Central giant cell granuloma of the jaws-long-term clinical and radiological outcomes of surgical and pharmacological management.

OBJECTIVES: To compare long-term results of different treatment modalities in central giant cell granuloma of the maxillofacial-skeleton. Primary resection may result in major defects. Alternative treatments include pharmacological agents. As yet there has been no consensus on the use of the variety of treatment options, and few studies have reported clarifying long-term results. MATERIALS AND METHODS: This retrospective study on 22 patients with 25 lesions evaluated clinical, radiological and histological features, treatment preformed and lesion recurrence. Success was defined as regression/calcification and failure as recurrence, progression or un-responsiveness. RESULTS: Of the presenting patients, 77% were under age 40. Lesion prevalence was higher in the anterior mandible and left posterior maxilla. Most cases exhibited pain, tooth-mobility or mucosal-expansion. The appearance was predominantly unilocular in the maxilla and multilocular in the mandible, which also exhibited higher prevalence of cortical perforation. Up to 80% of lesions were classified as aggressive. Intralesional steroids/calcitonin were used in 7 cases. Mean follow-up was 39.8 months. Two cases showed recurrence. In 71% of the cases treated pharmacologically, calcification/regression were observed. CONCLUSIONS: Our analysis indicates better outcomes using a combined approach, including both pharmacological and surgical treatments in large aggressive lesions. Pharmacological treatment resulted in decreased size or well-defined lesions, thus reducing the need for extensive bone resection. Dual treatment with corticosteroids and calcitonin showed no superior outcomes, but a larger cohort should be assessed. CLINICAL RELEVANCE: There are several protocols for treatment of central-giant-cell-granuloma lesions, but most are not fully established. It is important to report results that contribute to the establishment of proven protocols. This report attempts to establish the relevance of the combined approach: pharmacological treatment followed by surgical resection.

Evaluation of parental perceptions of lingual and labial frenectomy on their child: a comparison of CO2 laser and conventional scalpel.

To evaluate parental reports of postoperative pain, improvement and satisfaction following frenectomy with scalpel versus carbon dioxide (CO2) laser treatment. Forty-nine patients aged 2-6 years with a short labial or lingual frenulum who required frenectomy were randomly assigned to undergo CO2 laser or scalpel treatment. They were divided into a labial and a lingual frenulum group based on the severity of attachment. Frenectomy was performed using a scalpel or Pixel CO2 10,600 nm laser (Alma Lasers Company, Caesarea, Israel). Postoperative follow-up was conducted via a mobile application where pain was evaluated daily using the visual analog scale (VAS) in the first 72 hours, and painkiller use was recorded. Improvement and satisfaction were evaluated at 1-month post-surgery and compared among the groups. Our results showed significant differences between the degree of clinical attachment of the frenulum, one-month postoperative improvement and satisfaction based on VAS scores (p < 0.001). Although the use of scalpel was associated with lower postoperative pain scores than the CO2 groups, VAS scores of improvement and satisfaction after 1 month were higher in the CO2 groups (p < 0.05). This study showed that although laser was associated with more postoperative pain, it showed greater improvement and higher satisfaction among patients' parents at 1 month post-surgery compared with scalpel.

The Relationship Between Morphometric Measurements, Severity, and Success of Zygomatic Arch Fracture Reduction.

