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Background Dental implant placement carries a risk of iatrogenic damage to adjacent root surfaces. Purpose To classify and understand different types of trauma to the tooth root body by dental implants. Materials and methods This prospective case series included 43 implants placed between February 2017 and June 2020 that had primary stability and were in a position that accidentally invaded the adjacent teeth. The type and degree of the injury were evaluated clinically and radiographically. Tenderness, mobility, and sensitivity tests of the injured teeth were conducted at different visits. Implant failure was confirmed by the presence of implant mobility during the healing period. Results Overall, 43 patients had root injuries due to dental implant surgeries. Regarding the 43 injured roots, 32 developed transient tenderness to percussion, 16 developed variable degrees of resorption in the cementum, three lost pulp sensitivity and one had persistent tenderness to percussion. No injured teeth were lost. In three patients, implant periapical lesions were confirmed radiographically as radiolucency near the apex of the involved implants. Out of the 43 implants, 11 failed and were removed within 6 months, with an implant failure rate of (25%). Conclusions Root damage after implant surgery varies depending on the type and severity of injury. Periodic clinical and radiographical examination is necessary to monitor root resorption and implant integration and to rule out pulp necrosis.

Background OCT is a non-invasive imaging technique that enables the measurement of epithelial thickness and architectural changes, which can help in the diagnosis of pre-cancerous and cancerous lesions. The purpose of the study was to assess whether epithelial tissue thickness improves optical coherence tomography’s ability in detecting oral cancer. Patients and methods Surgically resected oral margins from 60 patients diagnosed with oral squamous cell carcinoma were subjected to OCT. Three OCT measurements (immediate, 1 h and 24 h post-resection) were conducted per resected tissue specimen to look at the effect of saline and formalin on the specimen and its effect on the reproducibility of the OCT. OCT was, then, used to measure the epithelial tissue thickness in cancer-free and cancer-involved margins in eight oral anatomical locations. This data was, then, combined with architectural changes data to calculate the sensitivity and specificity. Results An overall of 189 cancer-free margins and 51 cancer-involved margins had their epithelial thickness measured using OCT and compared to histopathology. With regards to the validity of the OCT and histopathological measurements, epithelial thickness showed good correlation between different readings at all oral sites. With regards to the reproducibility of the OCT measurements, the mean epithelial thickness for all measurements at first (immediate) and second (1 h post-resection – saline preserved) measurements was not significantly different. Underestimation of the epithelial depth in cancer-free margins was 20 μm, while in the cancer-involved margins was 10 μm. Combining data from architectural changes and epithelial thickness, a sensitivity of 92% and a specificity of 94% was achieved. Conclusion Oral epithelium measurements using OCT were valid compared to those made with gold standard pathology. Measurements made using OCT was also reproducible with minor underestimation. Epithelial thickness, combined with architectural changes, led to high accuracy in differentiating between cancer-free and cancer-involved margins.

Photodynamic therapy (PDT) is a method of treating various pathologies. In this retrospective study with prospective intent, a total of 22 patients with T1/T2 N0 cutaneous squamous cell carcinoma (SCC) were treated with intravenous mTHPC (meta-tetrahydroxyphenylchlorin) and surface illumination PDT. Comparisons with the clinical features, rate of recurrence and overall outcome were made.Surface illumination PDT was offered under local anaesthesia. 0.05 mg/kg mTHPC was administered intravenously into the midcubital vein 48 h prior to tissue illumination. A single-channel 652 nm diode laser was used for illumination and light was delivered at 20 J/cmClinical assessment revealed that 16 patients had lesions of2 cm in size (T1), while the rest were T2. No nodal involvement was identified in any of the patients. None of the patients had a locally recurrent lesion. During the 3-year follow-up, 20/22 patients had complete response (CR) and this was after one round of treatment. Two patients suffered from recurrent disease within 3 years of the follow-up, and they underwent surgical resection.PDT achieved high efficacy in the treatment of T1N0 cutaneous squamous cell carcinoma with greatly reduced morbidity and disfigurement. The technique is simple, can commonly be carried out in outpatient clinics, and is highly acceptable to patients.

Introduction Photodynamic therapy (PDT) is a relatively new method of treating skin cancers. This prospective study highlights the use of PDT in the management of basal cell carcinomas (BCCs) and T1N0 cutaneous squamous cell carcinomas (SCCs) involving the periorbital area. Materials and methods Surface illumination PDT was offered under local anaesthesia. mTHPC was administered intravenously. A single-channel 652 nm diode laser was used for illumination, and light was delivered at 20 J/cm2 per site. Lesion response evaluation was carried out according to response evaluation criteria in solid tumours (RECIST). Results After the first round of treatment, all cutaneous T1N0 SCC patients had complete response (CR) and continued to be in remission until last clinic review. For BCC patients, 12/14 patients had CR. The two remaining patients underwent a second round of treatment and also achieved a CR. All BCC patients were in remission at the last clinic review. Using visual analogue scale (VAS), 15 patients reported that this treatment gave them "excellent" cosmetic outcome (VAS 9-10). Conclusion Photodynamic therapy achieved high efficacy in the treatment of periorbital BCCs and cutaneous SCCs with greatly reduced morbidity and disfigurement.

A 77-year-old Caucasian male was diagnosed with squamous cell cancer of the right ear. The patient elected to take part in the first-in-man phase I TPCS2a based bleomycin photochemical internalization (PCI). On Day 0, The patient received the photosensitiser [Amphinex (TPCS2a)], by slow intravenous injection. Four days later, surface illumination based (PCI) was implemented 3 h after the slow infusion of Bleomycin. Four weeks following the infusion of the photosensitiser, the cancerous area turned into black rigid mass with clear demarcation from the macroscopically normal skin. The size of the treated area has been substantially reduced. Histopathologic assessment of the excised necrotic mass revealed no viable tumour and the excised margins (PCI-treated margins) were tumour-free. This case was a clear indication that PCI is a clinically relevant technique that has potential in the treatment of such cancers to avoid radical intervention.

Background The primary aim of this prospective study is to demonstrate the technical feasibility of OCT to map real tumor margins and to monitor skin changes that occurred post- PDT. Moreover, to optimize PDT efficacy based on the relationship between measured OCT features and treatment outcome. Material and Methods A series of 12 patients with overall 18 facial skin lesions were investigated by OCT before surface illumination by PDT to determine tumor free margins. Monitoring of the healing process was undertaken at 3, 6 and 12 months post-PDT. Parameters measured by the in vivo OCT during healing phase were the organization of skin layer and the degree skin fibroses for the active center and peripheral transit zone of the treated lesion. Clinical and aesthetics assessment was carried out at 12-month post-PDT. Results Distinct microstructural differences between normal skin, pre-cancer, cancer, and the transition zone between the two tissues were observed on OCT images. In the subsequent healing phase, OCT demonstrate marked delineation and organization of skin layer at late stage of healing. Early features showing bizarre non-homogenous disorganized layering (scab) but afterwards, OCT was able to differentiate between different histological layers. One lesion demonstrated clinical healing by fibrosis (scar) without sign of recurrence. Another lesion demonstrated skin erythema. Only one lesion did not response to treatment despite margins clearance. The CR rate was 95% at the end of the study. The cosmetic effect was "excellent" in 89% of the patients. Conclusions This feasibility study lays the groundwork for using OCT as a real-time, noninvasive monitoring device for PDT in patients with skin cancer.

