Applications of artificial intelligence in the field of oral and maxillofacial pathology: a systematic review and meta-analysis.

BACKGROUND: Since AI algorithms can analyze patient data, medical records, and imaging results to suggest treatment plans and predict outcomes, they have the potential to support pathologists and clinicians in the diagnosis and treatment of oral and maxillofacial pathologies, just like every other area of life in which it is being used. The goal of the current study was to examine all of the trends being investigated in the area of oral and maxillofacial pathology where AI has been possibly involved in helping practitioners. METHODS: We started by defining the important terms in our investigation's subject matter. Following that, relevant databases like PubMed, Scopus, and Web of Science were searched using keywords and synonyms for each concept, such as "machine learning," "diagnosis," "treatment planning," "image analysis," "predictive modelling," and "patient monitoring." For more papers and sources, Google Scholar was also used. RESULTS: The majority of the 9 studies that were chosen were on how AI can be utilized to diagnose malignant tumors of the oral cavity. AI was especially helpful in creating prediction models that aided pathologists and clinicians in foreseeing the development of oral and maxillofacial pathology in specific patients. Additionally, predictive models accurately identified patients who have a high risk of developing oral cancer as well as the likelihood of the disease returning after treatment. CONCLUSIONS: In the field of oral and maxillofacial pathology, AI has the potential to enhance diagnostic precision, personalize care, and ultimately improve patient outcomes. The development and application of AI in healthcare, however, necessitates careful consideration of ethical, legal, and regulatory challenges. Additionally, because AI is still a relatively new technology, caution must be taken when applying it to this industry.

Deep learning applied to the histopathological diagnosis of ameloblastomas and ameloblastic carcinomas.

BACKGROUND: Odontogenic tumors (OT) are composed of heterogeneous lesions, which can be benign or malignant, with different behavior and histology. Within this classification, ameloblastoma and ameloblastic carcinoma (AC) represent a diagnostic challenge in daily histopathological practice due to their similar characteristics and the limitations that incisional biopsies represent. From these premises, we wanted to test the usefulness of models based on artificial intelligence (AI) in the field of oral and maxillofacial pathology for differential diagnosis. The main advantages of integrating Machine Learning (ML) with microscopic and radiographic imaging is the ability to significantly reduce intra-and inter observer variability and improve diagnostic objectivity and reproducibility. METHODS: Thirty Digitized slides were collected from different diagnostic centers of oral pathology in Brazil. After performing manual annotation in the region of interest, the images were segmented and fragmented into small patches. In the supervised learning methodology for image classification, three models (ResNet50, DenseNet, and VGG16) were focus of investigation to provide the probability of an image being classified as class0 (i.e., ameloblastoma) or class1 (i.e., Ameloblastic carcinoma). RESULTS: The training and validation metrics did not show convergence, characterizing overfitting. However, the test results were satisfactory, with an average for ResNet50 of 0.75, 0.71, 0.84, 0.65, and 0.77 for accuracy, precision, sensitivity, specificity, and F1-score, respectively. CONCLUSIONS: The models demonstrated a strong potential of learning, but lack of generalization ability. The models learn fast, reaching a training accuracy of 98%. The evaluation process showed instability in validation; however, acceptable performance in the testing process, which may be due to the small data set. This first investigation opens an opportunity for expanding collaboration to incorporate more complementary data; as well as, developing and evaluating new alternative models.

Spontaneous resolution of an intraosseous mandibular lesion: a case report and review of the literature.

The objective of this case report and review of the literature is to address spontaneously regressing radiolucent lesions affecting the mandible. In 2010, a 16-year-old girl presented with an impacted mandibular third molar associated with a radiolucent lesion. At that time, the treating clinician considered the lesion to be at high risk of causing life-threatening bleeding. Therefore, it was suggested that she not have her tooth extracted. The patient was lost to follow-up for 8 years. Recent radiographs obtained by an oral and maxillofacial surgeon revealed that the lesion had resolved spontaneously. This article also reviews and summarizes cases in the literature in which radiolucent mandibular lesions regressed without treatment or with minimal intervention such as aspiration or incisional biopsy. The current case report and previously reported findings of spontaneous regression underscore the importance of establishing an accurate differential diagnosis and highlight the benefits of a multidisciplinary approach involving general dentists, oral and maxillofacial radiologists, pathologists, and surgical colleagues for management of mandibular radiolucencies.

