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Oral cancer, the 13th most common globally, is primarily squamous cell carcinoma linked to tobacco, alcohol, and HPV. Despite advances in care, it remains a major health concern due to high mortality and its impact on quality of life. This study analyzed socio-demographic disparities in oral cancer burden using data from 1990 to 2021. We analyzed annual incidence, mortality, and DALYs across 204 countries, using age-standardized rates and the Socio-demographic Index (SDI) to assess development-related impacts. Statistical methods included Kruskal–Wallis tests, linear regression, joinpoint regression for trends, and Exponential Smoothing for forecasts (2022–2030), with analyses conducted in STATA and Python, and p < 0.05 as significant. Incidence was highest in high SDI countries, while mortality and DALYs were highest in low and middle SDI countries (p < 0.001). From 1990 to 2021, incidence increased (AAPC: 0.5–1.0%), while mortality (APC: − 0.5%) and DALYs (APC: − 0.6%) declined in low SDI regions. Significant disparities across SDI categories (p < 0.001) showed incidence rising with socio-demographic development (R2 = 0.102, p < 0.001), with high-middle SDI regions bearing the highest mortality and DALYs. These findings highlight the need for awareness, prevention, early detection, and accessible care, especially in lower SDI regions. [ABSTRACT FROM AUTHOR]

Background: Adenocarcinoma not otherwise specified (NOS) is an uncommon malignant minor salivary gland tumor. We report gallium-67 SPECT/CT and diffusion-weighted MRI (DWI) in the palatal tumor, especially a rare case with adenocarcinoma NOS. Case presentation: An 85-year-old female patient presented with swelling on the palate within 3 months. DWI and apparent diffusion coefficient (ADC) maps indicated high and low signal intensities on the lesion, respectively. ADC value of the lesion was 0.58 × 10–3 mm2s−1. Gallium-67 SPECT/CT showed increased uptake on the lesion and no metastasis. The maximum SUV for the palatal lesion was 7.36. Histopathological diagnosis by a biopsy was adenocarcinoma NOS. Conclusion: The gallium-67 SPECT/CT and DWI should be effective for assessment of the palatal tumor. [ABSTRACT FROM AUTHOR]

Background: Data suggest that buccal mucosa squamous cell carcinoma (SCC) is the most common malignancy in India. In this study, we presented our 5-year clinical experience with oral SCC and examined factors associated with surgical outcomes. Methods: In this retrospective study, 45 patients diagnosed with SCC of buccal mucosa (January 2013–December 2018) underwent wide local excision (WLE) and neck dissection at our institution. Adjuvant radiotherapy (RT)/chemotherapy (CT) was given. Most were aged 60–69 (44.4%, n = 20), mean age of 58 ± 8.2 years, with a female-to-male ratio of 1.14. Tumor thickness, extracapsular spread (ECS), and survival were analyzed with ≥ 5-year follow-up for different stages. Results: The data was analyzed revealing that the T1 stage was most common (55.6%, n = 25), followed by T3 and T4 (15.6%, n = 7 each), then T2 (13.3%, n = 6). Smaller tumors had lower grades. Nodal involvement was seen in 44.4% (n = 20), with N2 stage being the most frequent. Larger tumors had a greater propensity for invasion. Survival probability was 71.1%. The T1 stage showed a higher survival rate than other stages. Nodal involvement reduced survival probability (29.5%). ECS with neural and vascular invasion significantly lowered survival (12%). All associations were highly significant (P < 0.001). Conclusion: Effective locoregional control is crucial for managing buccal mucosa SCC. Supraomohyoid neck dissection is recommended, even for the clinically negative neck with tumor thickness greater than 0.4 cm. Postoperative RT with or without CT, clear margins, and early detection enhance the survival outcomes of the patients. [ABSTRACT FROM AUTHOR]

Oral premalignant disorders (OPMDs) are a group of potentially malignant conditions that pose a significant health burden globally. MicroRNAs (miRNAs), small non-coding RNA molecules, have emerged as crucial regulators of gene expression and have been implicated in various biological processes, including carcinogenesis. This review synthesizes existing knowledge to provide a comprehensive understanding of the molecular mechanisms underlying OPMDs and to highlight the potential of miRNAs as promising biomarkers and therapeutic targets. Additionally, this review seeks to explore the potential of miRNA-based diagnostic biomarkers for early detection of OPMDs in the current literature on miRNAs in OPMDs, examining their involvement in disease pathogenesis, diagnostic potential, and therapeutic implications. Dysregulated miRNAs can target genes involved in critical cellular processes, such as cell cycle regulation, apoptosis, and DNA repair, leading to disease progression. Notably, miR-21, miR-31, miR-135b, and miR-486-5p have shown promise as potential biomarkers for early detection of oral premalignant lesions. Furthermore, the paper discusses the therapeutic implications of miRNAs in OPMDs. Preclinical studies have demonstrated the efficacy of miRNA-targeted therapies, such as miRNA mimics and inhibitors, in suppressing the growth of oral premalignant lesions. Early-phase clinical trials have shown promising results, indicating the potential for personalized treatment approaches. The findings underscore the importance of understanding the molecular mechanisms underlying these disorders and provide insights for the development of improved diagnostic and therapeutic strategies. However, they pose certain limitations given their intrinsic variability in expression profiles, the need for optimized isolation and detection methods, and potential hurdles in transitioning from preclinical success to clinical applications. Thus, future clinical studies are warranted to fully exploit the potential of miRNAs in the management of OPMDs. [ABSTRACT FROM AUTHOR]

Early diagnosis of potentially malignant disorders, such as oral epithelial dysplasia, is the most reliable way to prevent oral cancer. Computational algorithms have been used as an auxiliary tool to aid specialists in this process. Usually, experiments are performed on private data, making it difficult to reproduce the results. There are several public datasets of histological images, but studies focused on oral dysplasia images use inaccessible datasets. This prevents the improvement of algorithms aimed at this lesion. This study introduces an annotated public dataset of oral epithelial dysplasia tissue images. The dataset includes 456 images acquired from 30 mouse tongues. The images were categorized among the lesion grades, with nuclear structures manually marked by a trained specialist and validated by a pathologist. Also, experiments were carried out in order to illustrate the potential of the proposed dataset in classification and segmentation processes commonly explored in the literature. Convolutional neural network (CNN) models for semantic and instance segmentation were employed on the images, which were pre-processed with stain normalization methods. Then, the segmented and non-segmented images were classified with CNN architectures and machine learning algorithms. The data obtained through these processes is available in the dataset. The segmentation stage showed the F1-score value of 0.83, obtained with the U-Net model using the ResNet-50 as a backbone. At the classification stage, the most expressive result was achieved with the Random Forest method, with an accuracy value of 94.22%. The results show that the segmentation contributed to the classification results, but studies are needed for the improvement of these stages of automated diagnosis. The original, gold standard, normalized, and segmented images are publicly available and may be used for the improvement of clinical applications of CAD methods on oral epithelial dysplasia tissue images. [ABSTRACT FROM AUTHOR]

Oral competence is an important functional component of all patients affected with oral cavity malignancy who are undergoing different treatment modalities. Our primary objectives were to assess and compare the functional outcomes of patients with carcinoma lip undergoing various therapeutic interventions at our institution on the basis of FIGS (Functional Intra Oral Glasgow Scale) and FLiGS (Functional Lip Glasgow Scale) scoring systems. Between January 2021 and April 2022, 23 patients who were histologically confirmed with carcinoma lip were included in our analysis on accrual and were followed up post treatment. A questionnaire was given to the patients translated into their native language, and the responses were analyzed based on the FIGS (Functional Intra Oral Glasgow Score) and FLiGS (Functional Lip Glasgow Scale). Total number of patients that underwent surgical intervention were 78.3% (n-18), and the patients who underwent concurrent chemo-radiotherapy were 21.7% (n-5). Based on the average FIGS and FLIGS scoring and on the responses given by the patients, primary closure and local flap reconstruction scored relatively better (FIGS 15/FLIGS 25) than other forms of reconstruction techniques. Patients undergoing forehead flap reconstruction had responded to have a poorer functional outcome (FIGS 12/FLIGS 22]. Patients undergoing concurrent chemo-radiotherapy also had poor functional outcomes due to post radiotherapy sequelae as per the scoring system. Oncological outcomes in oral cavity malignancies need to emphasize on the functional component of these patients. FIGS (Functional Intraoral Glasgow Scale) and FLiGS (Functional Lip Glasgow Scale) scoring systems are a simple tool that can assess the functional outcomes after various definitive therapeutic interventions for patients with carcinoma lip. [ABSTRACT FROM AUTHOR]

