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Objectives The aim of this study was to determine the prevalence and clinical features of pigmented oral lesions from Thailand. Materials and Methods Biopsy records of the Department of Oral Pathology, Chulalongkorn University, Department of Oral Diagnosis, KhonKaen University, Department of Oral Biology and Oral Diagnostic Sciences, Chiangmai University, Department of Stomatology, Prince of Songkla University, and Rangsit University were reviewed for oral pigmented lesions diagnosed during 1999 to 2019. Demographic data were culled from the biopsy records. Ages of the patients were subdivided into 10-year intervals. Locations of the lesions were classified as gingiva, labial/buccal mucosa, palate, floor of the mouth, tongue, as well as the combination of sites. Data were analyzed by descriptive statistics using SPSS version 20.0. Results Of the 47,175 accessioned cases, 241 cases (0.51%) were diagnosed in the category of pigmented oral lesions. The age of the patients ranged from 1 month to 88 years with the mean ± standard deviation = 38.74 ± 20.96 years. Regarding gender, 172 patients (71.37%) with pigmented lesions were females, while 69 patients (28.63%) were males. The female-to-male ratio was 2.49:1. The majority of the pigmented lesions were encountered at the gingiva (29.88%) followed by labial/buccal mucosa (26.97%), palate (14.94%), lip (10.79%), alveolar mucosa (9.54%), and others (7.88%), respectively. The three most common pigmented oral lesions in the present study were nevus (39.83%), followed by melanotic macule (28.63%) and amalgam tattoo (17.43%), respectively. Conclusions The most common pigmented oral lesion in the present study is nevus. Demographic data of the patients in the present study are in accordance with previous studies with minor differences. Even though pigmented lesions of the oral cavity constitute a small portion of the oral pathology biopsies, accurate diagnosis is important since there is an overlap in clinical appearance of benign pigmented lesions and melanoma.

Objectives To identify the prevalence of high-risk human papillomavirus (HPV) genotypes 16 and 18 among patients with oral squamous cell carcinoma (OSCC) in Thailand and investigate the associations of p16 expression and HPV16/18 with the demographic, clinicopathologic, and risk parameters. Materials and methods A total of 403 formalin-fixed paraffin-embedded OSCC specimens from four centers in four regions were obtained. p16 expression was evaluated by immunohistochemistry. The detection of HPV16/18 DNA was performed by polymerase chain reaction. Results: Of all, 172 specimens (42.7%) were presented with amplifiable extracted DNA. Among these, 62.8% were positive for p16, 8.1% were positive for HPV16/18, and 5.8% were positive for both methods. Of all HPV-positive specimens, HPV18 was detected in 57.1%; HPV16 in 14.3%; and HPV16 and 18 (co-infection) in 28.6%. The prevalence of HPV16/18 varied between centers, with the highest rate in the northern center (20.0%). There was no significant correlation between p16 expression and HPV16/18. There were no significant associations of p16 expression and/or HPV16/18 with all variables. Conclusions The prevalence of HPV16/18 infection in OSCC geographically varied in Thailand, with the highest rate in the northern region. Poor correlation between p16 and HPV16/18 suggests p16 not be used as a surrogate marker for HPV-positive OSCC. .

Objective Tongue lesions constitute a considerable proportion of the oral lesions. Previous studies on tongue lesions were based on clinical studies. There has been a scarcity of the studies which are based on histopathological examination. This study aimed to determine the prevalence, demographic, and pathologic features of tongue lesions from Thailand. Materials and Methods Biopsy records of the participating institutions were reviewed for lesions on the tongue diagnosed during 1998 to 2017. Demographic data were collected from the biopsy records. Locations were arbitrarily classified as dorsal, lateral, and ventral surfaces, tip of the tongue, and the combination of sites. Lesions of the tongue were classified as reactive/inflammatory, developmental, immune-mediated, cystic, benign, premalignant, malignant, infectious, and miscellaneous categories. Statistical Analysis Data were analyzed by descriptive statistics using SPSS version 20.0. Results Of the 44,188 accessioned cases, 2,153 cases (4.87%) were diagnosed from the tongue. The age of the patients ranged from 3 to 93 years with the mean ± standard deviation = 45.26 ± 20.48 years. The female-to-male ratio was 1.49:1. The majority of the tongue lesions were encountered at the lateral border of the tongue (47.66%). Most of the tongue lesions in the present study (53.74%) fell into the reactive/inflammatory category. Irritation fibroma was the most prevalent lesion (18.99%) followed by squamous cell carcinoma (16.91%), and mucus extravasation phenomenon (14.26%), respectively. Conclusions This study offers new perspective into the study of tongue lesions apart from the clinically based studies. It also demonstrates the difference between the pediatric and the elderly patients. This study provides invaluable database for clinicians when formulating the clinical diagnosis of tongue lesions.

The aim of this study was to compare the frequencies of lower eyelid complications after subciliary versus transconjunctival approaches to orbital floor fractures. The investigators implemented a retrospective cohort study and enrolled a sample composed of subjects who had orbital floor repair. The predictor variable was surgical approach, classified as subciliary or transconjunctival. The primary outcome variable was postoperative lower eyelid complications (ectropion, entropion, and eyelid retraction). Other variables were demographic, anatomic, or time to surgery. Descriptive and bivariate statistics were computed. Statistical significance was set at P ≤ 0.05. The study samples were composed of 346 patients (98 [28.3%] females; 225 [65%] underwent a subciliary approach) with a mean age of 42.7 ± 21.1 years. The subciliary approach was significantly linked to the higher rates of ectropion and the lower rates of entropion at 7 days and 6 months postoperatively. There was no statistically significant difference in the frequency of eyelid retraction between both groups. In the setting of orbital floor fractures, these results suggest that the use of the subciliary approach increases the frequency of ectropion, while the transconjunctival approach increases the frequency of entropion. The authors decline to comment on what the better surgical approach to the orbital floor fractures is. The selection should be based on an individual patient basis and surgeon’s preference.