A retrospective analysis of oral and maxillofacial biopsied specimens in Malaysian newborns and infants.

BACKGROUND: Globally, research on oral and maxillofacial lesions among newborns and infants remains limited. AIM: To describe demographic patterns, histopathological findings, and locations of oral and maxillofacial lesions in newborns (birth-1 month) and infants (>1 month-2 years) reported over 51 years. DESIGN: A retrospective cross-sectional study on histopathological records of newborns and infants was conducted. Patients' demographic characteristics (age, gender, and race), histopathological diagnosis, and lesion's location were gathered. Pearson's chi-square or Fisher's exact test was performed to determine associations between demographic characteristics and different categories of lesions. RESULTS: Out of 66,546 specimens received, 0.44% (290 specimens) were from patients aged 2 years and younger (27 newborns and 263 infants). The most common category was inflammatory/reactive (44.2%), followed by tumour/tumour-like (42.0%), cystic/pseudocystic (6.6%), and miscellaneous lesions (5.5%). Mucous extravasation cysts (23.4%) and Langerhans cell histiocytosis (7.2%) were the most common histopathological diagnoses. Tumour/tumour-like lesions were significant in newborns (P = .021), and majority were congenital epulis (40.7%). Inflammatory/reactive lesions were significantly higher in male (P = .025) and infants (P = <.001) with predominant incidences of mucous extravasation cysts (24.7%). There was a more than one ten probability of malignant lesions (11.4%). CONCLUSION: Routine clinical head and neck examinations in newborns and infants are the key to early detection of lesions.

Pediatric oral pathology in Saudi Arabia: A 10-year retrospective study at an academic dental hospital.

Introduction: Pediatric oral pathology encompasses a wide range of diseases and conditions affecting the oral cavity in children. In this study we conducted an analysis on a dataset from one academic center in Saudi Arabia to investigate the prevalence of various oral lesions in pediatric patients. Methods: To conduct this study we analyzed oral pathology reports of pediatric patients (age range: 0-18 years) who underwent biopsies at our institution's oral pathology laboratory between January 2012 and December 2022. The data we collected included demographic information and diagnostic findings. Statistical analysis was performed to determine the prevalence rates of and associations between different variables. Results: The study analyzed a total of 183 pediatric cases with oral pathologies. The most common conditions observed were mucocele (12 %), periapical granuloma (7.7 %), dentigerous cyst (6.6 %), and radicular cyst (6.6 %). Some conditions showed variations in prevalence based on age and gender. For example, mucoceles were more prevalent among patients who were 6-12 years of age and female. Conclusion: This retrospective study provides valuable insights into the prevalence and demographic characteristics of pediatric oral pathologies. By understanding the prevalence of conditions in this population and recognizing differences in distribution compared with those cited in other studies, we highlighted the importance of considering regional and demographic influences. Further prospective studies are needed to investigate factors that may contribute to these variations.

Arteriovenous fistula of the mandible: a case report.

Intraosseous arteriovenous malformations (AVM) are uncommon high-flow vascular malformation that can affect the maxilla or mandible. AVM may present with aspecific and misleading signs and symptoms. The diagnosis is often accidental and bleeding may represent the first symptom. Radiographically, there are few characteristic features and misdiagnosis is easy. Here we report the case of a young male affected by arteriovenous fistula on the right side of the mandible initially misdiagnosed as a cystic lesion. The patient underwent transarterial embolization of the vascular malformation and subsequently the lesion was surgically removed. 1-year follow-up showed complete healing of the mandibular bone and absence of recurrence. Intraosseous arteriovenous malformations are rare entities. However, due to their harmfulness, both clinicians and radiologists must be aware of this type of lesion and should always consider them in the differential diagnosis of osteolytic lesions.

