Oral Health in Patients with History of Head and Neck Cancer: Complexity and Benefits of a Targeted Oral Healthcare Pathway.

PURPOSE OF REVIEW: This work consists in a literature review on the current state of knowledge regarding the oral management of patients with a history of head and neck cancer (HNC), corroborated by clinical cases and illustrated by clear infographic summaries. It aims to provide healthcare professionals with a comprehensive overview of the oral health status of HCN patients. RECENT FINDINGS: Head and neck cancers (HNCs) represent the seventh most common type of cancer worldwide, with over 660,000 annual new cases. Despite the significant negative impact of HNCs on oral health, patients often receive no or inappropriate oral care while the significant impact of oral pathologies on cancer prognosis is commonly underestimated. This work (i) describes the oral cavity during and after HNC through the prism of care complexity and (ii) highlights several potential key factors that could worsen long-time patients' prognosis and quality of life. By investigating the biological, microbiological, functional, and psychological dimensions of the interrelationships between HNCs and oral health, the authors explored the barriers and benefits of a targeted oral healthcare pathway. This article emphasizes the importance of multidisciplinary care and highlights the need for further research elucidating the intricate relationships between oral health and HNCs, particularly through the microbiota.

[Oral mesenchymal cells, a specific niche, from development to regeneration]. / Les cellules mésenchymateuses orales, une niche spécifique, du développement à la régénération.

Oral buccal tissues, including bone and mucosa, have unique properties. Oral mucosal fibroblasts and jaw osteoblasts, both derived from Cranial Neural Crest cells, play a key role in healing and repair. These cells express a specific repertoire of genes with their regenerative properties, but also craniofacial diseases. Understanding these tissues holds clinical promise for tissue regeneration and repair of bone and mucosal defects. These multidisciplinary advances also offer potential for better management of periodontal-related conditions and improved oral health.

Title: Les cellules mésenchymateuses orales, une niche spécifique, du développement à la régénération. Abstract: Les tissus muqueux et osseux oraux présentent des propriétés uniques. Les fibroblastes de la muqueuse orale et les ostéoblastes des mâchoires, issus des crêtes neurales crâniennes, jouent un rôle clé dans la cicatrisation/réparation. Ces cellules expriment un répertoire spécifique de gènes associés à leurs propriétés régénératives, mais aussi liés aux maladies rares crâniofaciales. La connaissance de ces tissus ouvre des perspectives cliniques pour la régénération tissulaire et la réparation des défauts osseux et muqueux. Ces avancées multidisciplinaires ont aussi un impact prometteur sur la prise en charge des maladies liées au parodonte et sur l'amélioration de la santé bucco-dentaire.

Role of periosteum during healing of alveolar critical size bone defects in the mandible: a pilot study.

OBJECTIVES: Minipigs present advantages for studying oral bone regeneration; however, standardized critical size defects (CSD) for alveolar bone have not been validated yet. The objectives of this study are to develop a CSD in the mandibular alveolar bone in Aachen minipigs and to further investigate the specific role of periosteum. MATERIALS AND METHODS: Three female Aachen minipigs aged 17, 24, and 84 months were used. For each minipig, a split-mouth design was performed: an osteotomy (2 cm height × 2.5 cm length) was performed; the periosteum was preserved on the left side and removed on the right side. Macroscopic, cone beam computed tomography (CBCT), microcomputed tomography (µCT), and histological analyses were performed to evaluate the bone defects and bone healing. RESULTS: In both groups, spontaneous healing was insufficient to restore initial bone volume. The macroscopic pictures and the CBCT results showed a larger bone defect without periosteum. µCT results revealed that BMD, BV/TV, and Tb.Th were significantly lower without periosteum. The histological analyses showed (i) an increased osteoid apposition in the crestal area when periosteum was removed and (ii) an ossification process in the mandibular canal area in response to the surgical that seemed to increase when periosteum was removed. CONCLUSIONS: A robust model of CSD model was developed in the alveolar bone of minipigs that mimics human mandibular bone defects. This model allows to further investigate the bone healing process and potential factors impacting healing such as periosteum. CLINICAL RELEVANCE: This model may be relevant for testing different bone reconstruction strategies for preclinical investigations.

Orofacial intramuscular lymphoma: first presentation.

The term lymphoma includes a wide variety of different clinical entities including diffuse large B-cell lymphomas (DLBCL). Skeletal muscle or intramuscular lymphomas represent less than 2% of B-cell Lymphoma, they are quite rare, even more in the orofacial area. We present the case of a painless growing mass of the right cheek mimicking a chronic oral cellulitis in a 34-year-old man. Magnetic resonance imaging (MRI) of the mandible revealed a well-defined 7x3cm mass around the core of the mandible that invades the buccal floor and the subcutaneous planes. A whole-body 18F-FDG PET/CT for the initial diagnosis revealed an intensely isolated hypermetabolic band corresponding to a voluminous tumoral permeation. The diagnosis of a skeletal muscle diffuse large B-cell lymphoma was established after an intraoral biopsy. It was treated with 4 chemotherapy cures and showed complete remission at one year of follow-up. This atypical form of lymphoma should be integrated into the differential diagnosis of soft tissue tumors in the oral cavity.

Multipotent progenitor cells in gingival connective tissue.

The gum has an exceptional capacity for healing. To examine the basis for this property and explore the potential of conferring it to organs with inferior healing capacity, we sought the presence of progenitor cells in gingival connective tissue. Colony-forming units of fibroblast-enriched cells from gingival fibroblast cultures were assessed for expression of membrane markers of mesenchymal stem cells; capacity to differentiate into osteoblasts, chondroblasts, and adipocytes; and engraftment efficiency after in vivo transfer. On the basis of their ability to differentiate into several lineages, proliferate from single cells, induce calcium deposits, and secrete collagen in vivo after transfer on hydroxyapatite carriers, we suggest that this population represents gingival multipotent progenitor cells. The discovery of progenitor cells in gingival connective tissue may help improve our understanding of how the wounded gum is capable of almost perfect healing and opens the prospect of cellular therapy for wound healing using readily available cells at limited risk to the patient.