Objectives Chemokine receptors have been shown to overexpress in several cancer types. Binding of chemokines to their cognate chemokine receptors on tumor cells can promote tumor growth, angiogenesis and metastasis. The purposes of this study was to examine the expression of chemokine receptors, CXCR4 and CXCR7, in salivary gland neoplasms and its association with pathologic characteristics. Design Sixty-two cases of salivary gland neoplasms, including 25 mucoepidermoid carcinomas (MEC), 18 adenoid cystic carcinomas (ACC), 14 pleomorphic adenomas (PA) and 5 polymorphous low-grade adenocarcinoma (PLGA) were investigated for CXCR4 and CXCR7 expression immunohistochemically. The immunoreactivity was categorized as low expression or high expression group, based on whether the positive staining was below or higher than 50% of the neoplastic cells, respectively. Results The majority of MECs, ACCs and PLGAs showed high CXCR4 and CXCR7 expression, whereas most PAs showed high CXCR4 but low CXCR7 expression. The levels of CXCR4 and CXCR7 expression were significantly correlated. In MECs, the expression of both chemokine receptors was localized to squamous cells, intermediate cells and glandular epithelial cells, whereas mucous cells and clear cells were negative. In ACCs and PAs, their immunoreactivity was more intense in ductal cells than myoepithelial cells. Most neoplastic myoepithelial cells in PAs did not express CXCR7, while those in ACCs showed strong CXCR7 expression. The increased CXCR4 expression was significantly associated with advanced pathologic grade of MECs (P = 0.03). Conclusion Overexpression of CXCR4 and CXCR7 is common in the 4 salivary gland neoplasms investigated. CXCR4 may play a role in the progression of MECs.

Ewing's sarcoma (ES) is an uncommon malignancy, especially in the head and neck region, with only 30 cases reported so far. The mandible is more affected than the maxilla. It represents the most frequent small round cell bone tumor of childhood and adolescence. This report presented a case of 19-year-old male with primary ES in the right side of maxilla, maxillary sinus, zygoma and temporal fossa areas. The clinical, radiographic, histopathologic features and main histopathologic differential diagnosis of ES were reviewed to avoid potential diagnostic pitfalls.

Niels Christian Pausch, MD, DMD, PhD , Andreas Neff, MD, DMD, PhD, FEBOMS, Kittipong Dhanuthai, DDS, MSc, FRCDT , Nattapong Sirintawat, MD, DDS, PGDipClinSc(OMS) , Chakorn Vorakulpipat, MD, DDS , Poramate Pitak-Arnnop, MD, DDS, PGDipClinSc(OMS), MSc, PhD, DSc⁎ a Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany b Research Group for Clinical and Psychosocial Research, Evidence-Based Surgery and Ethics in Oral and Maxillofacial Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany c Department of Oral and Maxillofacial Surgery, UKGM GmbH, University Hospital of Marburg, Faculty of Medicine, Philipps University, Marburg, Germany d Department of Oral Pathology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand e Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand f Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, Faculty of Medicine, Medical Center of the Johann Wolfgang Goethe – University Frankfurt am Main, Frankfurt, Germany

Background To determine the prevalence and clinicopathologic features of the oral cancer patients. Material and Methods Biopsy records of the participating institutions were reviewed for oral cancer cases diagnosed from 2005 to 2014. Demographic data and site of the lesions were collected. Sites of the lesion were subdivided into lip, tongue, floor of the mouth, gingiva, alveolar mucosa, palate, buccal/labial mucosa, maxilla and mandible. Oral cancer was subdivided into 7 categories: epithelial tumors, salivary gland tumors, hematologic tumors, bone tumors, mesenchymal tumors, odontogenic tumors, and others. Data were analyzed by descriptive statistics using SPSS software version 17.0. Results Of the 474,851 accessioned cases, 6,151 cases (1.30%) were diagnosed in the category of oral cancer. The mean age of the patients was 58.37±15.77 years. A total of 4,238 cases (68.90%) were diagnosed in males, whereas 1911 cases (31.07%) were diagnosed in females. The male-to-female ratio was 2.22:1. The sites of predilection for oral cancer were tongue, labial/buccal mucosa, gingiva, palate, and alveolar mucosa, respectively. The three most common oral cancer in the descending order of frequency were squamous cell carcinoma, non-Hodgkin lymphoma and mucoepidermoid carcinoma. Conclusions Although the prevalence of oral cancer is not high compared to other entities, oral cancer pose significant mortality and morbidity in the patients, especially when discovered late in the course of the disease. This study highlights some anatomical locations where oral cancers are frequently encountered. As a result, clinicians should pay attention to not only teeth, but oral mucosa especially in the high prevalence area as well since early detection of precancerous lesions or cancers in the early stage increase the chance of patient being cured and greatly reduce the mortality and morbidity. This study also shows some differences between pediatric and elderly oral cancer patients as well as between Asian and non-Asian oral cancer patients. Key words:Oral cancer, prevalence, clinic-pathologic features, retrospective study.