Secretory carcinoma of minor salivary glands.

Secretory carcinoma is a malignant salivary gland tumor, which typically presents as an indolent painless mass within the parotid gland. Involvement of the minor gland is reported but less common. Secretory carcinoma was often misclassified as other salivary gland mimics, particularly acinic cell carcinoma, prior to 2010. It was first recognized as a molecularly distinct salivary gland tumor harboring the same fusion gene as well as histologic and cytogenetic features seen in juvenile breast cancer. Secretory carcinoma is generally managed in the same way as other low-grade salivary gland neoplasms and has a favorable prognosis; however, high-grade transformation requiring aggressive therapeutic interventions have been documented. Recent studies of biologic agents targeting products of this fusion gene offer the promise of a novel therapeutic option for treatment of this malignancy. Due to the limited number of reported cases, the spectrum of clinical behavior, best practices for management, and long-term treatment outcomes for secretory carcinoma remain unclear. A long-standing secretory carcinoma involving minor salivary glands of the mucobuccal fold, which was detected years after it was first noted by the patient, is reported. This case brings to light the importance of a thorough clinical exam during dental visits and reviews diagnostic differentiation of this malignancy from other mimics and discusses decision making for its management.

Lingual Abscess in an Adult Patient With Pierre Robin Sequence: A Case Report.

A lingual abscess is a rare but serious infection within the tongue parenchyma, posing significant risks due to potential airway obstruction. Despite advancements in oral hygiene and antibiotics, timely diagnosis and treatment are critical to prevent severe complications. In this case, we report a 29-year-old male with Pierre Robin sequence (PRS) who presented with a four-day history of severe tongue pain, swelling, decreased appetite, and fever, without any reported trauma. Examination revealed left-sided tongue swelling, poor oral hygiene, and notable Mallampati III classification. A neck CT scan confirmed an abscess in the left hemitongue involving the intrinsic and mylohyoid muscles, measuring 26.5 x 30 x 30.5 mm with a volume of approximately 8 cc. Prompt intravenous antibiotic treatment was initiated, leading to spontaneous abscess drainage and significant clinical improvement. The patient was discharged after five days of intravenous antibiotics and continued oral antibiotics. At one-week follow-up, he was asymptomatic and fully recovered. This case underscores the importance of recognizing the potentially life-threatening nature of lingual abscesses, particularly in syndromic patients like those with PRS, who may experience quicker airway obstruction due to craniofacial abnormalities, such as micrognathia and glossoptosis. Given the rarity of such conditions, awareness and readiness to address these emergencies are essential for ensuring patient safety and positive outcomes.

Bisphosphonate-related osteonecrosis of the jaws: a potential alternative to drug holidays.

In 2011, the American Dental Association Council on Scientific Affairs released an update by their expert panel on managing the care of patients receiving antiresorptive therapy for the prevention and treatment of osteoporosis. In this report, the panel found no study results that confirmed the effectiveness of drug holidays to prevent antiresorptive agent-induced osteonecrosis of the jaws without increasing the risks of low bone mass. The purpose of this article is to provide suggestions for a pattern of patient care for individuals who desire or require an invasive surgical procedure of the jaws, but who also have a skeleton that is at risk for osteoporotic fracture. The authors reviewed pertinent literature related to basic bone histology, the pharmacokinetics of the aminobisphosphonates (nBP), diagnostic criteria for osteopenia/osteoporosis, and clinical applications of the antiresorptive agents. The skeletal system demonstrates a mixture of resting surfaces (osteocytes, 85%), resorbing surfaces (osteoclasts, 2%), and forming surfaces (osteoblasts, 10%-12%). Deposition of nBP is not uniform, and is highly concentrated in areas of bone remodeling. A full understanding of bone remodeling and the pharmacokinetics of nBP allow for the modification of the antiresorptive therapy and the timing of the oral surgical procedure in a manner that minimizes the prevalence of osteonecrosis while at the same time continuing to protect the patient's skeleton from osteoporotic fracture. The lack of support for drug holidays by the ADA's expert panel is strongly consistent with the science behind bone remodeling and nBP pharmacokinetics. In spite of this, creative interdisciplinary patient care has the potential to dramatically reduce the prevalence of bisphosphonate-related osteonecrosis (BRON), while at the same time continuing to protect the skeleton of the osteoporotic patient. Creative interdisciplinary patient care may prove to be an effective intervention to reduce the prevalence of BRON of the jaws.