Background Skin cancer continues to be the most common cancer in the Caucasian population. Over the past two decades, researchers around the world started assessing the possibility of diagnosing tissue pathologies by using optical systems. In this study, we aimed to use in vivo optical coherence tomography (OCT) technology to describe the morphologic features of normal and pathologic skin conditions. Materials and methods In this study, 72 patients with suspected skin pre-cancer/cancer were recruited. The lesions were subjected to in vivo OCT scanning using compact size probe. The main scanned areas were the centre of the lesion, periphery of the lesion and control reading at least 2cm from the lesion periphery but within the same dermatomal distribution. Following assessment, each lesion was surgically excised. All acquired OCT images were correlated with the corresponding histopathology images to ensure an accurate diagnosis and appropriate co-localisation of abnormal lesion on both OCT image and pathology slide. This was achieved in every resected lesion. Results Histopathological analysis revealed that of the 96 macroscopically suspicious scanned lesions 26 were actinic keratosis (AK), 51 were basal cell carcinoma (BCC) and 19 were cutaneous squamous cell carcinoma (SCC). Different layers of healthy skin can be distinguished with clear demarcation between the epidermis and papillary dermis. An increase in epidermal thickness was observed in OCT images in AK that appeared relatively hyperintense. Cutaneous SCC was characterized by hypoechoic signal free spaces within the dermis and damaged of dermal-epidermal junction. BCCs were visualized as hypoechoic structures but showed a mixed echogenicity. Solid nodular BCC appeared as single or multiple areas with no clear arrangement surrounding low-reflectivity lobular structures surrounded. Cystic structures were identifiable by signal-free areas adjacent to healthy skin. Sensitivity and specificity for in vivo OCT in diagnosing these lesions were impressive, based on this small sample size. Conclusions OCT have shown that there are qualitative differences in OCT image features of skin with varying degrees of pathology, and between normal and pathological skin. This study indicates that in vivo OCT shows a good promise as a useful optical diagnostic technique in diagnosing skin pathologies.

Background Thermography is a contemporary imaging modality based on acquiring and analyzing thermal data using non-contact devices. The aim of the present study was to assess the validity of thermography, compared with that of the reference-standard, for the diagnosis of periapical inflammatory lesions and to evaluate the temperature ranges for acute pulpitis with apical periodontitis (AAP), acute periapical abscess (AA) and chronic periapical abscess (CA). Methods AAP, AA and CA were diagnosed based on clinical and radiographic criteria. Thermographic data were acquired using the FLIR E-5 Infrared Camera. Extraoral thermal images were taken from the front and right and left sides of patients whose mouths were closed, and one intraoral thermal image was taken from the palatal perspective. Agreement in the diagnoses based on the combination of clinical and radiographic assessments and the thermographic evaluation was calculated. The temperature ranges of the three diagnostic subgroups were also measured. Results A total of 80 patients were enrolled in this study. The mean intraoral thermal image temperature for AA was 37.26 ± 0.36, that for CA was 35.03 ± 0.63 and that for AAP was 36.07 ± 0.45. The differences between the mean intraoral thermal temperatures of the three diagnostic groups were statistically significant (P P Conclusions Thermography is an effective, quantitative and nonionizing approach that can be used for the diagnosis of periapical inflammatory lesions. The results of the present study indicated that the highest thermal image temperatures were recorded for AA. Thermography might be able to detect inflammatory reactions during the preclinical stage, leading to early diagnosis.

Background: Thermography is a contemporary imaging modality based on acquiring and analyzing thermal data using non-contact devices. The aim of the present study was to assess the validity of thermography, compared with that of the gold standard, for the diagnosis of endo-perio lesions and to evaluate the temperature ranges for acute pulpitis with apical periodontitis (AAP), acute periapical abscess (AA) and chronic periapical abscess (CA).Methods: AAP, AA and CA were diagnosed based on clinical and radiographic criteria. Thermographic data were acquired using the FLIR E-5 Infrared Camera. Extraoral thermal images were taken from the front and right and left sides of patients whose mouths were closed, and one intraoral thermal image was taken from the palatal perspective. Agreement in the diagnoses based on the combination of clinical and radiographic assessments and the thermographic evaluation was calculated. The temperature ranges of the three subdiagnostic groups were also measured.Results: A total of 80 patients were enrolled in this study. The mean thermal image temperature for AA was 37.26±0.36, that for CA was 35.03±0.63 and that for AAP was 36.07±0.45. The differences between the mean thermal temperatures of the three diagnostic groups were highly statistically significant (PConclusions: Thermography is an effective, quantitative and nonionizing approach that can be used for the diagnosis of endo-perio lesions. This technology is able to distinguish different forms of infection by identifying the range of temperature increases related to each form.

Patients refractory to conservative treatment of temporomandibular disorders (TMD) are candidates for more invasive treatments like arthroscopy and arthrocentesis. The aim of the present study was to identify predictors of long-term success and persistence of treatment outcome for temporomandibular joint (TMJ) arthroscopic lysis and lavage and arthrocentesis for treatment of TMD. Analysis of 64 minimally invasive surgeries used to treat disc displacement without reduction in group I (n = 36), and osteoarthritis in group II (n = 28) was conducted. Success was identified as a pain score ≤ 3, disability score ≤ 2 and maximal mouth opening greater than 35 mm. The overall success rate was 85.9%. Difference in success rate between groups was not significant (p = 0.441). Preoperative predictors of success in group I were fewer tender muscles (p p = 0.046), lower pain (p p = 0.0104), while in group II were fewer tender muscles (p p p = 0.0131). In conclusion, arthroscopy and arthrocentesis were equally efficient after 5 years. Fewer tender muscles and lower disability preoperatively were common predictors of success. Pain recorded at one year, and maximum opening and disability recorded at 3 months were maintained after 5 years.

Dental implant surgery on atrophied maxilla has many risks; in some patients, simultaneous sinus lifting with implant placement must be performed to increase the chances of successful implantation; this procedure can cause implant migration. Eleven patients were diagnosed with implant migration into the maxillary sinus in four anatomical areas: the sinus floor above the alveolar bone, near the junction of the sinus and nasal floor, near the floor of the orbit, and the most posterior aspect of the sinus. Surgical removal was performed through four different direct non-endoscopic transoral approaches depending on the location of the displaced implant. Surgical challenges, surgery duration and postoperative complications were reported. The least challenging surgical intervention was noted when removing the displaced implants from the floor of the sinus through the crestal approach. More challenges were experienced during the surgical removal of anteriorly displaced implants near the roof of the orbital floor due to surgical access and the proximity of vital anatomical structures. Bleeding from the pterygoid venous plexus was profound with the posterior lateral approach. The choice of an appropriate surgical approach to retrieve displaced dental implants from the maxillary sinus depends on the location of the implant and the surrounding vital anatomical structures.

Objective This study aims to systematically review the role of differentially expressed microRNA (miRNA) in saliva as potential biomarkers in oral cancer patients. Design PubMed, Scopus and EBSCO online data bases were used as well as manual searching to extract studies from January 2008 up to October 2020. Results A total of 14 studies that met the eligibility criteria were included. All selected studies were of case-control type. A total of 25 differentially expressed miRNAs were identified. Thirteen of these miRNAs (Let-7a, miR 27, miR 34, miR 92, miR 124, miR 125a, miR 136, miR139 miR 145, miR 146a, miR 200a, miR 205 and miR 375) were downregulated and other twelve (miR 9, miR 21, miR 31, miR 122, miR 134, miR 184, miR 191, miR 196a, miR 196b, miR 412, miR 512 and miR 8392) were upregulated. Four miRNAs were evaluated in more than one study (miR21, miR31, miR125 and miR 200). Conclusion According to these results, salivary miRNA can aid in diagnosis and prognosis of oral squamous cell carcinoma (OSCC). However, controlled clinical trials with a large sample size are required to validate the differentially expressed miRNAs of the present review.