Maxillary palatal defects due to tumor resection require immediate reconstruction to prevent morphological/functional disorders. Reconstruction options ranges from obturator placement to free flap. We adopted a surgical maxillary exposure using nasolabial groove incision in contrast to classical Weber Ferguson incision. This has the added advantage of simultaneous reconstruction of the resultant defect using nasolabial flap, with a good cosmetic and functional outcomes. We hereby present our experience in ten cases with palatal defects post maxillectomy for carcinoma of the upper gingivobuccal sulcus and upper alveolus reconstructed with this technique. This is a case series of ten patients (7 males and 3 females) who underwent partial maxillectomy using nasolabial groove incision with simultaneous reconstruction of palatal defect with nasolabial flap from January 2019 to June 2021 in our department. The primary disease was squamous cell carcinoma (SCC) in all ten patients with clinically N0 and M0. No necrosis, infection, or severe scar contracture in grafts was found in any patient. The wound stabilized, ingestion was started, and rehabilitation was performed with appropriate denture within 10 days after surgery in these patients. The postoperative oronasal communication (5×5 mm in size) in the posterior midline end was found in two cases, seen 1 month after surgery. All patients have good extra oral cosmetic outcomes. No radiation therapy was given in any case. This is a feasible surgical option utilizing nasolabial groove incision for partial maxillectomy along with simultaneous reconstruction of the resultant defect using nasolabial flap. It is a simple surgical procedure with reduced operative time with good cosmesis. [ABSTRACT FROM AUTHOR]

Objectives: Low-dose-rate brachytherapy (LDR-BT) with 198Au grains and 192Ir pins is an essential treatment option for oral cancer due to its high rate of local control and low invasiveness. However, the radiation exposure of medical radiation workers is concerning. Thus, we aimed to determine the radiation dose delivered to medical radiation workers during LDR-BT using 198Au grains and 192Ir pins for oral cancer. Methods: Thirty-two patients with oral cancer underwent 198Au grain interstitial LDR-BT between June 2016 and May 2023, and 23 patients with tongue cancer underwent 192Ir pin interstitial LDR-BT between March 2015 and November 2017 at our hospital. Dosimetry was performed by attaching a dosimeter to the chest pocket of the operator and assistant during 198Au grain or 192Ir pin LDR-BT. Since the operator also loads 198Au grains into the implantation device, the operator's radiation dose includes the dose received during this preparation. Results: Mean radiation doses of the operators with 198Au grain and 192Ir pin LDR-BT were 165.8 and 211.2 μSv, respectively. Statistically significant differences between the radioactive sources of 198Au grain and 192Ir pin LDR-BT were observed (p = 0.0459). The mean radiation doses of the assistants with 198Au grain and 192Ir pin LDR-BT were 92.0 and 162.0 μSv, respectively. Statistically significant differences were observed between the radioactive sources of 198Au grains and 192Ir pin LDR-BT (p = 0.0003). Conclusions: Regarding radioactive source differences, 192Ir pin LDR-BT resulted in higher doses delivered to medical radiation workers than 198Au grain LDR-BT. [ABSTRACT FROM AUTHOR]

Odontogenic keratocyst (OKC) is a relatively common non-inflammatory jaw lesion. OKC is known to occur most often in the mandibular angle and mandibular ramus, but rarely outside the bone. In this report, we describe characteristic multimodality imaging of OKC in the buccal space, especially diffusion-weighted MR imaging (DWI) with apparent diffusion coefficient (ADC) mapping, extra-oral and intra-oral ultrasonography. On clinical examination, an approximately 20 mm in diameter mass with elastic hardness was found the left side of the buccal area. Contrast-enhanced CT showed areas of internal non-contrast lesions in the left buccal space. On T1-weighted image, the mass showed multilocular high signal intensity, and homogeneous internal. T2-weighted images revealed high signal at the marginal part and slightly median signal in the internal part. STIR images revealed a heterogeneous high signal in the interior. Furthermore, DWI and ADC map showed high signal and moderate-to-low signal intensity, respectively. ADC value of the lesion was 1.55 × 10–3 mm2 s−1. On extra-oral ultrasonography, the tumor showed clear boundary, hypoechoic, homogeneous internal architecture and vascular signals, and heterogeneous hard of the lesion. On intra-oral ultrasonography also showed clear boundary, hypoechoic, homogeneous internal architecture, heterogeneous hard of the tumor, and back echo enhance. The histopathologic diagnosis based on a full excisional specimen was odontogenic keratocyst. This case suggests that multimodality imaging, especially MR imaging with ADC and DWI, and extra and intra-oral ultrasonography with color Doppler imaging and elastography, could be effective for evaluating buccal lesions. [ABSTRACT FROM AUTHOR]

Purpose: Three-dimensional surgical planning (3-DSP) is becoming commonplace in the management of benign and malignant disease for oral and maxillofacial surgery practice within the last decade. Surgeons utilize a virtual "wrap" to preoperatively delineate and define maxillofacial tumor resection margins. The investigators hypothesized that the use of a wrap is a predictable method to obtain negative bony margins. Methods: The investigators implemented a retrospective chart review. The sample was composed of patients over the age of 18 treated at John Peter Smith Health Network and Parkland/UT Southwestern Medical Center who obtained 3-DSP for the pathology of the head and neck, involving the bone, with a virtual wrap utilized for bony margins. The proportion of cases was calculated, descriptive statistics were reported, and binomial exact calculation was performed for confidence intervals. The primary variable analyzed was bony margin status on final histopathology, involved or uninvolved, based on the pathology report. Results: The sample was composed of 39 cases, one of which was excluded due to aborting the preplanned 3-DSP. Of the 38 included cases, one had involved bony margin on final histopathology (2.6%; 95% confidence limits, 0.1%, 13.8%). There were 16 malignant cases (42%) and 22 benign cases (58%). When stratified by pathology, 1 out of the 16 malignant cases (6.3%; 95% confidence interval, 0.2%, 30%) and 0 out of the 22 benign cases (95% confidence interval, 0%, 15.4%) had an involved bony margin on final histopathology. Conclusion: The results of this preliminary study suggest three-dimensional surgical planning with wrap margins is a predictable method to obtain negative bony margins in benign and malignant disease of the maxillofacial complex. Further studies will focus on compiling prospective data to solidify the accuracy and predictability of using a wrap to obtain negative bony margins. [ABSTRACT FROM AUTHOR]

Trans oral robotic surgery (TORS) is a minimally invasive technique for head and neck cancers. It is shown favourable recovery and long-term functionality outcomes compared to traditional treatments. Our department at the Royal Surrey County Hospital implemented a service transformation project for a TORS programme in December 2019. The "plan, do, study and act" (PDSA) quality improvement model was used. This incorporated logistical, training, clinical and financial aspects. Twenty-five patients were selected for oropharyngectomy, tonsillectomy or tongue base resections over a period of 1 year. Patients were matched with similar patients undergoing the same non-robotic procedures. TORS showed an improvement in time required to return to normal diet and time needing regular analgesia. Peri-operative complications were similar in both groups. An improving learning curve was observed over time for console times. [ABSTRACT FROM AUTHOR]