The present and future status of oral and maxillofacial pathology in Iran: A multicenter study.

Background: At present, the status of oral and maxillofacial pathology (OMFP) in the country is not properly good. This study aimed to investigate the current status and develop practical approaches to improve occupational condition of the specialty in the future from the viewpoint of the beneficiaries. Materials and Methods: This was a descriptive cross-sectional study. The participants were oral and maxillofacial pathologists of the country (200 individuals), OMFP residents (9 individuals), and final year dental students at six dentistry school of the country at 2020 (200 individuals) through multicenter design. At the first phase, the related questionnaires were developed and assessed psychometrically. Reliability of the questionnaires, internal consistency, and repeatability were computed and confirmed. At the second phase, the survey questionnaires on the current and future condition were sent electronically to the study groups. The data were analyzed using descriptive statistical tests (mean, standard deviation, percentage) and the Pearson test using SPSS. Results: At the first phase, after primary design of the study too, 23 variables with content validity ratio below 0.56 and content validity index (CVI) below 0.79 were omitted. The questionnaire for the specialists was confirmed with Cronbach's alpha of 0.75 and intraclass correlation coefficient (ICC) as 0.83, and the questionnaire for the students and the residents were confirmed with Cronbach's alpha of 0.95 and ICC of 0.80. Results of the second phase showed that score of tendency of students to select OMFP specialty to continue education was 1.58 ± 0.57 from 5. Satisfaction score of specialists on specialized activity of this specialty is 2.7 ± 1.52 from 5. The most important reason for the students to select this specialty was "interest in being faculty member," and the "difficulty of the specialty" was the most probable reason for not selecting this specialty. The most important priority of the residents was "interest in specialty" and for the specialists was "being faculty member." The most important reason to change attitude regarding the specialty by the specialists was mentioned as "high occupational and profession responsibility as well as low income" with the score of 1.38 ± 3.99. "Fundamental revision in the educational curriculum of the specialty" with a score of 4.60 ± 0.93 from 5 was considered as the most important revisionary approach from the viewpoint of specialists. Conclusion: At present, the main problem regarding the OMPF specialty in the country is "high number of graduates and lack of the present occupational opportunities." Evaluation and validation of the relevant specialized departments, producing occupational opportunities, and fundamental revision in the educational curriculum to train well-powered specialists are necessary.

Analysis of 358 histopathological reports of oral and maxillofacial lesions in elderly patients from Tanzania: a cross-sectional study.

In Tanzania, roughly 6% of the total population is elderly, which is the age group that is vulnerable to several diseases in the orofacial region. This study aimed to determine the incidence of oral and maxillofacial lesions in elderly Tanzanian patients. Material and Methods: This was a cross-sectional study of histopathological results of patients with oral and maxillofacial lesions attended at Muhimbili National Hospital. All patients aged 60 years and above diagnosed with oral and maxillofacial lesions between 2016 and 2021 were included in the study. The information gathered included the age and sex of the patients, histopathological diagnosis, and anatomical location of the lesion. The Statistical Package for the Social Sciences, version 26 computer program was used for data analysis. Results: A total of 348 histopathological reports of 348 elderly patients with oral and maxillofacial lesions were obtained. There was an equal distribution by sex. Majority (78.2%) of the lesions were malignant, followed by benign ones (12.6%). The frequently affected site was the tongue (18.1%) and the mandible (15.4%). Squamous cell carcinoma was the most (60.3%) frequently encountered lesion. Others included adenoid cystic carcinoma (5.5%) and ameloblastoma (3.7%). Conclusions: The burden of oral and maxillofacial lesions among the elderly Tanzanian population was substantial. There was no sex predilection. A majority of the lesions were malignant, and the tongue was the frequently involved site.