Resuming regular clinical activities at dental premises after the COVID-19 lockdown period or post COVID-19 is likely to be a challenge for all dental institutes. When returning to the dental practice or training, staff and students alike should abide by the new rules and regulations. In the process of controlling viral spread, clinical dental facilities face a higher risk of disease transmission among patients as well as clinical and non-clinical staff. Aerosols formation and diffusion into the surrounding air can be a real concern of viral transmission, if no protective measures are established. We aim in this review to present the currently implemented measures and propose changes in clinical dental facilities to minimize the risk of transmission. Dental professionals should be prepared to treat every patient as a suspected COVID-19 carrier and be ready to receive and manage an overwhelming number of patients. We suggest that dental practices establish a sensible workforce shift schedule, improve ventilation levels, reduce dental aerosol generating procedures, and develop a comprehensive guidance to Healthcare Workers to reduce the risk of COVID-19 transmission.

Background: Dental implant surgery in atrophied maxilla has many risks, in some patients simultaneous sinus lifting with implant placement must be performed to increase the chances of successful implant which can cause implant migration. The aim of this study was to illustrate different surgical approaches to remove displaced dental implants into the maxillary sinus. Methods: Eleven patients were diagnosed with implant migration into the maxillary sinus. Radiographs were taken to identify the exact location of these implants which showed that they can be displaced in four anatomical area: sinus floor above the alveolar bone, near the junction of the sinus and nasal floor, near the floor of the orbit, and the most posterior aspect the sinus. The surgical removal was performed through four different trans-oral approaches depending on the location of the displaced implant. The surgical challenges, duration of surgery and postoperative complications were reported.Results: The least challenging surgical intervention was noted when removing the displaced implants from the floor of the sinus. More challenges were experienced during the surgical removal of anteriorly displaced implants near the nasal cavity using the Caldwell-Luc technique (anterior window) with noted difficulty to differentiate between the nasal cavity and maxillary sinus. Implant displacement into the maxillary sinus roof near the orbital floor can be technically challenging due to surgical access and the proximity of vital anatomical structures. Bleeding from the pterygoid venous plexus was profound with posterior lateral approach. Discussion: The choice of the appropriate surgical approach to retrieve displaced dental implants into the maxillary sinus depends on the implant’s location and the surrounding vital anatomical structures.

Introduction Photodynamic therapy (PDT) is a relatively new method of treating various kinds of pathologies. In this retrospective study, a total of 148 patients with basal cell carcinoma (BCC) were treated with surface illumination methyl aminolevulinate – photodynamic therapy (MAL-PDT) or meta -tetrahydroxyphenylchlorin (mTHPC-PDT). Comparisons with the clinical features, rate of recurrence and overall outcome were made. Materials and methods Surface illumination PDT was offered under local or general anaesthesia. For thin BCCs, the 16% strength cream (MAL) was applied topically 3 h prior to tissue illumination. A single-channel 628 nm diode laser was used for illumination and light was delivered at 100J/cm 2 per site. For thick BCCs, 0.05 mg/kg mTHPC was administered intravenously prior to tissue illumination. A single-channel 652 nm diode laser was used for illumination and light was delivered at 20J/cm 2 per site. Lesion response evaluation was carried out according to RECIST. Results The MAL-PDT sub-group included 86 patients with 127 thin BCCs; 80 patients had complete response (CR) after one round of treatment. The mTHPC-PDT sub-group included 62 patients with 116 thick BCCs; 60 patients had complete response after one round of treatment. Statistically significant factors associated with complete response to MAL-PDT included superficial BCC histotype (P Conclusion PDT achieved high efficacy in the treatment of basal cell carcinomas with greatly reduced morbidity and disfigurement. The technique is simple, can commonly be carried out in outpatient clinics, and is highly acceptable to patients.

Photochemical internalisation (PCI) is a unique intervention which involves the release of endocytosed macromolecules into the cytoplasmic matrix. PCI is based on the use of photosensitizers placed in endocytic vesicles that, following light activation, lead to rupture of the endocytic vesicles and the release of the macromolecules into the cytoplasmic matrix. This technology has been shown to improve the biological activity of a number of macromolecules that do not readily penetrate the plasma membrane, including type I ribosome-inactivating proteins (RIPs), gene-encoding plasmids, adenovirus and oligonucleotides and certain chemotherapeutics, such as bleomycin. This new intervention has also been found appealing for intracellular delivery of drugs incorporated into nanocarriers and for cancer vaccination. PCI is currently being evaluated in clinical trials. Data from the first-in-human phase I clinical trial as well as an update on the development of the PCI technology towards clinical practice is presented here.

Photochemical internalization (PCI) depends on the delivery of sublethal photodynamic reaction to facilitate the work of a chemotherapeutic agent. We discuss our experience in managing a patient with extensive squamous cell carcinoma of the right face and scalp under the TPCS2a -based bleomycin PCI treatment protocol. In this case, an 84-year-old Caucasian received 0.25 mg kg-1 of TPCS2a (Amphinex® , PCI Biotech AS, Oslo, Norway). Surface illumination photochemical internalization was carried out after 4 days, which was preceded by the chemotherapeutic agent infusion (Bleomycin). After one week from the illumination time, tissue necrosis was evident and tumor shrinkage was most noticeable at day 14 postillumination. Follow-up at 6 weeks continued to show tissue healing and regeneration with no clinical evidence of recurrence. Multiple surgical biopsies were taken at 1 and 3 months postillumination and found to be tumor free. PCI's depth of effect has been very significant with negligible damage to the collateral tissues. This technology has a role in interventional oncology especially when managing challenging cases.

Background In this immediate ex vivo study, we aimed to identify the structures of normal and pathological facial skin using optical coherence tomography (OCT) and compared them to the gold standard histopathology. Material and methods A total of 53 patients, with 57 suspicious facial lesions, participated in this study. A set of variables have been highlighted by the pathologist to represent the minimum unique features that could be used to diagnose a skin pathology have been included in a checklist. One pathologist used this checklist while examining the histopathology slides and one clinician while examining the OCT images. The data from both checklists have been reviewed and compared. Results Optical coherence tomography's overall accuracy in diagnosing AK was 83%. Best accuracy was achieved in diagnosing BCC and was 97%, while it was 85% for cutaneous SCC. OCT failed to diagnose LM with an accuracy of 33.3% based on the two parameters of the pathology checklist, while it was 81% for malignant melanoma. Conclusion This study proved the success of OCT in identifying structural changes in normal and pathological facial skin. Further studies to prove its usefulness in vivo are recommended.