Resection of advanced gingivobuccal squamous cell carcinoma results in complex posterolateral mandible and soft tissue defects. Optimal reconstruction would include a single osteocutaneous free flap. However, free flaps are not feasible in certain situations where pectoralis major musculocutaneous flap is preferred. But it is very bulky and cannot be thinned, hence suitable only for repairing very large defects. For medium-sized composite oro-mandibular defects, we used infrahyoid musculocutaneous flap in select patients and evaluated the surgical outcomes. Patients who underwent infrahyoid musculocutaneous flap reconstruction for composite oro-mandibular defects at our center from 2016 to 2021 were included. Patient and defect characteristics were evaluated from our prospectively maintained electronic medical records. Assessment of speech and swallowing function was done by our therapist. Cosmesis was assessed by an independent observer using the visual analogue scale. In our series of 11 patients, none of the flaps was lost. Two patients had partial skin paddle loss. Most of these patients had mandibular drift but none of them developed postoperative trismus. All patients resumed normal oral or soft solid diet. Speech intelligibility was normal in all patients. All patients had satisfactory cosmetic outcome. Infrahyoid musculocutaneous flap is a reliable, quicker, and safe alternative technique in select patients for the reconstruction of composite oro-mandibular defects. In our small series of select patients, speech and swallowing outcomes were excellent with great patient satisfaction. [ABSTRACT FROM AUTHOR]

Extramedullary plasmacytomas are rare solitary tumors consisting of neoplastic plasma cell proliferations other than bone. In contrast to the medullary plasmacytoma, which are localized to the bone, these tumors are localized to submucosal areas, with 80% of them occurring in the head and neck. These tumors do not usually disseminate, but may be locally aggressive and destroy adjacent structures. Here, we present a case report of extramedullary plasmacytoma of the buccal mucosa who has been treated surgically in our institution. [ABSTRACT FROM AUTHOR]

Plasmacytomas are localized monoclonal plasma cell lesions with no evidence of systemic involvement which are divided into solitary bone plasmacytoma (SBP) and extra-medullary plasmacytoma (EMP). The diagnosis of plasmacytomas (PCM) in the oral regions is challenging given the atypical clinical manifestations and low frequency. Here, we report an extremely rare case of plasmacytoma in an elderly male which initially appeared to be arising from the left buccal mucosa on clinical examination but after radiological imaging and intra-operative findings, the epicentre was found to be in the left infratemporal fossa (ITF). The patient underwent en-bloc compartment resection with high clearance of the ITF which proved to be an effective management strategy. It is crucial for the head and neck surgeon to be aware of the solitary bone plasmacytoma in the oral and maxillofacial region in order to identify it early and provide these patients with the best care possible before complications arise. [ABSTRACT FROM AUTHOR]

Objective: To determine the overall surgical outcomes of infranotch T4b oral cancers and compare them with T4a oral cancers. Methods: PubMed, EMBASE and Cochrane databases from 2000 to 2022 were systematically searched. Clinical studies reporting at least one outcome following curative surgery and adjuvant therapy for comparison of patients with either infranotch T4b (IN–T4b) or T4a tumour. The heterogeneity of the included studies was determined using Tau-squared, Chi-squared, and the Higgins I2 test. The random effects model was used to determine the log odds ratio (logOR). Results: The systematic review comprised 11,790 patients from 16 included studies. Seven studies were included in the meta-analysis (n = 11,381). For IN–T4b patients, the pooled 2 and 5 year overall survival (OS) were 59.3% and 53.2%, 2 and 5 year disease-free survival (DFS) 57.9% and 48.4%, 2 and 5 year disease-specific survival (DSS) 72% and 68%, and 2 and 5 year local control (LC), 47% and 56%, respectively. There was no statistically significant difference in 2 year OS [logOR = 0.28 (−0.47, 1.03), p = 0.46, confidence interval (CI) = 95%], 5 year OS [logOR = 0.7 (−0.4, 1.8), p = 0.54, CI = 95%], 2 year DFS [logOR = 0.22 (−0.35, 0.79), p = 0.45, CI = 95%], 5 year DFS [logOR = 0.17 (−0.42, 0.77), p = 0.57, CI = 95%], 2 year LC [logOR = 0.47 (−0.33, 1.26), p = 0.25, CI = 95%] and 5 year LC [logOR = 0.34 (−0.31, 0.99), p = 0.31, CI = 95%] between IN–T4b and T4a oral cancers. Conclusion: Results of this meta-analysis suggest that IN–T4b oral cancers have similar outcomes to T4a oral cancers, which supports down-staging IN–T4b cancers to T4a cancers. [ABSTRACT FROM AUTHOR]

Xenobiotic metabolic enzymes CYP1A1 and GSTM1 are known to increase the risk of head and neck cancer. However, their role in the development of oral potentially malignant disorders (OPMDs) in the Indian population is uncertain. This study aimed to investigate the CYP1A1 and GSTM1 gene polymorphism in the urban population of the state of Delhi as well as to investigate the risk of disease progression. Genotype analysis via polymerase chain reaction was conducted in 1169 cases and 1046 controls with regard to GSTM1 and CYP1A1 (ile-val) genes. The oral lesions were biopsied for histopathological diagnosis. Follow-up of the subjects was done at 6-month intervals and the status of the lesions was recorded as static, progressed, or regressed. Descriptive analysis was done with a p-value ≤ 0.05 and odds ratio with a 95% confidence interval being considered for a measure of association. Subjects who consumed both tobacco and alcohol and developed OPMD lesions were 8.2 times more likely to harbour CYP1A1 Val/Val genotype (p = 0.047; OR = 8.224; 95% CI = 1.024–66.037). The highest progression rate and lowest regression rate were found for the CYP1A1 Val/Val genotype in our sample. The CYP1A1 Val/Val genotype may be associated with an increased risk of development of OPMDs amongst consumers of both tobacco and alcohol. Real-time activity-based sensing of isoforms of the CYP1A1 enzyme in living systems is needed to validate the same. [ABSTRACT FROM AUTHOR]

Objectives: To investigate possible associations between diffusion-weighted imaging (DWI) parameters derived from a non-Gaussian model fitting and Ki-67 status in patients with oral squamous cell carcinoma (OSCC). Methods: Twenty-four patients with newly diagnosed OSCC were prospectively recruited. DWI was performed using six b-values (0–2500). The diffusion-related parameters of kurtosis value (K), kurtosis-corrected diffusion coefficient (DK), diffusion heterogeneity (α), distributed diffusion coefficient (DDC), slow diffusion coefficient (Dslow), and apparent diffusion coefficient (ADC) were calculated from four diffusion fitting models. Ki-67 status was categorized as low (Ki-67 percentage score < 20%), middle (20–50%), or high (> 50%). Kruskal–Wallis tests were performed between each non-Gaussian diffusion model parameters and Ki-67 grade. Results: The Kruskal–Wallis tests revealed that multiple parameters (K, ADC, Dk, DDC and Dslow) showed statistically significant differences between the three levels of Ki-67 status (K: p = 0.020, ADC: p = 0.012, Dk: p = 0.027, DDC: p = 0.007 and Dslow: p = 0.026). Conclusions: Several non-Gaussian diffusion model parameters and ADC values were significantly associated with Ki-67 status and have potential as promising prognostic biomarkers in patients with OSCC. [ABSTRACT FROM AUTHOR]

Objective: There is no known preoperative marker that can effectively predict the risk of delayed neck metastasis (DNM), which is an important factor that determines the prognosis of early-stage oral cancer. In this study, we examined whether 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET)/computed tomography (CT) uptake parameters of primary cancer can predict the risk of DNM in early-stage oral squamous cell carcinoma (OSCC). Methods: Data from patients with stage I–II OSCC who underwent surgical resection of the primary tumor without elective neck dissection between January 2009 and December 2016 were retrospectively reviewed. Patient characteristics, histopathological factors, and PET/CT parameters (maximum standardized uptake value [SUVmax], metabolic tumor volume [MTV], and total lesion glycolysis [TLG]) were evaluated for their association with DNM. DNM rates were calculated, and the parameters that were statistically significant in the univariate analysis were used as explanatory variables. Independent factors associated with DNM were identified using multivariate analysis. For all statistical analyses, p-values < 0.05 were considered statistically significant. Results: Data from 71 patients were analyzed in the study. The overall DNM rate among all patients was 21.8%. The univariate analysis showed that the T classification, depth of invasion, pattern of invasion, lymphovascular invasion, SUVmax, MTV, and TLG were significant predictors of DNM. However, the multivariate analysis revealed that only the depth of invasion, MTV, and TLG were independent predictors of DNM. Conclusion: This study suggests that, in addition to conventional predictors, volume-based PET parameters are useful predictors of DNM in those with early-stage OSCC. [ABSTRACT FROM AUTHOR]