Lepromatous Leprosy Manifesting As Chronic Macrocheilia: Report of a Rare Case.

Leprosy is a chronic debilitating disorder caused by the acid-fast bacilli Mycobacterium leprae (M. leprae) and Mycobacterium lepromatosis. These bacilli exhibit a distinctive predilection for the skin and peripheral nerves, although they can potentially impact any system in the body. Lately, there has been a notable reduction in mucosal symptoms, largely attributed to the timely diagnosis and treatment of leprosy. Nonetheless, oral lesions continue to hold significant epidemiological importance due to their crucial role in disease transmission. Oral manifestations, although rare, are frequently encountered in individuals afflicted with multi-bacillary leprosy. Chronic macrocheilia is an exceedingly rare manifestation of the disease, with only a few documented case reports and case studies. This article aims to document an exceptionally uncommon case of lepromatous leprosy with chronic macrocheilia as the sole presenting feature.

Prevalence of oral and maxillofacial lesions in children and adolescents at a regional Brazilian oral pathology service: a retrospective study and the relevant literature review.

PURPOSE: This study assessed the prevalence of maxillofacial lesions in children, i.e., 0-9 years, and adolescents, i.e., 10-19 years, in a Brazilian Oral Pathology Service and compared results with available literature. METHODS: Clinical and histopathological records from January 2007 to August 2020 were analysed and a literature review investigating maxillofacial lesions in paediatric populations was also performed. RESULTS: Overall, "reactive salivary gland lesions" and "reactive connective tissue lesions" were the most prevalent group of soft tissue lesions, affecting children and adolescents equally. From these, mucocele and pyogenic granuloma were the most prevalent histological diagnoses, respectively, regardless of age. These findings were consistent with the 32 studies included. Considering intraosseous lesions, "odontogenic cysts" and "periapical inflammatory lesions" were the most prevalent groups, with no relevant differences between age groups, except for the odontogenic keratocyst, which was more prevalent in adolescents. Moreover, several odontogenic tumours, such as ameloblastic fibroma and odontogenic myxoma, were significantly more prevalent in children. CONCLUSION: Most maxillofacial lesions presented a similar prevalence between children and adolescents. Reactive salivary gland lesions and reactive connective tissue lesions were the prevailing diagnostic categories, regardless of age. Some odontogenic tumours and the odontogenic keratocyst showed significantly different frequencies across these age groups.

Desmoplastic Fibroma of the Mandible: A Case Without Recurrence After Enucleation.

Desmoplastic fibroma (DF) is a rare, benign, yet locally aggressive bone tumor. It frequently affects the facial bones, and the mandible is the most commonly affected site. Treatment of choice is the removal of the tumor with resection of surrounding bone due to its aggressive behavior. We report a case of DF where the tumor showed resolution and almost complete bone deposition following enucleation. Although DF has a high recurrence rate, the patient remains disease-free 31 months post-surgery.

Clinically Unusual Pigmented Lesion of the Buccal Mucosa: A Case Report.