Background: Oral malignant tumors in Thailand have not been extensively studied. Hence the following study was conducted. Aims: To determine the prevalence and clinicopathologic data of the oral malignant tumors from Thailand. Subjects and Methods: Biopsy records of the Oral Pathology Department, Chulalongkorn University; Department of Oral Biology and Diagnostic Sciences, Chiang Mai University; Department of Oral Diagnosis, Khon Kaen University and Department of Stomatology, Prince of Songkla University, were reviewed for lesions diagnosed in the category of oral malignant tumors from 2005-2014. Demographic data and site of the lesions were collected. Statistical Analysis Used: Data were analyzed by descriptive statistics using SPSS software version 17.0. Results: Of the 22,639 accessioned cases, 1411 cases (6.23%) were diagnosed as oral malignant tumors. The mean age of the patients was 59.13 ± 17.32 years. A total of 651 cases (46.14%) were diagnosed in males, whereas 759 cases (53.79%) were diagnosed in females. The male-to-female ratio was 0.86:1. The sites of predilection for oral malignant tumors were the gingiva, followed by tongue and alveolar mucosa. The three most common oral malignant tumors in the descending order of frequency were squamous cell carcinoma, non-Hodgkin lymphoma and mucoepidermoid carcinoma. Conclusions: This study provides extensive data on the oral malignant tumors from several university biopsy services located in virtually all parts of Thailand. The data from the present study show some similarities with previous studies; however, differences such as gender and site of predilection still exist.

German animal terms have been used to name oral cleft deformity for centuries. However, their contemporary use and influence on cleft patients remain unstudied.The main aim of this study was to evaluate the current use of German animal terms for oral cleft and their influence on the perception of cleft patients.We used a cross-sectional study design and the study sample consisted of German adult cleft and noncleft subjects in Leipzig, Germany. The study was conducted during May and December 2008, using two questionnaires and two cleft photographs (one unilateral and one bilateral). The predictor variables were medical background and presence of oral cleft. The primary outcome variable was the terminology used for the deformity by noncleft subjects. The secondary outcome variables were self-perception of the cleft patients and their idea about the use of the animal terms. Other study variables included age, gender and specialty/future career of the noncleft participants. Appropriate descriptive, uni- and bivariate statistics were computed, and a P-value of0.05 was considered to be statistically significant.The study sample was composed of 261 noncleft (146 females [55.9%]) and 71 cleft subjects (33 females [46.5%]) with a mean age of 24.2 ± 6.4 and 24.9 ± 7.2 years, respectively. Noncleft subjects without medical background who used animal terms to name oral cleft deformity were more than those with medical background (P0.0001). Over half of cleft patients (60.6%) rejected public use of the animal terms, which was still common in their daily life (P0.0001).The study results suggest that animal terms have been used until now, especially by those without medical background. The cleft patients become insulted by these negative descriptions. This strikes the importance of public education to replace these animal terms with inoffensive words.

Objective The objective of this study was to supplement the current ameloblastoma database by reporting the clinicopathologic features of ameloblastoma from Asia and North America. Materials and Methods Biopsy records of the participating institutes were reviewed for lesions diagnosed as ameloblastoma during the years 1993 to 2009. Slides were reclassified according to the World Health Organization Classification of Odontogenic Tumors in 2005. Clinical information and radiographic features were collected and analyzed. Results The mean age of the patients ± SD was 38.27 ± 17.78 years; 662 patients (51.36%) were men. Mandible (84.26%) outnumbered maxilla and other locations combined in all countries. The number of multilocular radiolucencies (43.40%) was comparable with that of unilocular radiolucencies (42.04%). Follicular pattern was the most common histopathologic pattern (27.70%), followed by plexiform (21.10%) and unicystic pattern (20.71%), respectively. Conclusions The clinicopathologic features of ameloblastomas in the present study show some similarities with previous studies; however, minor differences exist.

Craniofacial fibrous dysplasia is a benign fibro-osseous lesion of bone that only affects the bones of the craniofacial complex. Here, we report a case of craniofacial fibrous dysplasia in a 16-year-old Thai male who presented with mild swelling and tenderness at the mandibular right first molar area and ipsilateral nasal congestion. Conventional and cone-beam CT radiographic examinations were performed. The radiographs revealed multiple mixed radiolucent and radiopaque lesions involving most of the craniofacial bones. The first biopsy from the right mandibular area was diagnosed as juvenile ossifying fibroma, whereas a biopsy from the right maxillary area was diagnosed as fibrous dysplasia. The defects appeared to have a genetic basis, because his mother and younger brother had the same clinical and radiological findings. Furthermore, the family history given by his mother revealed that several other members of her family had similar clinical signs and symptoms. We diagnosed this case as inherited craniofacial fibrous dysplasia on the basis of previously reported clinical, radiographic and histologic findings as well as family history.

Background Cleft-lip nasal deformity alters patient's self-image, as well as posing unique challenges for the rhinoplastic surgeon. Objectives The main purpose of this study was to compare the panel perceptions of nasal aesthetics following secondary cleft rhinoplasty with versus without caudal septal extension grafting (columella grafting). We also investigated whether patient's self-assessment and satisfaction correlated with 4 other variables: (1) rhinoplasty techniques; (2) patients' age; (3) patients' gender; and (4) panel perceptions. Methods Using a cross-sectional study design, we enrolled a sample of adult laypersons and medical experts. The predictor variable was the rhinoplasty techniques (with/without columellar grafting). The outcome variable was the panel rankings of nasal aesthetics based on the photographs of 50 nonsyndromic cleft patients before and after the rhinoplasty. Other variables included the patient's subjective assessment and satisfaction, demographic and anatomic variables. Appropriate descriptive, uni- and bivariate statistics were calculated. The significance level was set at P ≤0.05 and Results The sample consisted of 507 laypersons and 51 professionals who gave comparative ratings ( P >0.05). Columellar grafting was associated with higher rankings of postoperative nasal aesthetics ( P =0.04). Most of the patients (90%) rated positive outcomes. Surgical techniques, patients' age and gender, and panel perceptions were not individually significantly associated with subjective measures and satisfaction. Conclusions Our results suggest that caudal septal extension grafting improves the nasal aesthetics of the cleft patients, as judged by the panel. Patient's self-assessment seems unreliable to be used as an outcome measure.