Background: The molecular makeup of a head and neck squamous cell carcinoma (HNSCC) could vary as per the geography and corresponding variability in prevalent etiopathological factors. The objective of this study was to analyze the expression pattern of E-cadherin (E-cad), a transmembrane glycoprotein with tumour suppressor function, in a cohort of HNSCC treated at a tertiary care medical centre in the southern part of India. Material and methods: After obtaining the institutional ethics committee's permission, the expression of E-cad in HNSCC was assessed by using immunohistochemistry on retrospectively collected tumour specimens, obtained by a surgical cohort of cases operated between September 2018 and July 2019. The E-cad expression was then correlated with various clinical and pathological characteristics of HNSCC, retrieved via the medical records of corresponding patients. Results: A total of 60 patients of HNSCC were included, most of whom had lesion in the oral cavity, in an advanced stage. The majority had a strong or moderate expression of E-cad on the surface. On analyzing further, oral cavity tumours had significantly less expression of E-cad compared to laryngeal and hypopharyngeal tumours taken together, and primary tumours had less E-cad expression than recurrent cases. Multivariate analysis with proportional odds regression showed the significant associations of low expression of E-cad expression with the moderate/poor differentiation of tumours and with the extranodal extension. Conclusions: Among the HNSCC, the loss of E-cad expression was mostly associated with primary tumours of the oral cavity, moderate/poorly differentiated tumours, and in those HNSCCs that had an extranodal extension. [ABSTRACT FROM AUTHOR]

Segmentation of tumor regions in H &E-stained slides is an important task for a pathologist while diagnosing different types of cancer, including oral squamous cell carcinoma (OSCC). Histological image segmentation is often constrained by the availability of labeled training data since labeling histological images is a highly skilled, complex, and time-consuming task. Thus, data augmentation strategies become essential to train convolutional neural networks models to overcome the overfitting problem when only a few training samples are available. This paper proposes a new data augmentation strategy, named Random Composition Augmentation (RCAug), to train fully convolutional networks (FCN) to segment OSCC tumor regions in H &E-stained histological images. Given the input image and their corresponding label, a pipeline with a random composition of geometric, distortion, color transfer, and generative image transformations is executed on the fly. Experimental evaluations were performed using an FCN-based method to segment OSCC regions through a set of different data augmentation transformations. By using RCAug, we improved the FCN-based segmentation method from 0.51 to 0.81 of intersection-over-union (IOU) in a whole slide image dataset and from 0.65 to 0.69 of IOU in a tissue microarray images dataset. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the possible risk factors for mastoid cellulitis after treatment in patients with oral cancer. Methods: Patients with oral cancer who underwent preoperative and postoperative contrast-enhanced computed tomography (CECT) between January 2017 and March 2020 were retrospectively evaluated. Using an image reporting system, cases with reports containing the keyword "mastoid cellulitis" were registered in the mastoid cellulitis group. Fifty patients with oral cancer who did not develop mastoid cellulitis were randomly selected as the control group. Information concerning age, sex, location, and histopathological type of the primary tumor, presence or absence of cervical lymph node metastasis, and treatment methods were obtained from the hospital's electronic medical records to investigate the association between these factors and the occurrence of mastoid cellulitis. Results: Statistically significant differences were observed in the following factors: age (p = 0.004), primary tumor site (p < 0.001), histopathological type (p = 0.032), radiotherapy (p < 0.001), and chemotherapy (p < 0.001). Logistic regression analysis revealed that maxillary tumors (p < 0.001), histopathological type (p = 0.047), and radiotherapy (p = 0.0301) were significantly associated with the occurrence of mastoid cellulitis. Conclusions: In oral cancer, the risk of postoperative mastoid cellulitis was higher in patients with a maxillary tumor, histopathology other than squamous cell carcinoma, and history of radiotherapy. [ABSTRACT FROM AUTHOR]

Fibroepithelial polyp (FEP) is a common benign tumor occurring in the skin and genitourinary tract, and there are no reports of multiple FEPs occurring on the myocutaneous flap. We report two cases of FEPs occurring diffusely on the skin tissue of the free anterolateral thigh flap after surgical reconstruction for oral squamous cell carcinoma. Clinically, multiple papillary nodules on the myocutaneous flap gradually increased. CT and MRI showed multiple papillary nodules on an enhanced layer covering the entire myocutaneous flap. PET/CT showed high uptake. One case was diagnosed with FEPs by surgery, the other by biopsy. The tumor-limited localization on the myocutaneous flap, characteristic morphology showing multiple papillary projection with an enhanced layer, and MRI signal showing patchy mild elevation of the apparent diffusion coefficient value may help in differential diagnosis from tumor recurrence or secondary carcinoma of the myocutaneous flap on diagnostic imaging. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated the accuracy of estimating the cross-sectional area (CSA) at the third lumbar vertebra (L3) based on the CSA at the third cervical vertebra (C3) using computed tomographic images, and we identified the sources of error and bias using the evaluation of absolute reliability in 89 Japanese patients with oral squamous cell carcinoma. Methods: Skeletal muscle CSA was measured at the C3 and L3 on pretreatment computed tomographic images. We used the CSA at the C3 to estimate CSA at the L3 in an existing prediction formula. Correlation coefficients were used to evaluate the relative reliability of the estimate, and Bland–Altman analysis and minimum detectable change (MDC) were used to evaluate its absolute reliability. Results: Estimated and actual CSAs at L3 were strongly correlated (r = 0.885, p < 0.001). The mean difference between the estimated and actual CSAs was − 1.0887 cm2, the 95% confidence interval was − 4.09 to 1.91 cm2 (p = 0.472), and the 95% limits of agreement were − 29.0 and 26.8 cm2. The MDC at the 95% level of confidence in estimated and actual CSAs was 27.9 cm2. Conclusions: The estimation of CSA at the L3 from the existing prediction formula with the CSA at the C3 had no systematic biases, but it did have random errors. Random errors resulted from measurement errors and biological variation. Usefulness of the existing formula is limited by physical differences in populations. [ABSTRACT FROM AUTHOR]

Objectives: To determine the magnetic resonance imaging (MRI) features of methotrexate-related lymphoproliferative disorder (MTX-LPD) in the oral cavity of a patient with a chief complaint of oral symptoms. Methods: We included six patients who visited our hospital between November 2014 and November 2019, histopathologically diagnosed with MTX-LPD. All images were examined using 3 T MRI and reviewed by two radiologists. Results: Masses were detected in five cases; all masses demonstrated signal hypointensity and homogeneous signal hyperintensity on T1- and T2-weighted images with fat suppression. Homogeneous enhancement with fat suppression was evident on post-contrast T1-weighted imaging. We performed dynamic contrast-enhanced MRI in three cases and observed early enhancement with a low washout ratio pattern in all cases. Four patients underwent diffusion-weighted MRI and revealed low mean apparent diffusion coefficient (ADC) of 0.57 (range 0.5–0.65) × 10–3 mm2/s. Conclusions: We reported on the imaging characteristics of six rare cases of MTX-LPD in the oral cavity. Homogeneous hyperintensity on fat-suppressed T2-weighted images and low ADC values are possible features of MTX-LPD. Moreover, MTX-LPD can be differentiated from other carcinomas in the oral cavity. [ABSTRACT FROM AUTHOR]