Background Optical coherence tomography (OCT) has been shown to reliably identify skin changes with the combined advantage of resolution and penetration depth. The objective of this study was to assess the accuracy of OCT in diagnosing various skin pathologies, using pre-set diagnostic criteria, by two reviewers blinded to the actual diagnosis. Patients and methods This immediate ex-vivo study included skin specimens from 103 patients with suspicious skin lesions. In total, 110 lesions were scanned using OCT immediately following surgical resection. Two experienced OCT reviewers assessed these OCT diagnostic parameters blindly at two different intervals based on the parameters of the pre-set criteria. Furthermore, based on the diagnostic suggestions of the two reviewers, the sensitivity and specificity were calculated along with the kappa agreement statistic. Results A variety of lesions were diagnosed, as part of this study, including actinic keratosis (AK), basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (SCC), lentigo maligna (LM) and malignant melanoma (MM). Using the previously set diagnostic criteria, a sensitivity and specificity for AK was reported as 97.5% and 100%, respectively. For BCC it was 98% and 95.3%, respectively; while for cutaneous SCC was 83.3% and 94.9%, respectively. The sensitivity and specificity for LM was reported as 55% and 89.5%, respectively; while for MM it was 43.8% and 76.2%, respectively. High overall levels of intra- and inter-observer agreements were shown for most of the evaluated diagnostic parameters. Conclusion This study indicates that OCT shows good promise as an optical diagnostic technique in diagnosing skin pathologies. The sensitivity in diagnosing actinic keratosis and basal cell carcinomas was impressive, with satisfactory results in diagnosing cutaneous squamous cell carcinoma. The sensitivity in diagnosing lentigo maligna and malignant melanoma remains poor and require further studies. Experienced OCT reviewers are required to improve diagnostic accuracy.

Background Incomplete surgical removal of cancer is believed to be the main cause of local recurrence and high mortality. This study assessed the use of optical technology (namely optical coherence tomography [OCT]) in examining oral squamous cell carcinoma (OSCC) resection margins to assess if this modality could guide the surgeon during surgical resections. Materials and methods Twenty-eight T1–T2 N0M0 oral squamous cell carcinoma patients participated in this study. Nineteen patients were males and nine were females. The majority of lesions were in the ventro-lateral tongue, floor of mouth, retromolar trigone and the buccal mucosa. Following tumour resection, the specimen resection margins were optically scanned in the immediate ex vivo phase. Two independent assessors commented on the four resection margins of each specimen. The findings were then compared to the corresponding gold standard histopathology. The average epithelial thickness for both tumor-free and tumor-involved margins was also calculated. Results The pathology reports of the 112 margins revealed 90 tumor-free margins and 22 tumor-involved margins. Examining the data from both senior operating surgeons (assessors), the overall sensitivity and specificity was found to be 81.5% and 87%, respectively. Whilst the positive predictive value was 61.5% and the negative predictive value was 95%. OCT accuracy for the first assessor was 88% and for the second assessor 84%. The assessors’ inter-observer agreement was “very good” for superior, inferior and medial margins; while agreement on the lateral surgical margin status was “good”. Using OCT, the mean epithelial thickness at the tumor-free resection margins was 360 μm; while, it was 567 μm for the tumour-involved margins. Conclusion OCT is a valuable tool in the assessment of surgical margins. Tumour-involved margins can be identified by architectural changes and increase in epithelial layer thickness on the OCT image. Further studies are required to assess tumour margins in vivo.

Background The assessment of cutaneous cancer margins intra-operatively or in the immediate postoperative phase can guide the operator into achieving clear margins. Achieving clear (tumour-free) margins following surgery is an essential factor that can reduce morbidity and disfigurement. The aim of present study was to determine the accuracy of optical coherence tomography in assessing cutaneous cancer margins of the face. Materials and Methods The excised tissue specimens that were examined, in this study, were acquired from 70 patients with 70 facial cancer lesions, with no nodal disease. Forty lesions were basal cell carcinomas (150 margins; 27 tumour positive) and the remaining thirty were cutaneous squamous cell carcinomas (112 margins; 22 tumour positive). These 70 resected lesions were subjected to optical coherence tomography (OCT) in the immediate ex vivo phase to assess each specimen’s four margins status (anterior, posterior, medial and lateral). Two reviewers, blinded to the diagnosis, carried out the assessment of the acquired OCT images and measured the mean thickness. Intra- and inter-reviewer agreement was also calculated. Results On OCT, tumour-involved margins displayed sudden change in thickness associated with architectural changes. BCC-involved margins showed homogenous oval nests with dark rim and dark cysts or an empty space below dermo-epidermal junction depending on the sub-type. In the case of cutaneous SCC-involved margins, the DEJ had lost its integrity with/out the presence of small bright clusters in the papillary dermis and damage to the superficial epidermal layers. The mean thickness of the whole epidermal layer of the tumour-free margin was 128 μm, while for the BCC-involved margin 640 μm, and for the cutaneous SCC-involved margin 810 μm. The sensitivity of using OCT in examining BCC-involved margins was 88.9–92.6 % and the specificity was 96.8–98.4 %. For cutaneous SCC-involved margins, the sensitivity was 81.8–91.0 % and the specificity 85.6–91.1 %. There was “strong” inter-reviewer agreement on the BCC-involved margins, while the agreement was “moderate” for the cutaneous SCC-involved margins. Conclusion OCT provides good accuracy in identifying cutaneous cancer margins. This can potentially be used to guide and monitor resection in real-time. Tumour thickness could be measured due to the thin skin of the face, but may be more difficult to measure accurately in thick tumours and/or thick skin areas.

Objective In this prospective comparative study, we looked at the postoperative dental and skeletal relapses in patients undergoing orthognathic surgery for skeletal class III deformity. The surgical interventions were single-jaw versus double-jaw procedures. Study Design Twenty-four adult patients with skeletal class III deformity presented with functional and esthetic problems. Patients were randomized to receive single- or double-jaw corrective surgery. The assessment of outcome was by lateral cephalograms taken at different intervals and postoperative complications. Results At 1 year after surgery, no significant correlation was identified between surgical advancement and relapse regarding maxillary stability. The single-jaw procedure cohort had a significantly greater horizontal mandibular skeletal relapse. No differences were noted when examining the mandibular vertical stability. None of the patients reported any acute local neurology. Conclusions Single-jaw procedure may lead to less stability, leading to skeletal relapse, than double-jaw procedure. A higher evidence-based study and larger cohort is required to prove this.

Summary Background Optical coherence tomography (OCT) is an evolving optical technology that is capable of delivering real-time, high-resolution signatures of tissue. Objectives The purpose of this immediate ex vivo prospective clinical study was: (1) to assess the sensitivity and specificity of OCT on biopsy material in identifying potentially malignant and malignant oral lesions, (2) to determine the inter-observer agreement in the analysis of specific image parameters, and (3) to find out the oral epithelial thickness for different pathology groups. Materials and methods This prospective study involved 125 suspicious oral lesions from 125 patients. The lesions were surgically biopsied and subjected to OCT in the immediate ex vivo phase. Two independent readers (surgeon and pathologist) examined the OCT images and assessed several cellular features including keratin layer, epithelial layer, basement membrane and lamina propria, and recorded their findings using special OCT reading score. The sensitivity, specificity and accuracy of OCT to predict “the future need for surgical biopsy in case of any similar lesion” were calculated. The epithelial thickness was also measured. The degree of agreement between the two readers was recorded. Results The pathological diagnosis revealed that the majority of lesions demonstrated microinvasive carcinomas ( n = 43). Forty-one had different degree of dysplasia. Benign oral lesions were less common and included 22 keratosis, 11 non-specific lesions, 6 mucocels and 2 papillomas. Optical coherence tomography achieved a sensitivity of 85% and a specificity of 78% in the assessment of oral potentially malignant and malignant disorders. The positive and negative predictive values were 86.5% and 77.5%, respectively. The accuracy was 82% and the kappa coefficient of inter-observer agreement was 0.72 on “the need for biopsy”. OCT imaging of oral lesions provided valuable information on the oral epithelial thickness. Conclusion This study proposes that OCT can accurately identify wide spectrum of oral tissue pathologies. Further studies can assess the role of OCT in evaluating and guiding surgical biopsies and monitoring disease.