PURPOSE: Identify associations between preoperative radiographic measurements and clinical findings of zygomatic arch fractures and postoperative radiographic measurements. Based on those findings, propose a comprehensive treatment algorithm for the solitary zygomatic arch fracture and combined zygomatic arch-zygomatic complex fracture. METHODS: Retrospective cohort study with patients referred to our department for zygomatic arch fractures between 2013 and 2018. Data analyzed included patient demographics, clinical evaluation, and radiographic information. Predictor variables were preoperative morphometric measurements: the initial latero-lateral (LL) defect was determined by the difference between the preoperative LL distances of the fractured and the healthy arches, LL distance was measured from the midsagittal plane in the cranium to the inner cortex of the most displaced arch segment, initial arch coronoid distances were measured from the medial part of the most dislocated arch fragment to the lateral aspect of the coronoid, and the anterior-posterior telescoping was measured as the distance between the 2 points in the arch that lost continuity and overlapped as a result of the fracture. The outcome was defined as the residual defect. It was calculated as the ratio between the postoperative remaining LL distance and the initial LL defect. RESULTS: A total of 179 cases were enrolled, all involving head residual defects. Statistical analysis was performed only on 149 medially displaced fractures. Results show that an initial LL defect larger than 3.5 mm has an 86.3% chance of remaining with a better residual defect (<84.1%), P = .001. Cases with antero-posterior (AP) telescoping > 1.45 mm showed a 72.4% chance of remaining with a poor residual defect >84% (P = .003). Arch-coronoid initial distance showed little effect on the chance of remaining with a large remining defect (P = .417, CI = 95%) CONCLUSION: Based on our results, we found that morphometric measurements can be used to predict the reduction results and can assist the clinician in choosing the optimal reduction method and thus increasing the success rate.

Is Open Reduction Internal Fixation Using Titanium Plates in the Mandible as Successful as We Think?

ABSTRACT: Titanium plats are the gold-standard for fracture fixation. Titanium is considered biocompatible, corrosion resistant with an elasticity-modulus closest to bone. Nonetheless, titanium plates are not always as inherent as hoped. The authors investigated morbidity associated with titanium plates in mandibular fractures. A retrospective study of mandibular fractures treated between 2000 and 2018 using internal-fixation was conducted. Data included age, gender, complications, and location. Predictor-variable was location. Outcome-variable was plate removal. A total of 571 patients were included, 107 resulted in plate removal (18.7%). Body was the most prevalent location of fracture (29.3%). Symphysis/para-sym-physis showed the highest removal rate (24.1%), followed by body and angle (21.3/19.8%). A total of 23.4% of double-plating cases resulted in plate removal, upper-border in 15% and lower-border in 8.8%, all reconstruction-plates. Exposure was the most frequent complication leading to removal. Although titanium plates are the gold standard, almost every fifth patient returns for plate removal. Age-distribution emphasizing 41 to 50 with decrease towards extremities may imply better healing in the young and soft-tissue elasticity and less complaints in the elderly. Significantly more complications in double-plating compared to lower border suggests proximity to the oral-cavity as a risk-factor for removal. Complication rates and patterns are not negligible and perhaps should encourage clinicians to consider using biodegradable-systems for upper-border plates.

The Relationship Between Morphometric Measurments, Severity and Success of Zygomatic Arch Fracture Reduction.

PURPOSE: Zygomatic arch fractures are commonly treated by closed reduction. This kind of treatment is highly influenced by the treating surgeon and type of fracture. Thus, it is important to choose the optimal treatment for different fractures. Current treatment schemes for zygomatic arch fractures reduction are based on subjective assessments. We believe this approach should be refined. Create a new treatment algorithm for the solitary and combined zygomatic arch fractures based on radiological morphometric measurements. This will assist the clinician in tailoring a suitable treatment for each case and avoiding pitfalls, thus achieving best possible results. METHODS: A total of 179 radiologic images of patients treated in our department for zygomatic arch fractures were morphometrically measured and analyzed. RESULTS: Three variables showed a capacity to predict a large remaining defect; The presence of a preoperative esthetic defect and a large initial latero-lateral (LL) defect reduced the probability of a large remaining defect (OR = 0.289, P= .019; (OR = 0.78, P= .008; respectively). Patients with initial LL defect < 3.5 mm presented postoperative residual defect 3-times greater than patients with initial LL defect > 3.5 mm A large antero-posterior telescoping increased the probability of a large remaining defect (OR = 1.27 P= .003). Cases that had antero-posterior telescoping > 1.45 mm had a 72.4% probability of remaining with a poor residual defect > 84.1% (P= .003). CONCLUSIONS: Based on our results we believe that the use of morphometric measurements is important when assessing zygomatic arch fractures. We found that there are measurements that can be used to predict esthetic and functional defects, as well as probability of resolving them. Morphometric measurements can be used to predict the reduction difficulty and can assist the clinician in choosing the optimal reduction method and thus increasing the success rate.