We present a rare clinical case of a 64-year-old patient with a pigmented lesion localized in the left buccal mucosa. Subjective complaints of slight pain and discomfort in the process of eating and increased sensitivity when consuming hot food were reported. According to the information provided by the patient, the lesion had progressively increased in size. A history of previous dental manipulations was reported, namely, the extraction of teeth with amalgam obturations in the left half of the maxilla as per relevant indications. During the intraoral examination, a flat, black-colored lesion, 0.4 cm in diameter, with well-defined borders was observed in the buccal mucosa. Teeth 25, 26, and 27 were previously extracted five to seven years ago. An orthopantomography was performed as a routine procedure. It did not show any presence of X-ray contrast areas that could explain the symptoms of the patient. The symptomatic nature of the lesion as well as the negative radiological findings prompted surgical treatment and excisional biopsy with subsequent histological evaluation to rule out oral malignancy. An excision was performed. During the follow-up examination in the next eight days, all the symptoms of the patient were gone. The conclusion of the pathology report was "histological findings and clinical data consistent with amalgam tattoo". The amalgam tattoo is the most frequent iatrogenic pigmented lesion of the oral mucosa, which results from the implantation of amalgam particles in the soft tissues and it is usually asymptomatic. In this case, no surgical treatment is needed. However, in some rare cases, like the one we are presenting, some symptoms can occur and complicate the diagnostic process. In these cases, the complete excision of the lesion is to be performed with subsequent histological evaluation. The atraumatic intervention of teeth, obturated with definitive amalgam fillings, is a main factor for preventing this kind of pigmentation of the oral mucosa.

Multifactorial estimation of clinical outcome in HPV-associated oropharyngeal squamous cell carcinoma via automated image analysis of routine diagnostic H&E slides and neural network modelling.

OBJECTIVE: Routine haematoxylin and eosin (H&E) photomicrographs from human papillomavirus-associated oropharyngeal squamous cell carcinomas (HPV + OpSCC) contain a wealth of prognostic information. In this study, we developed a high content image analysis (HCIA) workflow to quantify features of H&E images from HPV + OpSCC patients to identify prognostic features and predict patient outcomes. METHODS: First, we have developed an open-source HCIA tool for single-cell segmentation and classification of H&E images. Subsequently, we have used our HCIA tool to analyse a set of 889 images from diagnostic H&E slides in a retrospective cohort of HPV + OpSCC patients with favourable (FO, n = 60) or unfavourable (UO, n = 30) outcomes. We have identified and measured 31 prognostic features which were quantified in each sample and used to train a neural network (NN) model to predict patient outcomes. RESULTS: Univariate and multivariate statistical analyses revealed significant differences between FO and UO patients in 31 and 17 variables, respectively (P < 0.05). At the single-image level, the NN model had an overall accuracy of 72.5% and 71.2% in recognising FO and UO patients when applied to test or validation sets, respectively. When considering 10 images per patient, the accuracy of the NN model increased to 86.7% in the test set. CONCLUSION: Our open-source H&E analysis workflow and predictive models confirm previously reported prognostic features and identifies novel factors which predict HPV + OpSCC outcomes with promising accuracy. Our work supports the use of machine learning in digital pathology to exploit clinically relevant features in routine diagnostic pathology without additional biomarkers.

A Literature Review of the Future of Oral Medicine and Radiology, Oral Pathology, and Oral Surgery in the Hands of Technology.

In the realm of dentistry, a myriad of technological advancements, including teledentistry, virtual reality (VR), artificial intelligence (AI), and three-dimensional printing, have been extensively embraced and rigorously evaluated, consistently demonstrating their remarkable effectiveness. These innovations have ushered in a transformative era in dentistry, impacting every facet of the field. They encompass activities ranging from the diagnosis and exploration of oral health conditions to the formulation of treatment plans, execution of surgical procedures, fabrication of prosthetics, and even assistance in patient distraction, prognosis, and disease prevention. Despite the significant strides already taken, the relentless pursuit of new horizons fueled by human curiosity remains unabated. The future landscape of dentistry holds the promise of sweeping changes, notably characterized by enhanced accessibility to dental care and reduced treatment durations. In this comprehensive review article, we delve into the pivotal roles played by AI, VR, augmented reality, mixed reality, and extended reality within the realm of dentistry, with a particular emphasis on their applications in oral medicine, oral radiology, oral surgery, and oral pathology. These technologies represent just a fraction of the technological arsenal currently harnessed in the field of dentistry. A thorough comprehension of their advantages and limitations is imperative for informed decision-making in their utilization.