Photochemical internalisation, a novel minimally invasive treatment, has shown promising preclinical results in enhancing and site-directing the effect of anticancer drugs by illumination, which initiates localised chemotherapy release. We assessed the safety and tolerability of a newly developed photosensitiser, disulfonated tetraphenyl chlorin (TPCS2a), in mediating photochemical internalisation of bleomycin in patients with advanced and recurrent solid malignancies.In this phase 1, dose-escalation, first-in-man trial, we recruited patients (aged ≥18 to85 years) with local recurrent, advanced, or metastatic cutaneous or subcutaneous malignancies who were clinically assessed as eligible for bleomycin chemotherapy from a single centre in the UK. Patients were given TPCS2a on day 0 by slow intravenous injection, followed by a fixed dose of 15 000 IU/m(2) bleomycin by intravenous infusion on day 4. After 3 h, the surface of the target tumour was illuminated with 652 nm laser light (fixed at 60 J/cm(2)). The TPCS2a starting dose was 0·25 mg/kg and was then escalated in successive dose cohorts of three patients (0·5, 1·0, and 1·5 mg/kg). The primary endpoints were safety and tolerability of TPCS2a; other co-primary endpoints were dose-limiting toxicity and maximum tolerated dose. The primary analysis was per protocol. This study is registered with ClinicalTrials.gov, number NCT00993512, and has been completed.Between Oct 3, 2009, and Jan 14, 2014, we recruited 22 patients into the trial. 12 patients completed the 3-month follow-up period. Adverse events related to photochemical internalisation were either local, resulting from the local inflammatory process, or systemic, mostly as a result of the skin-photosensitising effect of TPCS2a. The most common grade 3 or worse adverse events were unexpected higher transient pain response (grade 3) localised to the treatment site recorded in nine patients, and respiratory failure (grade 4) noted in two patients. One dose-limiting toxicity was reported in the 1·0 mg/kg cohort (skin photosensitivity [grade 2]). Dose-limiting toxicities were reported in two of three patients at a TPCS2a dose of 1·5 mg/kg (skin photosensitivity [grade 3] and wound infection [grade 3]); thus, the maximum tolerated dose of TPCS2a was 1·0 mg/kg. Administration of TPCS2a was found to be safe and tolerable by all patients. No deaths related to photochemical internalisation treatment occurred.TPCS2a-mediated photochemical internalisation of bleomycin is safe and tolerable. We identified TPCS2a 0·25 mg/kg as the recommended treatment dose for future trials.PCI Biotech.

Introduction This new prospective clinical study assessed the oncological outcomes following surface illumination mTHPC-photodynamic therapy of T1/T2 N0 oral squamous cell carcinoma (OSCC) patients. Material/Methods Thirty-eight patients participated in this study. Their mean age at the first diagnosis of OSCC was 58.0 years. Common clinical presentation was an ulcer mainly identified in the tongue, floor of mouth (FOM), or buccal mucosa. Current and ex-smokers represented 89.5% of the cohort; while current and ex-drinkers were 86.8%. Clinically nine patients had T1 disease while 29 had T2 disease. Results Pathological analysis revealed that 12 patients had well differentiated SCC, 16 moderately differentiated and 10 had poorly-differentiated cancer. All patients were discussed in a multidisciplinary meeting and, subsequently, underwent mTHPC-PDT. PDT was repeated in 6- to 7-month period following the first round when residual tumor was identified in the treated site. At last clinic review post-PDT, 26/38 patients showed complete normal clinical appearance of their oral mucosa in the primary tumor site. Recent surgical biopsies from the study cohort showed that 17 had normal mucosa, five with hyperkeratinization, 10 with dysplastic changes and six showed recurrent SCC. The overall recurrence was 15.8% and the 5-year survival was 84.2%. Death from loco-regional and distant disease spread was identified in three patients. The recurrence group comprised six patients. Most common presentation was an ulcer involving the buccal mucosa or retromolar area, identified in current or ex-smokers and current drinkers. The surgical margins in this group were also evaluated following laser or surgical excision and reconstruction. Conclusions mTHPC-photodynamic therapy (up to three rounds) is a comparable modality to other traditional interventions in the management of low-risk tumors of the oral cavity. Although, sometimes, multiple rounds of the treatment is required, morbidity following PDT is far less when compared to the three conventional modalities: surgery, radiotherapy, and chemotherapy. Lasers Surg. Med. 43:463–469, 2011. © 2011 Wiley-Liss, Inc.

Introduction Photodynamic therapy is a proven therapeutic modality in the management of variety of pathologies involving the human body. Our aim in this clinical study is to prospectively evaluate the outcome following interstitial photodynamic therapy for patients with vascular anomalies. Patients' reports on quality of life with clinical and radiological evaluation were the main end point parameters used to assess the outcome. Materials and methods Forty-three patients were referred to the UCLH Head and Neck Centre for treatment of vascular anomalies of the head and neck, including: infantile and congenital haemangiomas, venous, lymphatic and arteriovenous malformations. After multidisciplinary discussion, all patients underwent interstitial photodynamic therapy under general anaesthesia, using 0.15 mg/kg mTHPC as the photosensitising agent. Following treatment, patients were followed-up for a mean of 21 months. Results Fifteen out of nineteen patients who presented with long-term pain reported improvement after treatment. Also, 7/8 reported significant reduction of bleeding related to their vascular anomaly. Improvement of swelling was reported by 28/35 patients; while reduction of infection episodes was evident in 8/11 patients and 31/36 reported reduction in the disfigurement caused by their pathology. Significant reduction of swallowing problems was reported in 9/12 patients, and breathing problems in 7/9 patients. Clinical assessment showed that half of the patients had ‘good response’ to the treatment. Moderate clinical response was reported by 13 (30.2%) patients. Radiological assessment comparing imaging 6-week post-PDT to the baseline showed moderate response in 11 (25.6%) patients and significant response in 15 (34.9%) patients. Conclusion This study on 43 patients with vascular anomalies undergoing interstitial photodynamic therapy provided evidence that PDT is a successful modality in the management of these pathologies that are resistant to conventional modalities, with minimal side effects. Lasers Surg. Med. 43:357–365, 2011. © 2011 Wiley-Liss, Inc.

The use of the CO(2) laser in the management of oral dysplastic lesions has become a more common practice. Very few studies have evaluated recurrence, residual disease malignant transformation, and overall outcome in patients undergoing such a procedure. In this prospective study, a total of 123 oral dysplastic lesions from 77 consecutive patients were treated with the CO(2) laser (resection and/or ablation). The average age was 58 ± 4.8 years. The patients' recovery was uneventful and no complications were reported. Comparisons with the clinical and histopathological features and rate of recurrence as well as malignant transformation were made. The patients were followed-up for a mean of 6.4 years, and biopsies taken in case of changes suggestive of malignant development. Homogenous leukoplakias were identified in 31 patients, non-homogenous leukoplakias in 34 patients, whereas 12 patients had erythroplakias. Ex- and life-long smokers formed 88.3% of the recruited patients. While people who currently smoke and drink formed 55.8% of the cohort. Erythroplakias were solely identified in heavy life-long smokers. The most common identified primary anatomical locations were the lateral border of tongue, floor of mouth, and buccal mucosa. Moderate dysplasia was identified in 42 patients while 18 patients had severe dysplasia. Laser resection margins in selected cases (68 patients) were clear in 53 and showed mild-moderate dysplasia in the involved margins. The rate of recurrence had no significant association with the location but the severity of epithelial dysplasia. The rate of first recurrence after laser surgery was approximately 19.5%. Malignant transformation was observed in eight patients (10.4%), in the tongue and the floor of mouth. Recurrence and malignant transformation was mainly identified in erythroplakias and non-homogenous leukoplakias. Laser resection/ablation is recommended for oral dysplasia to prevent not only recurrence and malignant transformation but also postoperative oral dysfunction encountered by other conventional modalities.