To the Editor, It is believed that anti-aging preparations or cosmeceuticals, as less-invasive, nonsurgical alternatives, can retard the aging effect of the skin [1]. Table 1 presents some common ingredients in cosmeceuticals. However, the therapeutic benefits of most products remain unsubstantiated [1]. A recent randomized controlled trial showed that a high-priced luxurious antiwrinkle cream (Chanel Ultra Correction Restructuring Anti-Wrinkle Cream SPF 10; Chanel, Paris, France) was no more effective than a regular, cheap moisturizer (ACO Facial Cream; ACO Hud AB, Apteekkituotteet, Finland) [2]. Other options to promote eternal youth are massage with streaming and the use of facial masks. These are popular in spas and salons. Facial massage with an exfoliant may provide immediate superficial debridement, increased blood flow, warmth, substance P release, and an anxiolytic effect [3]. However, no long-term effect has been found, and erythema, edema, dermatitis, and acneiform eruptions may occur after the treatment [3]. Recently, gold for facial skin care has received an interest worldwide and is applied in many cosmetic centers, spas, and salons. It is used in two forms: as an ingredient of topical skin care (mask or cream) and as gold foil or gold leaf for direct application to skin (combined with massage therapy and use of cosmeceuticals with or without streaming). In 2010, an in vitro study showed that gold nanoparticles in an antiwrinkle face mask maximize contact of the active ingredients (L-ascorbic acid, retinoic acid, and collagen) with the skin, enhancing their skin permeation [4]. In animal models, gold facial masks improve blood circulation and cutaneous elasticity, rejuvenate the skin, and reduce wrinkle formation [4]. It is frequently said that Queen Cleopatra of the Nile slept with a pure gold mask every night, and this may have been the secret of her beauty (http://abcnews.go.com/Nightline/future-detox-gold-mask-saltcaves/story?id=9726168p http://www.ub.uni-leipzig.de/), and the Thai-Journal Citation Index Centre (http://www.kmutt. ac.th/jif/public_html/), as well as the online databases of 48 P. Pitak-Arnnop A. Hemprich K. Dhanuthai N. C. Pausch Department of Oral, Craniomaxillofacial, and Facial Plastic Surgery, Scientific Unit for Clinical and Psychosocial Research, Evidence-Based Surgery, and Ethics in Oral and Maxillofacial Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany

Aim: To determine the fluoride content of commercially-available bottled water in Bangkok. Methods: Thirty brands of bottled water (17 bottled plain water and 13 bottled mineral water) were obtained from supermarkets in Bangkok. Two randomly-selected samples of each brand were purchased 6 months apart. A 5-mL sample was mixed with 5 mL of total ionic-strength adjusting buffer III. The fluoride content of each sample was determined in triplicate by a fluoride ion-selective electrode. Fluoride standards ranging in concentration from 0.01 to 1.00 ppm were used to calibrate the measurements. Data were analyzed by Statistical Package for the Social Sciences software, version 13.0. Results: The fluoride content of bottled water in Bangkok ranged from 0.03 to 0.72 ppm, with a mean ± standard deviation of 0.17 ± 0.16 ppm. The mean fluoride content of bottled mineral water was slightly higher than that of bottled plain water, but the difference was not statistically significant. Conclusions: Most commercially-available bottled water in Bangkok contains negligible amounts of fluoride. This serves as baseline data for dentists prescribing a fluoride supplement to make the utmost use of the fluoride caries preventive effect, while avoiding adverse effects, such as dental fluorosis.

Summary Background The treatment of odontogenic keratocyst (OKC) of the jaws remains controversial. The aim of this study was to report the outcome of our conservative treatment protocol for OKC. Methods We collected data of all OKC patients treated in the Department of Maxillofacial Surgery, Pitie-Salpetriere University Hospital from 1995 to 2004. Basal cell naevus syndrome (Gorlin's syndrome) patients were excluded. Recurrence data was analysed in relation to radiographic features, type of microscopic diagnosis, presence of cortical perforation, and site of involvement. Results One hundred and twenty cysts in 109 patients were examined. OKCs were more frequent in the third and the fourth decades of life (range: 11–79 years, mean: 40 years) and in men ( n =71). Most of the lesions were unilocular radiolucencies in the tooth-bearing area and in the posterior part of the mandible. Histologically, 80 lesions showed parakeratosis. Most of the patients underwent uneventful enucleation. Postoperatively, infection occurred in 4 patients, and there was no jaw fracture. Recurrence was found in 28 cysts (26%), of which 7 cysts (6%) had multiple recurrences. There was no significant association between recurrences and radiographic features, histological type, cortical perforation, or site of involvement ( P >0.05). Recurrences were common in the first 5 years after the operation. The average follow-up was 86 months since the last operation (range: 18–151 months). Conclusions Despite the retrospective nature, no control group and a relatively high recurrence rate, our study suggests that enucleation with the aid of computed tomography and adequate postoperative surveillance is a conservative treatment which yields clinically acceptable results. However, the patients must strictly adhere to close follow-ups because recurrences may have serious consequences. Our algorithm for managing OKCs and cyst-like lesions of the jaws is also presented.