A retrospective analysis of benign paediatric jaw lesions according to new World Health Organization classification.

The aim of this study was to evaluate the benign paediatric jaw lesions based on the 2017 World Health Organization (WHO) classification. Demographic data, symptoms, radiographic findings, location, size, histopathologic diagnosis, treatment modalities, and outcomes were analysed retrospectively. Recurrence incidence, time to recur, and follow-up time were also evaluated. One hundred seven lesions were diagnosed in 100 patients (44 female, 56 male). The mean follow-up time was 56.6 ± 45.7 months. The mean age was 12. 9 ± 3.9 years and the majority of lesions were found in the permanent dentition group (p = 0.045). There were 73 patients with odontogenic cysts, followed by 16 patients with odontogenic tumors, and 11 patients with non-odontogenic tumors. Eighty seven lesions (81%) were radiolucent and 93 lesions (86%) were well-circumscribed. The majority of the patients (n = 96) were treated by enucleation. Recurrence was seen in 3 patients. The most notable difference between the results of the present study and the results of the study conducted in medical institutions was the distributions of jaw lesions. Within the limitations of the study it seems that a conservative treatment of benign jaw lesions should be preferred in the paediatric population because this treatment yields acceptable results.

Clinicoradiological spectrum of primary aneurysmal bone cysts of the maxillofacial region: A series of 31 cases.

OBJECTIVES: The aim of the current study was to analyse the demographic, clinical and radiological features of primary aneurysmal bone cysts (ABCs) involving the maxillofacial region. METHODS: Histologically confirmed cases affecting the maxillofacial region were retrospectively reviewed over a 21-year period (2000-2021). Cases were collected from the archives of five Oral Pathology laboratories from three countries: South Africa, Guatemala and Brazil. The information was analysed, with emphasis on the clinical and radiological spectrum. RESULTS: Following the inclusion criteria, a total of 31 cases of primary ABCs were included in the study. A nearly equal male-to-female distribution was seen, with ABCs occurring in males at an earlier age compared to females. Localised swelling was the main clinical presentation. ABCs had a mandibular predominance, particularly in the posterior regions. All ABCs presented as blow-out expansile well-demarcated radiolucent lesions with the majority having a multilocular appearance. Cortical expansion was seen in 91% of cases with loss of cortical integrity being common (78%). CONCLUSION: Primary ABCs involving the maxillofacial region are extremely rare with the majority of current published literature consisting of isolated case reports. The current study is the first large series detailing the radiological features.

Photodynamic therapy in the treatment of oral lesions caused by paracoccidiomycosis.

Paracoccidioidomycosis (PCM) is an endemic disease caused by the dimorphic fungus Paracocdioides brasiliensis and Paracoccidioides lutzii. Oral ulcers are usually the first clinical signs of the disease. As it is a systemic fungal disease, local treatments are considered complementary, such as photodynamic therapy (aPDT). We present a patient with ulcerated lesions in the oral cavity of about 6 months duration. The pain complaint in the oropharynx led to a reduction in food acceptance and a weight loss of around 40 kg. He underwent biopsy of the lip lesion, and the histopathological report described yeast with multiple buds compatible with PMC. Our team opted for treatment with aPDT sessions. Two sessions were carried out in the ward and six in the ICU, showing satisfactory results in the remission of ulcerated lesions associated with PCM as well as the painful symptoms in the oral cavity. Also, the patient underwent Amphotericin B and Sulfamethoxazole-trimethoprim. We believe that the association of aPDT with pharmacological therapy possibly accelerated the repair process of oral lesions, as well as providing fungal lesion decontamination, improving progressively the healing of oral lesions.