Introduction The management of tongue base carcinoma continues to be a major challenge in head and neck oncology. Our aim in this prospective study was to evaluate the outcome following ultrasound-guided interstitial photodynamic therapy (US-iPDT) of stage IV tongue base carcinoma patients. Patients' reports on quality of life with clinical and radiological evaluation were the main end point parameters used to assess the outcome. Material and Methods Twenty-one consecutive patients referred to the UCLH Head and Neck Centre for treatment of advanced and/or recurrent tongue base cancer were included in this study. Two-thirds of the referred patients had not been offered further conventional therapeutic options apart from palliative treatment. It was decided, by the multidisciplinary team, that the only available option was to offer US-iPDT under general anesthesia, using mTHPC (Foscan®) as the photosensitizing agent. Following treatment, patients were followed-up for a mean of 36 months (min. 21, max. 45). Results Nine of the 11 patients who presented with breathing problems reported improvement after treatment. Also, 19 of the 21 patients reported improvement of swallowing. Improvement of speech was reported by 11 of 13 patients. Clinical assessment showed that more than half of the patients had “good response” to the treatment and about a third reported “moderate response.” Radiological assessment comparing imaging 6-week post-PDT to the baseline showed stable pathology with no change in size in four patients, minimal response in seven patients, moderate response in six patients, and significant response in two patients. Eight patients died; four of which due to loco-regional disease; and two from distant tumor spread. Kaplan–Meir survival curve was generated from the survival and follow-up data. Conclusions Photodynamic therapy is a successful palliative modality in the treatment of advanced and/or recurrent tongue base carcinoma. Lasers Surg. Med. 43:283–292, 2011. © 2011 Wiley-Liss, Inc.

Introduction: Photodynamictherapy(PDT) is a minimally invasive surgical intervention used in the management of tissue disorders. It can be applied before, or after, any of the conventionalmodalities, without compromising these treatments or being compromised itself.Materials and Methods: In this prospective study, a total of 147 consecutive patients with oral potentially malignant disorders were treated with surface illumination PDT, using 5-ALA or mTHPC as the photosensitizer. The average age was 53 +/- 8.9 years. The patients' recovery was uneventful and no complications reported. Comparisons with the clinical and histopathological features and rate of recurrence as well as malignant transformation were made. The patients were followed-up for a mean of 7.3 years.Analysis and Results: Homogenous leukoplakias were identified in 55 patients, non-homogenous leukoplakias in 73 patients, whereas 19 patients had erythroplakias. Ex- and current lifelong smokers formed 84.4% of the recruited patients. While people who currently smoke and drink formed 38.1% (56 patients) of the cohort. Erythroplakias were mainly identified in heavy lifelong smokers. The most common identified primary anatomical locations were the lateral border of tongue, floor of mouth and retromolar area. Moderate dysplasia was identified in 33 patients while 63 patients had severe dysplasias; and 32 patients had a histopathological diagnosis of carcinoma in situ. The rate of recurrence in laser surgery was approximately 11.6%. Malignant transformation was observed in 11 patients (7.5%), in the tongue, floor of mouth and retromolar area. Recurrence and malignant transformation was mainly identified in erythroplakias and non-homogenous leukoplakias. The final outcome of the cohort showed that 11 (7.5%) suffered from progressive disease, 5(3.4%) had stable disease, 12(8.2%) were considered partially responsive to the therapy. Complete response was identified in 119/147 patients (81%).Conclusion: 5-ALA-PDT and/or mTHPC-PDT offer an effective alternative treatment for oral potentially malignant disorders. Lasers Surg. Med. 43:192-199, 2011. (C) 2011 Wiley-Liss, Inc.

Photodynamic therapy (PDT) has been identified as a successful therapy for skin cancer. This case study investigates the role of optical coherence tomography (OCT) in lesion (squamous cell carcinoma) mapping, assisting the surgeon to correctly deliver PDT and monitor the outcome. Optical coherence tomographic images were acquired pre-treatment to assess tumour extent and margins to enable guidance of the PDT. Tomographic images taken post-PDT up to 6 months revealed complete response to the treatment and no recurrence. OCT-guided PDT is one of the promising approaches to efficiently discriminate between tumor involved and noninvolved margins. It reduces the untoward healthy tissue necrosis and provides an encouraging monitoring of the healing process.

A cystic hygroma, or hygroma cysticum coli, was first described by Wernher in 1843 as a benign harmatoma of the lymphatic system [1]. They are most commonly known to affect the posterior triangle of the neck (70—80% of cases); however, the axilla, superior mediastinum and chest wall have also occasionally been involved. Although of unknown aetiology, theories suggest that they could originate from the growth arrest of primitive lymph channels. This causes the impediment of peripheral lymphatic’s resulting in the formation of fluid-filled sacs. The condition usually presents at birth or early infancy with variable size. It can be either unilocular or multilocular which in both cases transilluminate during examination. Symptoms can be severe when involving the neck giving rise to progressive airway obstruction and dysphagia and/or odynophagia. Surgical debridement or excision of small lesions has been recommended. However, large size lesions are difficult to excise due to increase risk of morbidity and disfigurement.

Department of Radiology, University College London Hospital, London, UKIntroduction:Interstitialphotodynamictherapyremainsan attractive remedial option in minimally invasivesurgery. Our aim in this prospective study was to evaluatethe outcome following ultrasound-guided iPDT of deep-seated pathologies. Patients’ reports on quality of life withclinicalandradiologicalevaluationwerethemainendpointparameters used to assess the outcome.Materials and Methods: Sixty-eight patients werereferredtotheUCLHHeadandNeckCentre fortreatmentof various deep-seated pathologies involving the head andneckregion,upperandlowerlimbs.Allpatientsunderwentinterstitial photodynamic therapy under general anaes-thesia, using 0.15mg/kg mTHPC as the photosensitisingagent.Followingtreatment,patientswerefollowed-upforamean of 7 months.Results: All three patients who presented with visualproblemsreportedimprovementaftertreatment.Also,14/17patients reported improvement of breathing. Improvementof swallowing was reported by 25/30 patients; while speak-ing improvement was evident in 16/22 patients and 33/40reported reduction in the disfigurement caused by theirpathology. All five patients with impeded limb functionreported some degree of improvement. Clinical assessmentshowed that half of the patients had ‘good response’ to thetreatmentandathirdreported‘moderateresponse’withtwopatients being free of disease. Radiological assessmentcomparingimaging6-weekpost-PDTtothebaselineshowedstable pathology with no change in size in 13 patients,minimal response in 18 patients, moderate response in23 patients and significant response in 11 patients.Conclusion: This study on 68 patients with deep-seatedpathologies undergoing interstitial photodynamic therapyprovided evidence that PDT can be the fourth modalityin the management of tissue disease. Lasers Surg. Med.41:612–621, 2009. 2009 Wiley-Liss, Inc.Key words: photodynamic therapy; ultrasound; headand neck; cancer treatment; tumour; vascular malforma-tion; hamartoma; interstitialINTRODUCTIONPhotodynamic therapy (PDT) remains an attractiveremedial option in oncology. In principle, light applicationto the target tissue leads to a non-thermal photochemicalreaction; this is usually initiated some hours following theadministrationofthephotosensitiser andleadstoselectivedamage to the target tissue. The efficacy of the treatmentdepends on the type and the concentration of the photo-sensitiser, light dose, fluence rate, the availability ofoxygen and cellular localisation. Several photosensitisersare currently being tested for better specificity of targettissue [1–3].Two generations of photosensitisers are currently beingused in oncological practice. Profimer sodium (Photofrin-first generation) is commonly used in Barrett’s high-gradedysplasia, cervical, gastric, oesophageal, endobronchialandpapillarybladdercancers.While5-aminolevulinicacid(5-ALA), a natural heme precursor, has been successfullyapplied in basal cell carcinoma, actinic keratosis and oraldysplasia. mTHPC (Foscan) a much more potent secondgeneration photosensitiser for cancer treatment, whencompared to Photofrin and ALA, is commonly used in headand neck cancer. Third generation photosensitisers (tinethyl etiopurpurin, mono

