gland. Clinical examination revealed a giant mass on the right side of the face, however without any sign of facial nerve damage. The tumor was completely resected by total parotidectomy and preservation of the facial nerve. Macroscopically, the tumor measured 28 cm and weighed 4.0 Kg. On the histological examination there was a predominance of epithelial and myoepithelial cells in a hyaline and myxoid stroma. It was not found any area of malignant transformation. In the post-operatory the aesthetic and functional results were excellent.

Hepatitis C: incidence and knowledge among Brazilian dentists.

OBJECTIVES: To evaluate the incidence of Hepatitis C among dentists from the city of Piracicaba-SP--Brazil, and also to analyze the knowledge of this disease among these health care workers. DESIGN: Two hundred and sixty-seven dentists completed a questionnaire and supplied a sample of blood for serologic testing for hepatitis C virus (HCV). RESULTS: Only one participant was positive for HCV, representing 0.4% of total. There was a lack of knowledge of this disease among dentists. CONCLUSIONS: There is an occupational risk of infection for HCV in dentistry and there is a need to make professionals aware of it.