Kimura's disease (KD) is a chronic inflammatory disorder, characterised by tumour-like lesions in the head and neck region, producing salivary gland nodules and lymph node enlargement. Many authors suggest that KD is a reactive immunological disorder; however, its aetiology remains unknown.To study immunohistochemical characteristics of head and neck lesions of KD (HN-KD) and to investigate the possible role of human herpesvirus-8 (HHV-8) and Epstein-Barr virus (EBV) in the development of HN-KD.This study enrolled five HN-KD specimens from three patients treated between 1995 and 2005 at Pitié-Salpêtrière University Hospital, Paris, France. Immunohistochemical studies were performed on formalin-fixed, paraffin-embedded tissue. HHV-8 DNA was determined by polymerase chain reaction (PCR) analysis, whilst EBV sequences were identified by PCR and in situ hybridisation.The immunohistochemical studies revealed CD20+ germinal centres with prominent staining of CD23+ dendritic reticular cells, surrounded by numerous interfollicular CD3+, and CD4+ or CD8+ T-cells. Factor VIII-related antigen, CD31 and CD34 occurred in the thin-walled blood vessels. The reactivity of CD1a, HHV-8 and EBV-associated latent membrane protein 1-EBV (LMP1-EBV) were negative, and in situ hybridisation confirmed the lack of EBV DNA. No patient recalled an external insult or chronic irritation.The results of this study indicate the reactive nature of HN-KD (or a subset of HN-KD), and it is unlikely that HHV-8 and EBV play a role in the pathogenesis of the lesion. However, the patients in this series did not have previous history of trauma or chronic irritation; thus, a neoplastic origin could not be excluded. Further multicentre studies based on more specimens are warranted.

Since the spring of 2009, there have been a considerable number of infected as well as fatal cases by virologically confirmed swine-origin H1N1 influenza A virus (S-OIV). The virus continues to spread globally. The World Health Organization (WHO) has now raised the level of S-OIV influenza pandemic alert to phase 6 ('the pandemic phase') because of the human-to-human transmission of the virus and the community-level outbreaks worldwide. The WHO also issues its concerns about the global surveillance, the diagnostic capacity for the infection and the pandemic preparedness plan in every country. However, no critical review on S-OIV influenza and dental practice published in the literature exists hitherto. Based on information up to November 2009, the aim of this article was to summarise significant data on this novel virus and a clinical practice guideline for dental professionals.

Objective The objective of this study was to analyze complications following fibular free flap (FFF) transfer for mandibular reconstruction using our definition of postoperative complications. Study design Retrospective observational study. Patients and methods This retrospective study presents our 4-year experiences with FFF for mandibular reconstruction by a single microsurgical team. Data were collected through patient record review and clinical evaluation by 2 independent assessors. We defined complications as any unwanted postoperative outcomes that compromised patient care. Early complication occurred within the first 2 weeks postoperatively; late complications occurred afterward. Results Of 25 patients included, 13 patients (56%) experienced complications. Early and late complications occurred in 13 and 9 patients, respectively. These included flap loss, malunion, skin-paddle necrosis, orocutaneous fistula, wound dehiscence, hematoma, soft tissue contracture, intraoral hair growth, facial asymmetry, osteoradionecrosis, donor-site morbidity, and medical complications. Revision surgeries were performed in 10 patients, ranging from wound dressing to flap removal. All but 2 flaps survived, yielding an overall success rate of 92%. Most of the patients were alive without disease (92%) at the end of the study. Average follow-up was 47.2 months (range: 26-77). Conclusion Despite the small number of patients, these preliminary data suggest a relatively high frequency of complications following the FFF reconstruction based on our definition. Minor complications are common and should not be neglected because they may lead to devastating consequences. This should also be a part of informed consent for patients. Complications after the FFF transfer await keen evaluation to establish guidelines to improve end results.

Aims To review our experiences with giant mandibular ameloblastoma (GMA) over a 5-year period, and to formulate a treatment algorithm for managing this tumour. Methods We retrospectively reviewed all GMA patients who underwent segmental mandibulectomy and immediate free fibular osteoseptocutaneous flap reconstruction (SM-IFFOFR) by a single reconstructive team from 2002 to 2006. All treatment methods and outcomes were analysed. Findings Forty-four ameloblastoma patients were operated upon during this study period. Sixteen cases had GMA, of which 9 patients were included in this series (mean age: 35 years). The defects in the mandible ranged from 7 to 16 cm in length (mean: 12 cm). The average length of the harvested fibula was 11 cm, and the number of osteotomies ranged from 1 to 2. The mean ischemic time was 137 min (range: 90–180 min). Neck recipient vessels were used for flap perfusion in all cases. All but one flaps were viable without any complications, whilst partial skin-island necrosis occurred in 2 patients. Hospital stay was 2 weeks in most of the patients. No tumour recurrence was found during the follow-up period (range: 26–73 months). Dental implants were placed in 2 patients. Conclusions Despite several limitations of this study, we suggest that a radical approach with the SM-IFFOFR is an effective treatment for GMA. Further well-designed, larger series with longer follow-up periods are still encouraged.

Ameloblastic fibroma (AF) is a rare odontogenic tumour of the jaw which usually occurs in the first 2 decades of life. The common clinical manifestation is a slow-growing swelling. We report a case of a 16-year-old male patient presenting with extensive AF of the mandible. He underwent a conservative enucleation. The tumour recurred 2 years after the initial surgery, requiring the second enucleation.The patient has continued to be followed closely and has been disease-free for 4 years. Recent evidence suggests that the recurrent rate of AF is relatively high, and malignant transformation of AF may occur after recurrences or multiple surgeries. A conservative treatment approach with close surveillance is recommended. Anatomical limitations should be taken into account, especially when enucleation of AF in the posterior portion of the jaw is performed. Current surgical pathologic issues of the tumour are also discussed. (Eur J Dent 2009;3:224-228)