There are around 2,500 new cases of oral cavity squamous cell carcinoma (OSCC) reported yearly within Australia. Resection often leads to substantial defects, requiring complex reconstruction. The aim of this study was to examine how reconstruction at a dedicated head and neck cancer unit has evolved over a 30-year period. A retrospective review was conducted of all OSCC carcinoma cases performed from 1988 to 2017. Data was analysed in six-time periods; pre-1995, 1995–1999, 2000–2004, 2005–2009, 2010–2014, and 2015 and above. A total of 903 patients were identified, of which 56.1% (n = 507) underwent free flap reconstruction including 426 (84.0%) soft tissue free flaps (STFF) and 81 (16.0%) bony free flaps (BFF). STFF usage remained stable over time. The radial forearm was the most common free flap but declined over time with increasing use of the anterolateral thigh flap. The number of BFF increased from 5.0% before 1995 to 20.4% in 1995–2015. The tongue was the most common subsite, followed by the floor of mouth. Free flaps were utilised in more than 50% of OSCC reconstructions at each time period. Over time, the proportion of different STFF evolved towards increased use of the ALT flap and BFF within our institution. Level of evidence: Level four. [ABSTRACT FROM AUTHOR]

Objectives: To examine the diagnostic usefulness and procedures of ultrasonography (US) for mass lesions in the soft tissue of the oral region. Methods: This study involved patients with mass lesions (tumorous lesions and cysts) who had undergone US and histopathological examinations from January 2017 to December 2019. The following points were evaluated by two observers using an evaluation scale: vascularity, echo intensity level, boundary, margin shape, distribution of internal echoes, and capsule. The usefulness of each point for differential diagnosis of tumorous lesions and cysts was statistically analyzed. Results: Forty-five mass lesions in the soft tissue of the oral region (33 tumorous lesions and 12 cysts) were analyzed. There were significant differences in four evaluation points between the tumorous lesions and cysts: vascularity, echo intensity level, boundary, and margin shape. Cysts were almost completely excluded diagnostically, especially when vascularity was observed. There were also significant differences in two evaluation points between nonvascular tumorous lesions and cysts: echo intensity level and boundary. Conclusions: In US examination for mass lesions in the oral region, it was possible to diagnose tumorous lesions and exclude cysts when vascularity was observed. When vascularity was not observed, however, tumorous lesions and cysts could be identified using two evaluation points: echo intensity level and boundary. [ABSTRACT FROM AUTHOR]

Squamous cell carcinoma is a very common type of oral cancer that affects the health of people with an unacceptably high mortality rate attributed to the difficulties in detecting the disease at an early stage. Therefore, effective techniques for early diagnosis and effective therapy of oral cancer are necessary. In the present study, we exploit the ability of gold nanoparticles (AuNPs) to undergo coupled surface plasmon resonance when closely spaced to improve diagnosing squamous cell carcinoma of the tongue. The prepared AuNPs are characterized by UV-VIS spectroscopy, dynamic light scattering, Fourier transform infrared spectroscopy, and transmission electron microscopy. The size of the prepared AuNPs is 12 ± 2 nm with narrow size distributions and exhibited high stability with a zeta potential of - 16.5 mV. The light fluorescence of the normal and cancer cells is recorded before and after NP addition using a spectrometer upon excitation by 405-nm laser irradiation. Furthermore, the light reflectance of the examined samples is measured at different laser wavelengths (red to NIR region). The obtained results show that the cancer cells mixed with AuNPs produce a higher fluorescence peak at 489.2 nm than the cancer cells without AuNPs. Moreover, the optical diffuse reflectance analyses reveal that the addition of AuNPs enhances cancer detection especially at the 635-nm irradiation with sensitivity (94%), specificity (87%), and overall accuracy (91%). [ABSTRACT FROM AUTHOR]

Radiation therapy for head and neck squamous cell carcinoma (HNSCC) is associated with several complications. Although photobiomodulation (PBM) has radioprotective effects in normal tissue, it could also enhance the growth of neoplastic cells. Thus, the present study aimed to investigate the cellular response of oral squamous cell carcinoma with pre-exposure to low-level phototherapy before radiotherapy. SCC9, Cal-27, A431, and HaCaT cell lines were subjected to low-level light therapy and radiotherapy. The cells were treated with a single energy density (300 J/cm2) of a light-emitting diode (660 nm) prior to ionizing radiation at different doses (0, 2, 4, and 6 Gy). After 24 h, wound scratch, proliferation, clonogenic cell survival, cell death, and reactive oxygen species (ROS) analyses were performed to evaluate cell response. The cell lines pre-exposed to PBM at the analyzed dosage were radiosensitive. The treatment significantly reduced cell proliferation and clonogenic cell survival. Migration and cell death assays also revealed positive results, with the treatment group showing lower rate of migration and higher cell death than did the control group. Moreover, PBM effectively increased the intracellular levels of ROS. PBM at 300 J/cm2 is a promising radiosensitizing modality to reduce the radiation dose and avoid the intolerable side effects of radiotherapy for HNSCC, thus increasing the probability of successful treatment. However, further studies are needed to support and confirm the results. [ABSTRACT FROM AUTHOR]

This paper explores how Islamic religious beliefs; spiritual practices and fatalism may act as barriers to a diagnosis of oral cancer in Rawalpindi/Islamabad Pakistan. The qualitative methodology is oral history and interviews took place with fifteen women diagnosed with oral cancer and receiving treatment in hospital. The research provides a model illustrating how religiosity, fatalism and the social determinants of health exist on a continuum and influence the perspectives of women in Pakistan, contributing to their late presentation and diagnosis of oral cancer. Analysis of the patients' oral histories, suggests improved communication between medical professionals and integration of spiritual/traditional healers into the existing health care system of Pakistan which may assist in reducing oral health inequalities. [ABSTRACT FROM AUTHOR]

Summary: Background: Although anti-programmed death receptor-1 (PD-1) agents have been evaluated in the neoadjuvant setting for the treatment of locally advanced head and neck cancer, including oral cavity squamous cell carcinoma (OCSCC), the overall response rate is modest. The aim of the present study was to evaluate the efficacy and safety of neoadjuvant nivolumab in combination with stereotactic body radiotherapy (SBRT) for the treatment of locally advanced OCSCC. Methods: OCSCC patients who underwent surgical resection within 6 months of treatment with nivolumab plus SBRT from December 2018 to February 2021 were analyzed retrospectively. Results: All 30 eligible patients enrolled in this study well tolerated the neoadjuvant treatment with no serious adverse events (AEs). Of them, 27 patients (90.0%) achieved R0 resection, and 5 patients (16.7%) experienced procedure-associated complications. The complete response (CR), partial response (PR) and stable disease (SD) were 10.0%, 46.7% and 43.3% respectively. The major pathological response (MPR), complete pathological response (pCR) and clinical to pathological downstaging rate were 60.0%, 33.3% and 83.3% respectively. During the median follow-up period of 13.5 months, 26 patients (86.7%) who underwent surgical resection remained alive. The disease-free survival (DFS) and overall survival (OS) at 24 months were 70.4% and 76.4% respectively. Conclusions: Neoadjuvant nivolumab plus SBRT is safe and efficacious, and could be used as a potential neoadjuvant option for the treatment of patients with locally advanced OCSCC. [ABSTRACT FROM AUTHOR]

Swallowing disorder is one of the most common postoperative complications for oral cancer patients and seriously influences quality of life. Limited attention has been paid to evaluating swallowing training measures in postoperative oral cancer patients. This study systematically reviewed swallowing training measures for these patients. A comprehensive search strategy was undertaken across various databases for studies published between database inception and 15 June 2021. Raters independently judged titles, abstracts and full articles for selection according to inclusion and exclusion criteria. The included literature was evaluated for quality and data were extracted. Meta-analyses were conducted using RevMan 5.3. Ten intervention studies (four randomized controlled trials and six quasi-experimental studies) involving 588 patients were identified. Across the studies, most started in the early postoperative stage; however, there were differences in starting time, training time and duration, and type of training. We summarized four training methods: oral exercise, oral sensory stimulation, compensatory strategies and protective airway manoeuvres. The meta-analysis indicated that swallowing training could improve patients' swallowing function and quality of life in the short term, but the long-term effects were not obvious. Swallowing training mostly occurred in the early postoperative period and training measures were often used in combination. The timing, frequency and content of interventions varied between studies, and the effectiveness of any single measure was unclear. High-quality randomized controlled trials are necessary to study the efficacy and clinical applicability of various training measures, to provide a theoretical basis for their optimal selection and to develop a standardized training programme for postoperative oral cancer patients. [ABSTRACT FROM AUTHOR]