Postextraction Mucormycosis in Immunocompromised-Patient Management and Review of Literature.

PURPOSE: Mucormycosis is an uncommon aggressive, opportunistic infection that can produce widespread orofacial tissue necrosis. This primarily affects immunocompromised individuals. It is the deadliest and most rapidly progressing type of human-affecting fungal infection. The aim of the study is to investigate the diagnostic criteria and treatment approach in 10 cases of mucormycosis in the author's institute from 2008 to 2019. Moreover, a review of the English literature presents all cases of mucormycosis after tooth extraction. MATERIALS AND METHODS: Ten patients at our institute have been treated. They were evaluated and discussed as per their diagnostic criteria, surgical treatment, and mortality rates. RESULTS: All 10 immunocompromised patients had a primary hematologic malignancy. The criteria for a positive diagnosis were clinical symptoms and a biopsy for microbiological culture and histologic analysis. Each patient was subjected to vigorous surgical resection and underwent antifungal treatment. Seven patients died because of their main disease. Owing to the unregulated spread of mucormycosis, 2 patients died. Four cases were diagnosed after maxillary tooth extraction. CONCLUSIONS: The most important factor for patient survival tends to be the management of the underlying disease with early detection and active surgical and antifungal action. Four of 10 cases diagnosed with mucormycosis appeared after tooth extraction, a relatively high number compared with the literature. Therefore, it is the dental profession's obligation to be familiar with the possibility of the potentially severe and possibly fatal complication.

Management of Pediatric Orbital Fractures.

INTRODUCTION: Although uncommon in children, orbital fractures can be devastating to both vision and appearance. Due to the scarce information in the literature, the authors here present our experience and management with all pediatric orbital fracture patients. MATERIAL AND METHODS: A 6-years retrospective study was conducted on pediatric patients presented with orbital wall fracture (OFx). All patients (n = 43) were grouped for comparison based on the treatment method. The cohorts were analyzed for demographics data, location of fracture, type of material used for reconstruction, complication rate and follow up length. Data was analyzed utilizing SPSS for χ2 test. RESULTS: The majority of patients were male (86%) and the mean age of patients was 12.09 ±â€Š4 years. Mean follow-up time was 237 ±â€Š72 days. Most of Patients 31 (72%) underwent surgical intervention. A higher rate of complications was observed in the surgically treated group (32%) compared to the conservative group (8%) regardless to the defect size. Subgroup analysis of the surgery treated group revealed that large size defect had inferior outcome compared to small size defect. CONCLUSION: The consequences of treatment on long-term growth and development must be a cornerstone when choosing the optimal therapeutic method. Conservative management should be considered first in the absence of significant clinical pathologies. In addition, when surgery is indicated the least invasive procedure should be applied. The use of autogenous bone graft is preferable over alloplastic materials, however, when there is insufficient bone quantity the use of alloplastic materials is not contraindicated for reconstruction.

Osteotomy of the Premaxilla in Bilateral Cleft Lip: A Useful Technique Following Failure of Primary Lip Closure.