Aim To review and discuss the management of jaw bone osteoradionecrosis (JORN) based on levels of evidence. Methods The Medline/PUBMED and Cochrane search was performed to identify all studies on the management of JORN, published in English, French, and German during January 1975–October 2007. Only clinical researches were identified and classified into four levels of evidence before being examined. All references of the retrieved articles were analysed. Findings Seventy three articles and their additional 45 citations were evaluated. Most of the eligible literature provided observational evidence. Hyperbaric oxygen therapy (HBOT) is an adjunct; however, its clinical usefulness remains controversial. A conservative approach should be limited to early-onset JORN, while radical surgery is indicated for an advanced or refractory lesion. Free tissue transfer is the reconstruction of choice for large defects without the need of HBOT. Some new technologies have also been studied, including ultrasound, biological molecules, distraction osteogenesis and antioxidant agents. Conclusions Most of the reports on the treatment of JORN offer weak evidence. Current information seems insufficient for establishing the definite treatment guideline; thus, well-designed studies with long-term clinical data are encouraged.

Background Oral cancer is the fourth most common cancer in males and the seventh most common cancer in females in Thailand. The survival rates and quality of life of oral cancer patients will significantly be improved if they receive treatment for lesions that are less advanced or premalignant. Early diagnosis is therefore of paramount importance. A number of techniques have been developed to supplement clinical examination for oral malignancy. One interesting screening method is the application of 3% to 5% acetic acid, which has been used for cervical cancer screening. Objectives The primary objective of this study was to assess the sensitivity, specificity, and accuracy of using vinegar (5% acetic acid) for the examination of oral cancer. The secondary objective was to investigate the association between clinical examination using acetic acid and expression of the tumor marker, p53. Methods The study included 30 participants suspected of having oral squamous cell carcinoma. Five percent acetic acid was applied to the lesions, followed by incisional biopsy. The specimens were microscopically examined for pathological diagnosis and p53 immunohistochemical investigation. Results The sensitivity, specificity, and accuracy of using acetic acid for oral cancer examination were 83.33%, 84.21%, and 83.64%, respectively. There was a statistically significant association between clinical examination using acetic acid and expression of p53 protein (P = .000). Conclusions The results of this study suggest that 5% acetic acid has high sensitivity, specificity, and accuracy in detecting oral squamous cell carcinoma and might be used as an adjunct for oral cancer examination.

Objective The aim of this study was to determine the biologic profile of the adenomatoid odontogenic tumor (AOT) in a Thai population. Study design Sixty-seven cases of AOT registered from January 1974 to May 2006 were studied retrospectively. Age, sex, variants of AOT, site and extent of tumors, associated impacted teeth, initial clinical diagnoses, clinical presentations, and duration of symptoms were analyzed. Results All AOT cases were intraosseously located, of which 55.2% were follicular and 44.8% extrafollicular. The 2 variants together were found more frequently in the maxilla than in the mandible, with a ratio of 2:1. Females were affected more often than males, with a ratio of 1.8:1. The peak incidence (56.7%) was found in the second decade of life. The majority of AOT lesions (68.7%) was found in the anterior jaws. Adenomatoid odontogenic tumors were observed more often on the left side of jaws (50.7% vs. 38.8%). Canines were the most common teeth associated with follicular AOT (67.5%), and the maxillary canines alone accounted for 51.3% of all cases. The majority of our patients presented with a painless swelling and with duration of symptoms of 6 months and longer. Conclusions The distribution and characteristics of AOT in a Thai population are similar to the findings found in other populations. Interestingly, in this series we observed a case involving an impacted deciduous canine and a case associated with an impacted maxillary third molar.

Drug-induced lichenoid reaction is quite common in the oral cavity. Patients with oral lichenoid lesions (OLL) may increase risk of developing epithelial dysplasia and squamous cell carcinoma. Although this subject remains controversial, several studies suggested that the overall rate of malignant transformation of OLL was greater than that of general population or patients with oral lichen planus (OLP). In the present article, we report a 66-year-old female Thai patient with OLL associated with many medications including simvastatin. She also had a history of hypertension, osteoarthritis and hepatitis B virus infection. Her physician treated her with amlodipine, etoricoxib, glucosamine and chondroitin sulfate for more than 20 years. Simvastatin had been prescribed for the treatment of dyslipidemia for 2 years. Notably, the patient reported that oral symptoms and lesions arose after taking this medication. This patient later developed epithelial dysplasia and carcinoma in situ within areas of OLL approximately 7 and 8 years, respectively after its initial presentation. This case report will be useful for clinicians to become aware of the possible adverse outcome of long-standing drug-induced OLL.

Oral lichen planus (OLP) is a chronic inflammatory mucosal disease that cell-mediated immunological mechanisms are involved in pathogenesis. The objective of this study was to investigate the expression of CD44 isoforms including CD44s, CD44v5, and CD44v6 in biopsy specimens and saliva from OLP patients. Thirty-one OLP patients and 30 healthy subjects were enrolled in this study. Immunohistochemical methods were used to detect the expression of CD44 isoforms in oral epithelia, and enzyme-linked immunosorbent assay (ELISA) was performed to measure levels of salivary CD44 isoforms. Our results demonstrated that expression of CD44v6 in oral epithelia from OLP patients was significantly decreased in comparison to controls (p = 0.021). Levels of salivary CD44s and CD44v5 from OLP patients were significantly higher than those from controls (p = 0.007 and p = 0.002, respectively). In summary, our findings provided additional evidence that the pathological stress, such as chronic inflammation, altered the expression of CD44 isoforms in oral epithelia and saliva of OLP patients.