In the perspective of oral cavity squamous cell carcinoma, it is necessary to improve quality of life to some extent by reducing complications. Saliva plays a major role in maintaining oral health as it provides 50–70% of salivary production daily. Many surgeons follow a traditional method of neck dissection with submandibular gland excision. This affects the well-being and hampers the quality of life of the patient due to reduced salivary secretions. Therefore, if this gland can be preserved, it will promote the overall quality of life in postoperative period. To know the rate of submandibular gland involvement in oral squamous cell carcinoma. This provides basis wether IT can be preserved in appropriate cases. We reviewed the histopathological reports of 51 patients with oral squamous cell carcinoma who underwent excision of primary with simultaneous neck dissection and submandibular gland excision. We have found that out of 51 patients, only 2 patients had submandibular gland involvement. Based on our observational study, the rate of submandibular gland involvement in oral squamous cell carcinoma is very low. Due to rarity of involvement, it can be persevered wherever feasibility persists. Preserving submandibular gland is based on factors such as primary site of tumor, staging, lymph nodal involvement with or without extracapsular spread, and depth of invasion. Here, we are concluding that our study gives the basis in favor of preserving the gland so that we can reduce xerostomia and promote quality of life to the patient. [ABSTRACT FROM AUTHOR]

Objective: The higher sensitivity of the new-generation positron emission tomography/computed tomography (PET/CT) with silicon photomultiplier (SiPM) may increase false-positive rates in detecting metastatic lymph nodes (LNs). This study aimed to clarify the usefulness of the SiPM PET scanner in diagnosing LN metastasis of oral squamous cell carcinoma (SCC). Methods: We retrospectively reviewed consecutive F-18 fluorodeoxyglucose PET/CT images of 39 SCC patients using SiPM PET and 31 SCC patients using non-SiPM PET. We measured the maximum standardized uptake value (SUVmax) of the LNs on PET images and maximum short-axis diameter on transverse CT images. Results: The sensitivity and specificity of SiPM PET were 86.2% and 95.6%, respectively (cut-off SUVmax, 4.6). The area under the curve (AUC) of SiPM PET (0.977; 95% confidence interval [CI], 0.958–0.995) was significantly higher than that of non-SiPM PET (0.825; 95% CI 0.717–0.934) (P < 0.01). In a size-limited analysis of diameter, the AUC of SiPM PET (≥ 0.96 for all diameters) was significantly higher than that of non-SiPM PET (tended to decrease as the LN diameter decreased) for the diagnosis of LN metastasis by SUVmax. Conclusion: SiPM PET had higher diagnostic accuracy for LN metastasis of oral SCC than non-SiPM PET, even for small LN metastasis without increasing false-positives. [ABSTRACT FROM AUTHOR]

Background: This study aimed to translate and validate an Arabic version of the Functional Assessment of Cancer Therapy Head and Neck Scale (FACT-H&N, v-4) for use among Sudanese oral cancer patients. Methods: The instrument underwent translation and validation following the standard FACT translation methodology. The translated instrument was pre-tested for face validity and content validity using semi-structured, in-depth interviews with ten oral cancer patients to assess acceptability. The questionnaire was pilot tested with 60 patients; reliability was tested for internal consistency with Cronbach's alpha while construct validity was tested using 'known-group validity'. Results: The pre-test study revealed no major issues, apart from a reluctance to answer questions on sexual satisfaction. The FACT-H&N demonstrated good internal consistency, it considered five particular constructs: PWB, SWB, EWB, FWB and FACT-H&N, their Cronbach's α values were positive and close to 1 with values of 0.85, 0.788, 0.86, 0.895 and 0.703 respectively, indicating that the questionnaire was valid and the responses consistent. Sixty patients were asked the global health-related quality of life item, 36.3% rated their QOL as very good or good (36.3%), while 41.7% rated it as average, and 21.7% as poor or very poor. Then FACT subscale mean scores were tabulated against three categories; patients with very poor/poor recorded significantly lower scores indicating construct validity. Some psychometric properties were consistent with other FACT-H&N translations such as the Chinese, French, Pakistani and Malaysian. Conclusions: This study validates the Arabic version of the FACT-H&N. It is a reliable tool and, will assist further QoL research in other Arabic-speaking countries. Plain English Summary: While survival rates are routinely used to evaluate treatment outcomes in oral cancer, increased understanding of the human cost of this disease highlights the need to also consider the impact of the disease and therapy on patients' quality of life (QoL). Measurement of quality of life outcomes requires a validated QoL questionnaire with proven applicability in that specific context. Little research has been undertaken on the QoL of cancer patients in Sudan and no published research exists to date on the QoL of Sudanese oral cancer patients. While an Arabic version of the FACT-G general questionnaire exists, the FACT-H&N module was not previously available in Arabic. This paper describes the translation of the FACT-H&N from English into Arabic to suit Sudanese patients and other Arabic-speaking patients, with a detailed pre-test review by 10 patients, a pilot study with 60 patients and further validation with 130 patients. This study represents the first QoL research undertaken in oral cancer patients in Sudan and provides some insight into the impact of oral cancer on their lives. Findings from this study indicate that the Arabic version of the FACT-H&N questionnaire is a valid, reliable and acceptable method for assessing health related QoL in Arabic-speaking Sudanese oral cancer patients. This work will benefit future researchers working with Arabic-speaking oral cancer patients. [ABSTRACT FROM AUTHOR]

Background: Angiogenesis is a key rate-limiting step in the process of tumour progression. Cancer-associated fibroblasts (CAFs), the most abundant component OSCC stroma, play important roles in pro-angiogenesis. Recently, the stroma "reverse Warburg effect" was proposed, and PFKFB3 has been brought to the forefront as a metabolic enzyme regulating glycometabolism. However, it remains unclear whether glycometabolism reprogramming is involved in promoting the angiogenesis of CAFs.Methods: CAFs and paracancerous fibroblasts (PFs) were isolated from OSCC and adjacent tissues. We detected the pro-angiogenesis and glycometabolism phenotype of three pairs of fibroblasts. Targeted blockage of PFKFB3 or activation of PGC-1α signal was used to investigate the effect of glycolysis on regulating angiogenesis of CAFs in vitro and vivo.Results: CAFs exhibited metabolic reprogramming and enhanced proangiogenic phenotype compared with PFs. Inhibition of PFKFB3-dependent glycolysis impaired proangiogenic factors (VEGF-A, PDGF-C and MMP9) expression in CAFs. Furthermore, CAFs proangiogenic phenotype was regulated by glycometabolism through the PGC-1α/PFKFB3 axis. Consistently, PGC-1α overexpression or PFKFB3 knockdown in CAFs slowed down tumour development by reducing tumour angiogenesis in the xenograft model.Conclusion: CAFs of OSCC are characterised with glycometabolic reprogramming and enhanced proangiogenic phenotypes. Our findings suggest that activating PGC-1α signalling impairs proangiogenic phenotype of CAFs by blocking PFKFB3-driven glycolysis. [ABSTRACT FROM AUTHOR]

Unknown in the U.S., areca nut (AN) is the fourth most used psychoactive substance in the world and is associated with oral cancers. We investigated the availability of AN in San Antonio ethnic grocery stores and assessed AN practices in immigrant communities. Grocery stores were contacted to assess AN availability. A survey on AN knowledge and utilization were administered at four community sites with large immigrant populations. 13 of the 19 identified grocery stores carried AN. Most survey participants (n = 66) recognized AN. Most Southeast Asians and South Asians knew what AN is, knew someone who uses it, and knew where to buy it. Most South Asian participants knew its harmful effects. AN usage is associated with older age, male sex, and recent immigration. AN is widely available and utilized among immigrant populations in San Antonio. Further work is needed to raise AN awareness among healthcare workers. [ABSTRACT FROM AUTHOR]