• There is a range of therapies used in the management of vascular anomalies depending upon the character of the lesion.

Introduction Photodynamic therapy (PDT) is a minimally invasive intervention used in the management of tissue disorders. In this retrospective study, a total of 62 patients with actinic keratosis (AKs) were treated with surface illumination PDT. Comparisons with the clinical features, rate of recurrence as well as malignant transformation and overall outcome were made. Materials and methods The medical records of 62 consecutive patients who presented with suspicious skin lesions and diagnosed with AKs were examined. These patients with 178 AKs lesions were treated with surface illumination methyl aminolevulinate—photodynamic therapy (MAL-PDT). The 16% strength cream (MAL) was applied topically 3 h prior to tissue illumination. A single-channel 628 nm diode laser was used for illumination and light was delivered at 100 J/cm 2 per site. These patients were followed-up for a mean of 7.4 years. Results Eight recurrences were reported after the first round of MAL-PDT, and two recurrences after the second round. Malignant transformation to squamous cell carcinoma (SCC) was noted in 2 patients only. The 3-year outcome resulted in 60 patients with complete response (CR), and this was maintained at the final outcome (last clinic review). Assessment of lesional outcome vs. response showed that 175/178 treated lesions had complete response (CR) at 3-year follow-up, which increased to 176/178 lesions at the last clinic follow-up. Conclusion MAL-PDT offers an effective treatment for AKs lesions with excellent cosmetic outcome.

Introduction Burkitt’s lymphoma is a highly aggressive lymphoma. The endemic form is present with Epstein - Barr virus. The most common sites are the mandible, facial bones, kidneys, gastrointestinal tract, ovaries, breast and extra-nodal sites. We present the first reported case of a primary Burkitt’s lymphoma of the postnasal space occurring in an elderly Caucasian male. Case presentation A 72-year-old Caucasian male farmer presented with a 6-week history of a productive cough and a painless left sided cervical swelling. Examination of the neck revealed a 5 cm by 5 cm hard mass in the left anterior triangle. A CT scan of the head and neck showed a soft tissue swelling in the postnasal space. Histology of the postnasal space mass showed squamous mucosa infiltrated by a high grade lymphoma. Immunohistochemical staining and in situ hybridisation confirmed the tumour to be Epstein - Barr virus Ribonucleic acid negative suggesting this was a rare sporadic form of the tumour presenting in a location that is atypical for the clinical subtype and age of the patient. Conclusion This is the first reported case of sporadic Burkitt’s lymphoma of the postnasal space of an elderly Caucasian male in the absence of Epstein - Barr virus or human immunodeficiency virus infection and further serves to illustrate the diversity of histological subtypes of malignancies that may develop at this concealed site.

Background: Optical coherence tomography (OCT) is a non-invasive optical technology using near-infrared light to produce cross-sectional tissue images with lateral resolution. Objectives: The overall aims of this study was to generate a bank of normative and pathological OCT data of the oral tissues to allow identification of cellular structures of normal and pathological processes with the aim to create a diagnostic algorithm which can be used in the early detection of oral disorders. Material and methods: Seventy-three patients with 78 suspicious oral lesions were referred for further management to the UCLH Head and Neck Centre, London. The entire cohort had their lesions surgically biopsied (incisional or excisional). The immediate ex vivo phase involved scanning the specimens using optical coherence tomography. The specimens were then processed by a histopathologist. Five tissue structures were evaluated as part of this study, including: keratin cell layer, epithelial layer, basement membrane, lamina propria and other microanatomical structures. Two independent assessors (clinician and pathologist trained to use OCT) assessed the OCT images and were asked to comment on the cellular structures and changes involving the five tissue structures in non-blind fashion. Results: Correct identification of the keratin cell layer and its structural changes was achieved in 87% of the cohort; for the epithelial layer it reached 93.5%, and 94% for the basement membrane. Microanatomical structures identification was 64% for blood vessels, 58% for salivary gland ducts and 89% for rete pegs. The agreement was “good” between the clinician and the pathologist. OCT was able to differential normal from pathological tissue and pathological tissue of different entities in this immediate ex vivo study. Unfortunately, OCT provided inadequate cellular and subcellular information to enable the grading of oral premalignant disorders. Conclusion: This study enabled the creation of OCT bank of normal and pathological oral tissues. The pathological changes identified using OCT enabled differentiation between normal and pathological tissues, and identification of different tissue pathologies. Further studies are required to assess the accuracy of OCT in identification of various pathological processes involving the oral tissues.

Photodynamic therapy (PDT) is a minimally-invasive surgical tool successfully targeting premalignant and malignant disorders in the head and neck, gastrointestinal tract, lungs and skin with greatly reduced morbidity and disfigurement. The technique is simple, can commonly be carried out in outpatient clinics, and is highly acceptable to patients. The role of photodynamic therapy in the management of oral potentially malignant disorders and early oral cancer is being discussed.

The complete surgical removal of disease is a desirable outcome particularly in oncology. Unfortunately much disease is microscopic and difficult to detect causing a liability to recurrence and worsened overall prognosis with attendant costs in terms of morbidity and mortality. It is hoped that by advances in optical diagnostic technology we could better define our surgical margin and so increase the rate of truly negative margins on the one hand and on the other hand to take out only the necessary amount of tissue and leave more unaffected non-diseased areas so preserving function of vital structures. The task has not been easy but progress is being made as exemplified by the presentations at the 2nd Scientific Meeting of the Head and Neck Optical Diagnostics Society (HNODS) in San Francisco in January 2010. We review the salient advances in the field and propose further directions of investigation.