Aim. To survey the paediatric oral lesions in Thailand. Design. Biopsy records over a 15-year period (1990–2004) were retrieved from the files of the Department of Oral Pathology, Faculty of Dentistry, Chulalongkorn University. Paediatric cases with an age of 16 years or younger were selected. The age of the patients was divided into three groups according to the dentition period. The lesions were classified into three categories: inflammatory/reactive lesions, cystic lesions, and tumour/tumour-like lesions. Results. From a total of 8314 oral biopsies, 1251 cases (15.05%) were in the paediatric population. The greatest number of lesions fell into the cystic category, followed closely by the inflammatory/reactive category and tumour/tumour-like category, respectively. The top ten most frequently encountered lesions in the present study were dentigerous cyst, mucocele, pyogenic granuloma, ameloblastoma, radicular cyst, odontoma, odontogenic keratocyst, irritation fibroma (focal fibrous hyperplasia), fibrous dysplasia, and osteomyelitis. The majority of lesions were found in the mixed dentition period (49.24%). There was no statistical difference in the occurrence between genders in this study. Conclusions. The present study shows an almost similar trend to previous studies except in the ranking among and within categories. These differences may be attributable to the nature of the population studied and because Chulalongkorn University is a major referral centre.

BACKGROUND: Adenomatoid odontogenic tumour (AOT) is a benign odontogenic jaw lesion. The aim of this study was to update the biological profile of AOT. MATERIAL AND METHODS: Cases published in the literature and cases in files of co-authors were included. RESULTS: 550 new cases were retrieved, and of a total of 1082 cases analysed, 87.2% were found in the second and third decades. The M:F ratio was 1:1.9. 70.8% were of the follicular variant (extrafollicular: 26.9%, peripheral: 2.3%). 64.3% occurred in the maxilla. 60% of follicular AOTs were associated with unerupted canines. Nineteen cases of AOT (2.8%, M:F ratio was 1:1.4) were associated with embedded third molars. Twenty-two peripheral AOTs (2.3%, M:F ratio was 1:5.3) were recorded. The relative frequency (RF) of AOT ranged between 0.6% and 38.5%, revealing a considerably wider AOT/RF range than hitherto reported (2.2–7.1%). CONCLUSIONS: This updated review based on the largest number of AOT cases ever presented, confirms the distinctive, although not pathognomonic clinicopathological profile of the AOT, its worldwide occurrence, and its consistently benign behaviour.

Kimura's disease is a benign chronic condition of unknown cause. It afflicts mainly Oriental populations, especially Chinese and Japanese people. Kimura's disease usually presents with a painless swelling of subcutaneous tissue in the head and neck region, especially in the major salivary glands and regional lymph nodes. Kimura's disease has been confused with angiolymphoid hyperplasia with eosinophilia. However, angiolymphoid hyperplasia with eosinophilia can be distinguished from Kimura's disease by differences in clinical and histopathological features. This report is of a 46-year-old Karen man with Kimura's disease. The patient developed progressive swelling in the left cheek and parotid gland as well as lymphadenopathy in the submandibular and submental regions. Histopathological examination revealed typical characteristics of Kimura's disease. He was treated by superficial parotidectomy and local excision for his left cheek lesion. Recurrence was observed 1 year after the surgery. The pathogenesis, treatment modalities, and differences between Kimura's disease and angiolymphoid hyperplasia with eosinophilia are discussed.

Background Oral lichen planus (OLP) is a common chronic inflammatory disease involving T cells-mediated immunity. Tumor necrosis factor (TNF)-alpha has been reported to be involved in the disease process. The purpose of this study was to investigate the effect of fluocinolone acetonide in orabase (FAO) 0.1% on the expression of TNF-alpha in patients with OLP. Methods Eighteen Thai patients with atrophic or erosive OLP were recruited. Biopsy specimens were taken before and 1 month after treatment with FAO 0.1% and sent for histopathologic examination where they were immunohistochemically stained with antibody to TNF-alpha. Twenty normal mucosa specimens were identically processed. Oral squamous cell carcinoma tissue was used as a positive control for TNF-alpha expression, whereas OLP sections without primary antibody were served as negative control. Results Sixteen of 18 cases (88.89%) of OLP exhibited positive staining for TNF-alpha. Most of the TNF-alpha was observed in the mononuclear cells. Ten cases (55.56%) of OLP demonstrated TNF-alpha expression in keratinocytes. The number of mononuclear cells positive for TNF-alpha before the treatment with FAO 0.1% in orabase was statistically higher than that after the treatment (P=0.000) and in the normal mucosa (P=0.000). Moreover, the number of mononuclear cells after treatment with FAO 0.1% in orabase was statistically lower than before the treatment (P=0.000). Conclusion Our study exhibited that TNF-alpha may be associated with the immunopathogenesis of OLP in Thai patients and FAO 0.1% had an effect on the reduction of TNF-alpha expression.

Objective: To evaluate the proliferative activity of odontogenic cysts and ameloblastomas. Patients and Methods: Ten radicular cysts, 10 dentigerous cysts, 10 odontogenic keratocysts, 14 ameloblastomas, 5 unicystic ameloblastomas, and 9 recurrent ameloblastomas were immunohistologically stained with antibody to proliferating cell nuclear antigen. Immunoreactivity was evaluated by counting cells. Results: Odontogenic keratocysts elicited the highest proliferating cell nuclear antigen labelling index within the odontogenic cyst group. Most of the proliferating cell nuclear antigen-positive cells were predominantly found in the suprabasal region of odontogenic keratocysts. Odontogenic keratocysts demonstrated a significantly higher proliferating cell nuclear antigen labelling index than radicular cysts (p < 0.05), but not higher than dentigerous cysts. In the ameloblastoma group, proliferating cell nuclear antigen-positive cells were preferentially located at the periphery of the ameloblastic islands. Recurrent ameloblastomas showed the highest proliferating cell nuclear antigen labelling index, while unicystic ameloblastomas showed the lowest labelling index. The differences in the proliferating cell nuclear antigen labelling index between recurrent ameloblastomas and the other ameloblastoma groups were not statistically significant. Conclusions: The proliferating cell nuclear antigen labelling index correlated well with the biological behaviour of odontogenic cysts and ameloblastomas, and may be useful as a marker to predict the clinical behaviour of odontogenic lesions.