This study aimed to assess the role of preoperative 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) for predicting late neck metastasis in clinically node-negative (cN0) early-stage oral squamous cell carcinoma (OSCC). We retrospectively investigated the standardized uptake value (SUV) parameters in patients with late neck metastasis based on the neck node level. The study population consisted of 16 patients with cT1N0 or cT2N0 oral SCC who were evaluated with dual-phase FDG-PET/CT and were treated with local resection of the primary tumor and watchful waiting for neck management. The SUV at each level was measured on the early and delayed images, and the laterality of the SUV was calculated. The laterality on the delayed images significantly differed between positive and negative pairs at the levels Ib (p = 0.002) and IIb (p = 0.013); a cut-off value of 1.4 yielded a true-positive rate of 50% and a false-positive rate of 6%. The laterality of FDG-uptake should be used to stratify the risk for nodal-level metastasis. [ABSTRACT FROM AUTHOR]

Objective: This study aims to assess the outcomes of adjuvant interstitial brachytherapy (BT) to the tumor bed for oral cavity squamous cell carcinoma (SCC), and to compare the oncological outcomes and toxicity profile of low-dose-rate (LDR) and pulsed-dose-rate (PDR) BT. Design: This retrospective single-center study included all patients who underwent postoperative LDR- or PDR-BT to the tumor bed as the sole adjuvant treatment for an oral tongue or floor of the mouth SCC between January 2000 and December 2020. Results: A total of 79 patients were eligible for this study. The cohort was divided into an LDR group (n = 38) and a PDR group (n = 41). The median time interval between surgery and brachytherapy was 55 days. Median delivered total dose was 55 Gy and median hospital stay was 5 days. Five patients (8.3%) experienced grade 3–4 early toxicity, 2 in the LDR group and 3 in the PDR group. Late toxicities were present in 28 patients (44.4%) and were dominated by grade 1–2 residual pain and dysesthesia, without a statistical difference between the groups. After a median follow-up of 65.1 months, 5‑year local control (LC), disease-free survival (DFS), and overall survival (OS) for the whole cohort were 76.3% (95% CI = 63.4–85.1), 61.6% (95% CI = 49.0–72.0), and 71.4% (95% CI = 58.6–80.8), respectively. Conclusion: Adjuvant BT after excision of oral cavity SCC provides satisfactory oncological outcomes along with good tolerance. In our study, PDR-BT showed similar oncological and functional results to LDR-BT in this indication. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to retrospectively evaluate the radiation dose and complications in soft tissue and mandible caused by 198Au grain brachytherapy alone or the combination with other modalities in patients with the cancer of the floor of the mouth. Materials and methods: Twelve patients with T1 (n = 5) and T2 (n = 7) squamous cell carcinoma of the floor of the mouth, who were treated with 198Au grain brachytherapy alone (n = 5) or the combination of external beam radiotherapy (EBRT) and/or chemotherapy and 198Au grain brachytherapy (n = 7) from January 2005 to December 2016, were included. The relationships between the radiation dose and the complications of the soft tissue or mandible were investigated. Results: Seven of 12 patients had died. Of these 7 patients, one with T1 and 2 with T2 had died of the causes related to the cancer of the floor of the mouth. Two with T1 and 2 with T2 had died of other diseases. Two patients had grade 2 complications of the soft tissue and mandible. These patients were treated by the combination of EBRT and/or chemotherapy and 198Au grain brachytherapy and irradiated with 123 or 139 Gy in total dose, respectively. And one of these patients was treated by the chemotherapy in addition to EBRT. Conclusion: Our study showed that the combination of EBRT and 198Au grains brachytherapy for the floor of the mouth cancer patients might be associated with risks of developing complications of soft tissue ulcer and mandibular bone necrosis. [ABSTRACT FROM AUTHOR]

Objective: Oral and maxillofacial metastasis may be the first indication of an undiscovered malignancy in a significant number of cases. Therefore, the rationale of this article is to highlight the clinical and radiological presentation of metastatic lesions involving the oral and maxillofacial region. This will serve as a reference for clinicians, who may first encounter patients with possible metastatic lesions in this region. Methods: Histologically confirmed cases of oral and maxillofacial metastasis were retrospectively reviewed over a 30-year period. Twenty-three patients were included in the study. The following clinical information was reviewed: age at diagnosis, gender, medical history, main complaint, site of metastatic tumour, radiological features, preliminary clinical diagnosis and final histological diagnosis. Results: Females were twice as commonly affected, with metastatic lesions three times more likely to occur in the mandible. Common clinical presentations included swelling, pain and paraesthesia, with non-specific dental-related symptoms occurring in a few cases. Fifteen cases presented radiologically with an osteolytic lesion with poorly demarcated margins. Four cases presented with well demarcated lesions with additional signs of destruction. Additionally, four cases showed an osteogenic radiological appearance. In the current population sample, metastasis to the oral and maxillofacial region most commonly originated from the breast. Conclusion: Lesions with poorly demarcated margins with cortical destruction, accompanied by clinical signs of swelling, pain and paraesthesia in the absence of any inflammatory process, should raise suspicion for metastasis. Considering the poor prognosis of these metastatic lesions, the responsibility lies with the clinician to identify these lesions and make appropriate referrals. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) is a versatile imaging modality utilized in various medical fields. Specifically used for evaluation of soft tissues, with non-ionizing radiation and multiplanar sections that has provided great guidance to diagnosis. Nowadays, use of MRI in dental practice is becoming more pervasive, especially for the evaluation of head-and-neck cancer, detection of salivary gland lesions, lymphadenopathy, and temporomandibular joint disorders. Understanding the basic principles, its recent advances, and multiple applications in dentomaxillofacial region helps significantly in the diagnostic decision making. In this article, the principle of MRI and its recent advances are reviewed, with further discussion on the appearance of various maxillofacial pathosis. [ABSTRACT FROM AUTHOR]

The review summarizes the current understanding of dental health in children with chronic kidney disease (CKD). Oral conditions associated with CKD and its medical and surgical management have been described in cohort studies. Children with CKD may present with severe developmental defects of enamel (DDE) including discoloration, pitting, and reduced hardness leading to extensive tooth wear with normal function. The alkaline oral pH resulting from the uremia of CKD inhibits cariogenic bacteria, reduces dental caries risk, and increases accumulation of dental calculus. The malnutrition, acidosis, growth hormone resistance, anemia, and renal osteodystrophy in CKD provide multiple mechanisms for abnormal craniofacial growth and delayed tooth eruption. Following successful kidney transplant, caries risk increases due to normalization of oral pH in the presence of DDE; optimized diet and oral hygiene become critical in caries control. Post-transplant medications including cyclosporine A and calcium channel blockers may cause gingival overgrowth which in severe cases requires gingival surgery to allow tooth eruption, improve appearance, or permit orthodontic treatment. Immune suppression with sirolimus or everolimus may cause severe debilitating oral ulcerations. Long-term immune suppression increases the risk for development of oral candidiasis and oral cancers. Dental examinations and treatment are recommended for children with all stages of CKD to mitigate adverse oral outcomes of the disease and its management. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy and safety of superselective intra-arterial (IA) chemoradiotherapy with cisplatin and transcatheter arterial embolization (TAE) on advanced oral cancer, and to compare it with that of systemic chemoradiotherapy. Materials and methods: This single-center retrospective study included 23 consecutive patients with locally advanced oral squamous cell carcinoma from November 2011 to November 2019. Of these, 15 received superselective IA cisplatin chemoradiotherapy with altered blood flow in the branches of the external carotid artery, and eight received systemic chemoradiotherapy. Medical charts were reviewed for the evaluation of patient data, drug toxicity, and antitumor efficacy. Results: Local control rate for the superselective IA infusion group, who underwent 6–7 cycles was significantly higher than that of the systemic chemotherapy group (11/13, 85% vs 3/8, 38%; p = 0.04). Regional control, locoregional control, disease-free survival, and overall survival rates were not significantly different between the groups (p = 0.15–0.907). Acute toxicity rates of grade 3 or higher were not significantly different between the IA and IV chemotherapy groups (p = 0.221). Conclusion: Superselective IA chemoradiotherapy with cisplatin using altered blood flow in the branches of the external carotid artery with TAE may be useful for inoperable oral cancer. [ABSTRACT FROM AUTHOR]