OBJECTIVES: Successful aesthetic repair of the bilateral cleft lip and palate (BCLP) is one of the most challenging cases encountered by a surgeon. This challenge is heightened when the premaxilla is anteriorly protruded in relation lateral maxillary segments. Our aim is to demonstrate a useful technique for reducing the cleft size before secondary lip repair. We use a premaxillary osteotomy to posteriorly reposition the premaxilla between the lateral segments. METHODS: Six patients with BCLP underwent repositioning of the protruded premaxilla. Five patients had previous primary lip closure procedures with unsatisfactory results. The cleft size was reduced by premaxillary osteotomy from nasal septum and partial removal of the vertical vomer. The osteotomized premaxilla was then repositioned, fixed with a custom-made orthodontic appliance. Following this procedure, the lip was closed in a traditional fashion. RESULTS: All patients demonstrated satisfying lip closure without tension. In each case, the premaxilla was vital and exhibited partial stabilization during follow-up. CONCLUSIONS: In this study the authors demonstrate the usefulness of a premaxillary segment setback as an adjunct to improved function and aesthetics in bilateral lip repair. This method serves as useful technique for previously unsuccessful closure of BCLP.

Diagnostic correlation between clinical protocols and magnetic resonance findings in temporomandibular disorders: A systematic review and meta-analysis.

BACKGROUND: Our aim was to assess the diagnostic correlation between clinical protocols and magnetic resonance (MRI) findings in temporomandibular disorders (TMDs), including disc displacement with and without reduction (DDwR; DDwoR) and arthralgia. METHODS: A systematic review performed in two phases according to the PRISMA checklist. Specific indexing terms were used for search of studies assessing TMDs through clinical diagnostic protocols with the aid of Research Diagnostic Criteria for TMDs or Diagnostic Criteria for TMDs. Quality assessment performed using QUADAS-2. Heterogeneity was assessed using I2 . Publication bias was assessed using funnel plots. For meta-analysis, we used random effect model or fixed effect. The main outcomes were sensitivity and specificity of clinical protocols. RESULTS: Fourteen studies included in the qualitative analysis and 11 studies in the meta-analysis. None of the studies fulfilled all criteria of QUADAS-2. High heterogeneity and high publication bias were found among the studies. Clinical protocols for assessing DDwR compared with MRI showed pooled sensitivity of 66% and specificity of 72%. For DDwoR, sensitivity was 61% and specificity 98%. For arthralgia, sensitivity was 43% and specificity 68% for the presence of effusion. CONCLUSIONS: This review reveals the need for studies with improved quality. Clinical protocols show poor to moderate validity in diagnosis of DDwR and DDwoR compared with MRI. No correlation was found between a clinical diagnosis of arthralgia and MRI effusion. Clinical diagnostic protocols can be used as screening tools, reserving the use of MRI for a more accurate diagnosis in patients with symptoms or dysfunction.

The Influence of Mandibular Gonial Angle on Fracture Site.

PURPOSE: The mandibular angle is influenced by multiple codependent morphologic dynamic factors, such as osseous anatomy, forces exerted by the muscles of mastication, occlusal loading patterns, and anatomic structures. These factors can influence the presence of a fracture in this area. Our research aimed to investigate a potential correlation between the risk of angle fractures and age, gender, fracture etiology, gonial angle size, presence of mandibular third molars, or presence of occlusal support. MATERIALS AND METHODS: This retrospective cohort study was composed of patients treated for mandibular fractures between 2007 and 2018. The primary predictor variable was the gonial angle, and the primary outcome variable was the fracture site. Other study variables included demographic data, fracture etiology, third molar status, and presence of occlusal support. Appropriate univariate, bivariate, and multivariate statistics were applied, and statistical significance was set at P < .05. RESULTS: Of 332 isolated mandibular fractures included, 109 were angle fractures; 165, condylar; and 58, body or symphysis. The mean age of patients with angle fractures was 25.5 years, compared with 31.3 years and 32.7 years for those with condylar fractures and body or symphysis fractures, respectively. The mean gonial angle was 125.4° in patients with angle fractures compared with 120.9° and 120.2° in those with condylar fractures and body or symphysis fractures, respectively. The variables that were found predictive of angle fractures were a wider gonial angle and the presence of third molars. CONCLUSIONS: Third molars and the gonial angle are predictors of the location of mandibular fractures. Wide gonial angles and the presence of third molars are predictors of mandibular angle fractures.