Objective: This study was performed to determine the incidence of odontogenic tumours in the Thai population. Patients and Methods: The pathology records of 1020 patients with odontogenic tumours diagnosed at the Department of Oral Pathology, Chulalongkorn University, Thailand, during a 26-year period from 1977 to 2002 were reviewed and reclassified according to the World Health Organization 1992 criteria. Clinical data, including age, gender, and anatomical distribution of lesions, were also collected and analysed. Results: Odontogenic tumours accounted for 7.6% of all the oral and maxillofacial lesions (n = 13,472). Of these, 1010 patients (99%) had benign tumours and 10 (1%) had malignant tumours. Ameloblastoma, odontoma, and myxoma were the commonest lesions encountered. The mean age for benign odontogenic tumours was 30.0 years and for malignant lesions was 33.5 years, with the majority (54.1 %) of odontogenic tumours presenting in the second and the third decades of life. Women outnumbered men for benign tumours, while the reverse was true for malignant tumours. Benign and malignant odontogenic tumours showed a predilection for the mandible, especially the posterior region. Conclusions: Odontogenic tumours are uncommon lesions in the Thai population. The data from this study show similar trends to those from Asian and African series with minor differences.

To carry out an oral biopsy survey in geriatric patients from the participating institutions.The biopsy records of the participating institutions were reviewed for oral lesions from patients aged 65 years and older diagnosed from 2003 to 2012. Demographic data and the site of the lesions were collected. Histopathological diagnoses were categorized into two categories: non-neoplastic lesions (reactive/inflammatory lesion, cyst, allergic/immunologic disorders, potentially malignant disorders, infection and others) and neoplastic lesions (benign and malignant tumors). Data were analyzed by appropriate statistics using stata11.Of the 76,045 accessioned cases, 11,346 cases (14.92%) were in geriatric patients. The mean age of the patients was 72.98 ± 6.25 years. A total of 5010 cases (44.16%) were diagnosed in males, whereas 6336 cases (55.84%) were diagnosed in females. The male-to-female ratio was 0.79:1. Non-neoplastic lesions outnumbered the neoplastic counterpart. The five most prevalent oral lesions in the geriatric population in the present study in descending order of frequency were squamous cell carcinoma, focal fibrous hyperplasia (irritation fibroma), radicular cyst, osteomyelitis and epithelial dysplasia, respectively. The site of predilection was labial/buccal mucosa, followed by gingiva, mandibular bone, tongue and maxillary bone, respectively.The geriatric oral lesions from the present study showed a similar trend with studies based on histopathological data, but different from the studies based on clinical data. This study also shed more light on potentially malignant disorders, as well as benign and malignant tumors.

To identify factors associated with scientific productivity (SP) of German oral-maxillofacial surgery (OMFS) training centers.This retrospective cohort study was composed of a set of data from German OMFS training centers. A total of eight predictor variables were grouped into demographic, structural, and personal categories. The outcome variables were average publications in 2013 per senior staff, and percentage of OMFS trainees with1 publications. Descriptive and univariate statistics were computed using P 0.05.The sample included outputs from 62 OMFS departments (34 [54.8 %] university-based; 46 [74.2 %] in large cities). Average publications were 2.4 ± 3 per senior staff (range, 0-27), and 160 trainees (31.7 %) published1 papers. The number of publications and productive trainees was not linked to department name and number of female senior staffs, but publication count was significantly increased when the hospital was in a metropolis (P = 0.018) or university-based (P 0.0001), the OMFS' chairperson and3 staffs within the department had a postdoctoral degree (German "Habilitation") (P = 0.013 and0.0001), and the chairperson had h-index10 or the first/last authorship in 2013 (P 0.0001). Female senior surgeons were less scientifically productive than the male ones (P = 0.01).SP of German OMFS training centers is greatly different across the country and influenced by city size, university base, educational backgrounds, and research activities of chairpersons and senior staffs. This helps students, trainees, and young surgeons to reach the career choice that is personally appropriate. The involved organizations may need to encourage research output of less productive surgeons/centers. Increasing postdoctoral-qualified staffs will increase SP of the department.

To determine the fluoride content of commercially-available bottled water in Bangkok. Thirty brands of bottled water (17 bottled plain water and 13 bottled mineral water) were obtained from supermarkets in Bangkok. Two randomly-selected samples of each brand were purchased 6 months apart. A 5-mL sample was mixed with 5 mL of total ionic-strength adjusting buffer III. The fluoride content of each sample was determined in triplicate by a fluoride ion-selective electrode. Fluoride standards ranging in concentration from 0.01 to 1.00 ppm were used to calibrate the measurements. Data were analyzed by Statistical Package for the Social Sciences software, version 13.0.The fluoride content of bottled water in Bangkok ranged from 0.03 to 0.72 ppm, with a mean ± standard deviation of 0.17 ± 0.16 ppm. The mean fluoride content of bottled mineral water was slightly higher than that of bottled plain water, but the difference was not statistically significant.Most commercially-available bottled water in Bangkok contains negligible amounts of fluoride. This serves as baseline data for dentists prescribing a fluoride supplement to make the utmost use of the fluoride caries preventive effect, while avoiding adverse effects, such as dental fluorosis.