Objectives: Oral hemangioma is a benign vascular tumor characterized by the presence of numerous blood vessels. We aimed to examine the clinical and ultrasonographic findings of patients diagnosed with oral hemangioma in our ultrasonography (USG) archive, retrospectively. Methods: This study was conducted by examining 20 patients diagnosed with oral hemangioma and underwent USG examination in the Department of Oral and Maxillofacial Radiology of Atatürk University Faculty of Dentistry from 2016 to 2020. All patients had intraoral and radiographic examinations. Patients pre-diagnosed clinically oral hemangioma were evaluated as intraoral with USG. The intraoral USG examinations were performed using both the B-mode and the color Doppler mode. Results: The mean age of the patients was 42.4 ± 19.14 years; 16 patients were female and four were male. The lesions were mostly observed on the alveolar mucosa (30%), followed by the buccal mucosa (25%), the lower lip (15%), the mouth floor (15%), the tongue (15%). In intraoral USG examinations of all oral hemangiomas, we detected submucosal located, well-defined, lobulated, non-capsule, hypo-isoechoic, heterogeneous lesion areas. Additionally, while we detected only peripheral blood flow in 6 (30%) of 20 patients, we detected both internal and peripheral blood flow in 14 (70%). Conclusions: In our study, the examination of the oral hemangiomas with the intraoral probe and the color Doppler mode was very helpful in the differential diagnosis. Although histopathology has an important place in definitive diagnosis, particularly intraoral USG can provide sufficient information for the diagnosis of oral hemangiomas. [ABSTRACT FROM AUTHOR]

Objectives: Lipomas are the most common benign mesenchymal tumors of soft tissue. According to previous studies, 1–4% of the cases has been observed in the oral cavity. A histological variant of lipoma featuring bone formation is called osteolipoma and has been very rarely observed (less than 1% of the total). In order to make a meaningful addition to this rare knowledge base, our study aims to provide a literature review and to report an additional case of osteolipoma. Methods: An electronic search in the PubMed database with the keyword "osteolipoma" was conducted. Among 69 search results, only the cases of osteolipoma located in the "oral cavity" were included in this study. The findings of the previously reported 20 cases (in English) of osteolipoma of the oral cavity were organized in a table along with a new case of osteolipoma located in the mandibular buccal vestibule with radiological and histopathological findings provided by the authors. Results: Osteolipoma affects both sexes and usually emerges in middle-aged or elderly patients with a long history of slow progression. Different imaging techniques may be utilized in the radiographic evaluation. Conclusion: Differential diagnosis includes a wide range of lesions; therefore, the clinical and radiographic evaluation should be confirmed by histopathological examination. The suggested treatment is complete surgical excision and follow-up, and the prognosis is generally good. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to compare dual-energy computed tomography (DECT) virtual monochromatic imaging (VMI) and iodine density imaging (IDI) of oral cancers in terms of visual scoring and tumour volume estimation. Materials and methods: Nine patients diagnosed with oral cancer who underwent DECT VMI and IDI were enrolled. One radiation oncologist, one head and neck surgeon and nine oral surgeons evaluated image clarity and quality in each patient in terms of metal artefacts due to dental prosthesis, internal tumour structure, tumour–organ boundary and total quality of images for diagnosis. Tumour volume was estimated using VMI, IDI and magnetic resonance imaging (MRI). Results: The mean score for image artefact was significantly higher for IDI than for VMI in three observers, the mean score for internal structure was significantly higher for IDI than for VMI in five, the mean score for tumour–organ boundary was significantly higher for IDI than for VMI in two and the mean score for total quality of images for diagnosis was significantly higher for IDI than for VMI in five. Standard deviation of estimated tumour volume was not significantly different between VMI and IDI, but that of MRI was significantly lowest in three images. Conclusions: In DECT for oral cancer, IDI has a visual image superior to VMI; thus, we recommend the use of IDI. Trial registration: Clinical trial number: UMIN000038994. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate the knowledge about oral cancer in a Brazilian population, including initial clinical signs, causal factors, and the health professional of first choice when suspected of the disease. A total of 2261 participants were interviewed in a cross-sectional study, to investigate associations between sociodemographic descriptive variables and knowledge of oral cancer, risk factors, disease precursor lesions, and health professional of choice for diagnosis. The variables were descriptively analyzed and possible associations investigated considering p values < 0.05. A total of 83.4% of participants reported knowing about oral cancer, and 59.5% reported knowing about potentially malignant lesions; both variables were associated (p < 0.0001). Tobacco was identified as the main risk factor (83.6%), followed by family history (66.2%), and poor oral hygiene (54.5%). Interviewees with higher education level had greater knowledge about cancer (p < 0.0001), and the dentist was the health professional of choice for 43.1% of those who knew about the disease (p = 0.007), with the generalist being the most sought specialist. The population evaluated had a low knowledge of oral cancer given the lack of specific clarifications on etiological factors and risk situations. Health education initiatives are necessary to increase population awareness of potentially malignant oral lesions and improve early diagnosis and recognition of the dentist as a qualified professional for diagnosis of the disease. [ABSTRACT FROM AUTHOR]

Background: Overexpression of anti-apoptotic MCL-1 protein in oral squamous cell carcinoma (OSCC) is linked to disease progression, therapy resistance and poor outcome. Despite its characteristic short half-life owing to ubiquitin-proteasome-dependent degradation, oral tumours frequently show elevated MCL-1 protein expression. Hence, we investigated the role of deubiquitinase USP9X in stabilising MCL-1 protein and its contribution to oral tumorigenesis.Methods: Expression of MCL-1 and USP9X was assessed by immunoblotting and immunohistochemistry in oral cancer cell lines and tissues. The association between MCL-1 and USP9X was confirmed by coimmunoprecipitation and immunofluorescence. Cell death assessment was performed by MTT, flow cytometry and clonogenic assays.Results: Both USP9X and MCL-1 are significantly elevated in oral premalignant lesions and oral tumours versus normal mucosa. USP9X interacts with and deubiquitinates MCL-1, thereby stabilising it. Pharmacological inhibition of USP9X potently induced cell death in OSCC cells in vitro and in vivo. The elevated expression of USP9X and MCL-1 correlated with poor prognosis in OSCC patients.Conclusion: We demonstrate the oncogenic role of USP9X in driving early-to-late stages of oral tumorigenesis via stabilisation of MCL-1, suggesting its potential as a prognostic biomarker and therapeutic target in oral cancers. [ABSTRACT FROM AUTHOR]

The present study is to examine the expression of microRNA (miRNA or miR)-758 in tumor tissues, blood, and serum from patients with oral squamous cell carcinoma (OSCC) and try to investigate its regulatory mechanism on OSCC. Twenty-eight OSCC patients and 36 healthy subjects were included in the study. Tumor tissues and tumor-adjacent tissues were collected from OSCC patients. Peripheral blood and saliva were collected from OSCC patients and healthy subjects. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to determine the expression of mRNA and microRNA. Western blotting was carried out to measure protein expression in tissues, while ELISA was employed to determine protein content in serum and saliva. Dual luciferase reporter assay was used to identify the direct interaction between COX-2 mRNA and miR-758. COX-2 mRNA and protein expression was elevated in OSCC patients. In addition, expression of miR-758 was decreased in OSCC patients. miR-758 was able to bind with the 3′-UTR seed region of COX-2 mRNA to regulate its expression. The present study demonstrates that increased expression of COX-2 in tumors, serum, and saliva from OSCC patients is correlated with the decrease of miR-758 expression. miR-758 might regulate OSCC via COX-2 and can be used as a potential gene marker for OSCC. [ABSTRACT FROM AUTHOR]