Craniofacial Injuries Seen Among Electric-Motorized Bicycle Riders.

The popularity of electric-motorized bicycles (E-bikes) has increased dramatically over the past few years. As a result, E-bike--associated injuries are quickly becoming a substantial issue. The aim of the present study was to evaluate the epidemiology and general nature of these injuries, with special attention to craniofacial trauma. This was a retrospective study of 84 E-bike riders who suffered from trauma and treated at our level 1 trauma center between the years 2014 and 2018. The information consisted of demographics, characteristics of injury, Injury Severity Score, and number of hospitalization days.Regarding craniofacial trauma, the mean age was 22.7 years. Data about helmet usage was missing. The most common cause of injuries in maxillofacial region, was falling (80%). The most prevalent injury in the maxillofacial region was fractures of the zygomatic complex with the orbit (33%) and soft tissue lacerations.There is little data regarding craniofacial trauma attributed to electric-motorized bicycle accidents. In Israel there are a lot of young adults and teenagers that use E-bikes as an economical solution for mobility. Education regarding road behavior and the proper use of protective measures such as wearing a helmet can reduce significantly overall injuries and cranio-facial trauma in particular.

Endoscopically Assisted Open Reduction and Internal Fixation of Sub-Condylar Fractures: Debunking Some of the Myths.

Endoscopically assisted open reduction and internal fixation has cumulate advantages over both open and closed techniques. Even though, this approach had not become popular. The study intended to summarize the outcomes and complications from the first 12 consecutive cases of sub condylar fractures that treated by endoscope and trans-buccal trocar. All patients experienced improvement in mouth opening. No postoperative malocclusion was noticed. The learning curve was assessed subjectively regarding the use of the endoscope and objectively by operating time reduction. The significant decrease in operating time and the ease of handling the endoscope were already noticed after the 5th operation. The mean time for endoscopically assisted open reduction and internal fixation in our study was 180 minutes, which was the same as for external approaches open reduction and internal fixation for sub-condylar fracture cases. No special designed instruments except an endoscope and a trans-buccal trocar were used. We can conclude that the learning curve for this technique is not as steep as it was thought to be, and it can be mastered after a relatively small number of operations. There is no difference in mean operation time comparing to external approaches. No need for special designed instruments.

The Face of War: Maxillofacial Patients in the Syrian Civil War.

The type of the armed conflict on the Syrian battle field acquired several types of injuries; including injuries that were caused by explosive, shrapnel and blast injuries.In the current study, the authors conducted an overview of maxillofacial patients, who mainly suffered from ballistic injuries in term of injuries, reconstruction, and management.Overall, 53 maxillofacial Syrian patients were treated. The most prominent injury was soft tissue lacerations (21/97) and in terms of hard tissue injuries, the most prominent site was the mandible (N = 19) while the ramus and the body presented the most common sub-sites of injury. Hard tissue injuries were treated either by close or open reduction to obtain primary stabilization.From the psychological aspect, most of the patients suffered from guilt for leaving the combat area, those patients were mostly males in their 20s or 30s. On the other hand, older patients suffered mainly from depression, stress, and fear of returning to their home land.To conclude, the Syrian civil war has several characteristics that defer from other combats. Thus, the management of Syrian patients has to be tailored accordingly.

Effects of Timing of Extracorporeal Shock Wave Therapy on Mandibular Distraction Osteogenesis: An Experimental Study in a Rat Model.