Summary Introduction Photodynamic therapy, the fourth oncological interventional modality has proved its success in the management of variety of pathologies involving the human body. Our aim in this prospective clinical study was to continue evaluating the outcome following ultrasound-guided interstitial PDT of pathologies involving the human body. Patients’ reports on quality of life with clinical and radiological evaluation were the main end point parameters used to assess the outcome. Materials and methods One hundred and ten patients were referred to the UCLH Head and Neck Centre, London for treatment of various deep-seated pathologies. These included tumours in the head and neck as well as vascular anomalies of the limbs. After multidisciplinary discussion, all patients underwent interstitial photodynamic therapy (iPDT) under general anaesthesia, using 0.15 mg/kg mTHPC as the photosensitising agent. Following treatment, patients were followed-up for a mean of 26 months. Results Four out of five patients who presented with visual problems reported improvement after treatment. Also, 27/32 reported improvement of breathing. Improvement of swallowing was reported by 30/37 patients; while speech improvement was evident in 22/29 patients and 43/52 reported reduction in the disfigurement caused by their pathology. Seven out of nine patients with impeded limb function reported some degree of improvement. Clinical assessment showed that nearly half of the patients had “good response” to the treatment and 5 became disease free. Moderate clinical response was reported by 39 patients. Radiological assessment comparing radiological imaging 6-week post-PDT to the baseline showed moderate response in 45 patients and significant response in 32 patients. Conclusion This study on 110 patients with deep-seated pathologies undergoing interstitial photodynamic therapy provided further evidence that PDT is a useful modality in the management of these pathologies that are otherwise resistant to conventional treatments, and with minimal side effects.

Photodynamic therapy, the fourth oncological intervention modality has proved its successfulness in the management of variety of pathologies involving the human body. Our aim in this prospective clinical study was to evaluate the outcome following ultrasound-guided iPDT of pathologies involving the head and neck region as well as the upper and lower limbs. Patients’ reports on quality of life with clinical and radiological evaluation were the main end point parameters used to assess the outcome.

The use of CO2 laser in the management of oral dysplastic lesions have been put into practice for more than a few years now. The main advantage is the decrease in local tissue morbidity. Very few studies have evaluated recurrence, malignant transformation and overall outcome in patients undergoing such procedure.

Objective Oral cancer is the sixth most common cancer in the world. The incidence of oral squamous cell carcinoma (OSCC) continues to be high, if not increasing. This prospective study assessed the oncological outcomes following transoral CO2 laser resection of T1/T2 N0 OSCC. Patients' 3-year disease-specific survival and disease-free survival were evaluated. Material and Methods The patients' data included a range of clinical, operative, and histopathological variables related to the status of the surgical margins. Data collection also included recurrence, cause of death, date of death, and last clinic review. Ninety patients (64 males and 26 females) participated in this study. Their mean age at the first diagnosis of OSCC was 63.5 years. Two thirds of the patients were Caucasians. Usually patients present with an ulcer of the tongue, floor of mouth, or buccal mucosa. Current and ex-smokers represented 82.2% of the cohort, whereas current and ex-drinkers were 78.9%. Comorbidities included history of oral lichen planus, oral submucous fibrosis, immunodeficiency, oral dysplasia, or OSCC. Clinically, 81 patients had T1N0 disease and 9 had T2N0 disease. Results Pathologic analysis revealed that nearly half of the patients had moderately differentiated OSCC, 18 moderately to poorly differentiated, and 19 poorly differentiated carcinoma. Study of the tumor margins was carried out and showed a mean of 5.7-mm depth of invasion; tumor clearance was primarily achieved in 73 patients. Recurrence was identified in 11 (12%) patients. The mean age of first diagnosis of the recurrence group was 76.4 years. The most common clinical presentation in the recurrence group was an ulcer involving the tongue or buccal mucosa; most commonly were identified in current or ex-smokers or drinkers. Recurrence was associated with clinical N-stage disease. The surgical margins in this group were also evaluated following relaser excision or surgical excision ± neck dissection. Follow-up resulted in a 3-year survival of 86.7%. Twelve patients died: 9 from noncancer-related causes, 2 from locoregional disease spread, and 1 from distant metastasis to the lungs. Conclusions Squamous cell carcinoma of the oral cavity has a poor overall prognosis with a high tendency to recur at the primary site and extend to involve the locoregional lymph nodes. The overall results of this study suggest that CO2 laser is a comparable modality to other traditional interventions (surgery) in the management of low-risk (T1/T2) tumors of the oral cavity.

Head and neck metastatic tumours are uncommon. The primary tumors most likely to metastasize are those of the thyroid, breast, and lungs. The management of metastatic carcinoma in the orofacial region is variable. Palliative and symptomatic approaches are the mainstay in the management. The purpose of this case report is to highlight the feasibility of using PDT to alleviate nasal and visual symptoms and control the growth of metastatic renal cell carcinoma to the orofacial region.

Adenoid cystic carcinoma is a malignant neoplasm arising from the salivary glands. It accounts for 10-15% of all salivary gland neoplasms, representing 1-2% of malignant neoplasms of the head and neck. It is characterized by slow growth, diffuse invasion and potential to produce distant metastases, mainly to the lungs and bone. We present a case of adenoid cystic carcinoma of the base of tongue treated with ultrasound guided transcutaneous interstitial photodynamic therapy (PDT) as a salvage treatment.

We present a technical note which reduces the occurrence of carotid artery rupture during the treatment of peri-carotid disease. The use of radiologically inserted endoluminal carotid stenting prior to photodynamic therapy provides vessel protection.

We present the successful use of interstitial photodynamic therapy in the treatment of lacrimal gland mantle cell lymphoma associated with cervical and axillary lymphadenopathy in a 59-year-old female.

Chondrosarcoma;Hyoid;PhotodynamictherapyChondrosarcoma is a malignancy that is cartilaginous in ori-gin and represents approximately 25% of all primary osseousneoplasms. Chondrosarcomas are rare with 90 new cases ayearreportedintheUK.Ofthese,only10%occurintheheadandneck.Peakincidenceisbetweentheagesof30—50,withno apparent correlation with gender [1,2].There are two common grading systems for chondrosar-comas. They can be graded 1—3, with 1 being the leastaggressive and 3 the most. Alternatively, chondrosarcomasare graded low or high grade, with low grade tumours char-acterised by well-differentiated cells and high grade poorlydifferentiated, with a high mitotic rate [1,2].Approximately 90% of conventional chondrosarcomas arelow to intermediate grade that have low metastatic poten-tial, and the rest are high grade or grade 3 lesions with ahigh metastatic rate. The 5-year survival rate of patientswith grade 1, 2, and 3 tumors were 90%, 81%, and 43%

Objective Earlier reports, including a preliminary study within our unit, have shown that the surgeon's experience is one of the most influential factors in determining the likelihood of both permanent inferior alveolar nerve (IAN) and lingual nerve (LN) paresthesia, following third molar surgery. The effect of this and other factors influencing such prevalence are assessed in this study. Study design This prospective study involved 3236 patients who underwent surgical removal of impacted third molars. Patients' demographics and radiological parameters were recorded along with the grade of the treating surgeon. The prevalence of inferior alveolar and lingual nerves paresthesia at 1 month, 6 months, and 18 to 24 months postoperatively were also traced. Results At 1 month postoperatively, the incidence of IAN paresthesia was 1.5% and the LN was 1.8%. These figures decreased over time and 18 to 24 months postoperatively, the incidence of permanent dysfunction of the IAN was 0.6% and LN was 1.1%. With regard to inferior alveolar nerve paresthesia, risk factors included the patient's age (26-30 years), horizontally impacted teeth, close radiographic proximity to the inferior alveolar canal (IAC), and treatment by trainee surgeons. With regard to the lingual nerve, risk factors included male patients, distoangular impactions, close radiographic proximity to the IAC, and treatment by trainee surgeons. Conclusion One of the main risk factors of developing permanent sensory dysfunction in the distribution of these nerves is related to the surgical skills/experience of the operator. Other factors are associated with the type of impaction and the radiographic proximity of the tooth to the inferior alveolar nerve. Such long-term complications can affect the patient's quality of life; the impact on profession, education, and research is unknown.