PURPOSE: Distraction osteogenesis (DO) is an established method for bone lengthening in the craniofacial skeleton. Its major drawback is the long consolidation period with attendant morbidity and possible complications. Several methods have been suggested to shorten the consolidation period. We evaluated the timing and effects of extracorporeal shock wave therapy (ESWT) on bone mineralization and extracellular bone matrix proteins during mandibular DO. MATERIALS AND METHODS: Twenty-seven rats underwent mandibular DO (latency period, 3 days; distraction period, 10 days; 0.5 mm/day) and were divided into 3 groups according to the timing of ESWT application: group I (control) received no treatment, whereas groups II and III received ESWT (0.18 mJ/mm2) before and after the active distraction period, respectively. The distracted mandibles were harvested after 4 weeks of consolidation and analyzed radiographically, histologically, and immunohistochemically. RESULTS: Group III showed significantly increased mineral density, enhanced bone formation, a higher collagen orientation index, and greater expression of type I collagen and osteocalcin proteins. CONCLUSIONS: Application of ESWT after active distraction enhances bone maturation and mineralization.

Craniofacial Morphometric Features Associated With Pericondylar Fractures of the Mandible.

The research aimed at investigating potential correlations between craniofacial morphological measurements and mandibular pericondylar fractures, based on a retrospective study of 380 mandible fractures treated in our department, during 2010 to 2017. Predictors included morphological measurements and features. Primary outcome was presence of pericondylar fracture; 133 pericondylar fractures were found, including subcondylar, condylar neck, and condylar head fractures. Condylar neck fractures showed negative correlations with condylar neck width (5.7 mm versus 6.7 mm sagittaly, and 6.1 mm versus 6.8 mm coronally, respectively). Gonial angle (117.3 degrees versus 128.7), and mandibular length 106.2 mm versus 110.4 mm, respectively) showed negative correlation with all pericondylar fractures. Ramus height correlated positively with pericondylar fractures (53.6 mm versus 51.2 mm, respectively). Thus, our results showed condylar neck width was a predictor for condylar neck fractures. In addition, individuals suffering from pericondylar fractures had significantly smaller gonial angles, longer ramus height, and shorter mandibular length. These morphologic features are characteristic of individuals with decreased anterior facial height. Our results corroborated a previous study we had conducted, which suggested that increased anterior vertical growth correlates with angle fractures.

The Relation Between Morphometric Features and Susceptibility to Mandibular Angle Fractures.

The study was aimed to determine possible relations between skeletal morphologic parameters to mandibular angle fractures. Retrospective study of 100 patients suffering from mandibular fractures and treated in the Rambam Health Care Campus between the years 2013 and 2017 was conducted. Predictor variable was facial skeletal morphologic features as derived from the measurements. Outcome variable was mandibular angle fractures. About 42 patients suffered from angle fractures. Gonial angle (131.3° versus 118.1°), condylar neck width (8.3 mm versus 6.8 mm sagittaly and 7.1 mm versus 5.8 mm horizontally), and wisdom tooth prevalence and impaction were positively correlated to the fracture. Ramus height (48.3 mm versus 53.4 mm) was negatively correlated to angle fractures. Many reports in the literature show positive relations between impacted 3rd molars and angle fractures, yet only sporadic reports describe relations between facial fractures and facial features. Our results showed the predictable positive relation between angle fractures and 3rd molar prevalence and impaction. Yet surprisingly, we found unequivocal significant positive correlation between angle fractures to gonial angle and condylar neck width and negative correlation to ramus height. Based on the correlation to the gonial angle and ramal height, it is concluded that enlarged anterior vertical growth is a predictor for angle fractures, as are condylar neck width, and wisdom teeth.

Antral Wall Approach for Reconstruction of Orbital Floor Fractures Using Anterior Maxillary Sinus Bone Grafts.

Isolated orbital wall fractures account for 4% to 16% of all facial fractures. Even a modest change in the position of the bony walls can have a significant impact on orbital volume and globe position. Alloplastic materials or autogenous bone grafts such as the antral maxillary wall can be used to reconstruct small- to medium-size orbital fractures. The main advantage of an antral wall graft is the intraoral approach with minimal morbidity. Nine patients underwent repair of orbital floor fractures using the extraoral and the intraoral antral wall approach. The patients underwent preoperative computed tomography imaging and a minimum of 1 year follow-up. The size of the defects ranged from 0.5 to 1.4 cm. Two patients experienced minor immediate postoperative complications; infraorbital hypoesthesia. On follow-ups, none of our patients suffered from ocular movement restrictions or complications regarding the maxillary antral wall approach. The use of harvested bone grafts from the anterolateral wall of the maxillary sinus is a promising approach for the reconstruction of small- to mid-size orbital floor defects with minimal complications and excellent cosmetic and functional results.

Trend and Demographic Characteristics of Maxillofacial Fractures in Level I Trauma Center.

AIM: The aim of this study was to analyze the pattern and treatment of craniomaxillofacial injuries in the northern part of Israel, within a Jewish majority and large Arab minority population. PATIENTS AND METHODS: A 5-year retrospective study evaluated patients treated for craniomaxillofacial fractures. Fracture cause, type, site, and patient demographics were evaluated. RESULTS: Patient age ranged from 1 to 94 years with an average age of 36.7 years; 52% of the victims were Jews and 48% Arabs. There was male predilection in both sectors (78.3% vs 21.7%). The main site of injury was the zygomatic bone (33.5%) followed by nasal bone, orbital, mandible, frontal sinus, and maxillary fractures. The main etiology of injuries was falls (45.4%) with significantly more falls reported by females (52.1% vs 43.2% in males). Motor vehicle accidents caused injuries more frequent in males. Arabs experienced CMF fractures at a younger age compared to Jews (27.8 and 44.8 average age, respectively). In the elderly, the trend reversed where Jews were more prone to craniomaxillofacial fractures. CONCLUSIONS: Compared to their weight in the population, the Arab sector experiences more craniomaxillofacial injuries. The Jewish elderly population tends to reside in nursing homes where they are more susceptible to accidental falls, whereas young Arab males are more exposed to motor vehicle accidents and interpersonal violence. Falls were the main cause of injuries particularly in women. This may reflect the women's fear of reporting domestic violence. We believe that increased government investments in infrastructures and education will lower the incidence of craniomaxillofacial trauma and balance the gap between both sectors and sexes.

Cancer-associated fibroblasts are an infrequent finding in the microenvironment of proliferative verrucous leukoplakia-associated squamous cell carcinoma.

BACKGROUND: Cancer-associated fibroblasts (CAFs) are generally associated with negative prognostic factors. This study compares the clinicopathologic impact of CAFs in oral squamous cell carcinoma in patients with a history of proliferative verrucous leukoplakia (p-scca) and patients with conventional squamous cell carcinoma of the buccal mucosa, gingiva, and palate (c-scca). METHODS: A retrospective clinicopathologic and immunohistochemical analysis of 97 tumor specimens from 78 patients (13 patients with proliferative verrucous leukoplakia-associated squamous cell carcinoma (n = 32) and conventional squamous cell carcinoma from the buccal mucosa, gingiva, and palate (n = 65) was conducted. Immunostaining with anti-alpha-smooth muscle actin (α-SMA) antibody was used to evaluate the presence of CAFs. RESULTS: α-SMA expression was an infrequent finding in p-scca and seen in only 6% of p-scca compared to 40% of c-scca (P < 0.0004). In the c-scca subgroup, α-SMA significantly correlated with tumor size (T) (P = 0.009), tumor thickness (P < 0.0009), perineural invasion (P = 0.009), and microscopic grade (P = 0.018). CONCLUSIONS: The presence of CAFs was an infrequent finding in our p-scca cohort which may contribute to its seemingly slower growing and less invasive growth pattern. In the cohort of c-scca patients, higher levels of CAFs correlated with microscopic invasiveness, tumor size, and perineural invasion. Practically, these are important observations as targeting strategies are being developed to combat carcinoma types where CAFs significance has been validated.