ABSTRACT Purpose The purpose of this study was to perform texture analysis of late neck lymph nodes metastases (NLNMs) and non‐NLNMs in postoperative oral squamous cell carcinoma (SCC) on ultrasound (US) images and identify the optimal texture features for distinguishing these neck lymph nodes. Methods Fifty NLNMs and 53 non‐NLNMs were enrolled in this study. Seventy texture features were retrieved from the US images using the LIFEx software. The Mann Whitney U test was measurably utilized to survey on the off chance that there was a measurably noteworthy distinction within the textural characteristics between NLNMs and non‐NLNMs. The capacity of the surface highlights to recognize between NLNMs and non‐NLNMs was illustrated utilizing the receiver operating characteristic (ROC) analysis curves (ROC). Youden's J statistic was used to determine the cutoff positions in each ROC curve that maximized sensitivity and specificity. Results GLRLM of GLNU highlight appeared the foremost noteworthy contrast between these nodes ( p < 0.001). GLRLM of GLNU had AUC of 0.916, sensitivity of 0.92, and specificity of 0.792 when measured at the Youden cutoff value of 47.574. Conclusion Our results suggest that GLRLM of GLNU feature may be the best texture feature to differentiate from non‐NLNMs and to predict NLNMs in postoperative oral SCC.
ABSTRACT Aim To evaluate whether preoperative prognostic nutritional index (PNI) values predict prolonged postoperative hospital stay in patients with oral cancer undergoing highly invasive surgery. Methods We retrospectively evaluated background factors (age, sex, primary site, preoperative clinical stage, type of free flap, and the PNI) and postoperative hospital stay in patients with oral cancer who underwent radical resection and free flap reconstruction at our department between June 2007 and July 2023. Patients who remained hospitalized for postoperative treatment were excluded. The PNI was calculated from serum albumin levels and peripheral blood lymphocyte counts, and a cutoff value of 43 was used to categorize patients into two groups (PNI‐low/high). The length of postoperative hospital stay was compared between the groups. Results Ninety patients (55 males and 35 females) were included. A significant negative correlation was observed between the PNI and postoperative hospital stay. The median postoperative hospital stay was 51 days. Significant differences in hospital stay were observed for age, type of free flap, and the PNI; however, only the PNI remained a significant factor in the analysis of covariance. Kaplan–Meier analysis showed that postoperative hospital stay was significantly longer in the PNI‐low group than in the PNI‐high group. Conclusions Preoperative PNI was identified as an independent predictor of prolonged postoperative hospital stay in patients with oral cancer undergoing highly invasive surgery. These findings suggest that the PNI may serve as a simple and practical tool for preoperative risk stratification in clinical practice.
ABSTRACT Background CT scout images are primarily obtained to determine the imaging field of view; however, lesions or pathological findings may occasionally be identified outside the designated scan area. We report a case of dental infection where pleural effusion was incidentally revealed on a CT scout image. Case Presentation A 57‐year‐old male was referred to our department from a local dental clinic for evaluation of right cheek swelling. Swelling was observed on the right cheek, and the maxillary right first molar exhibited moderate mobility. Contrast‐enhanced CT images revealed an abscess cavity in the cheek, extending from the maxillary right first molar. Blood tests revealed elevated levels of CRP and interleukin‐2 receptor (IL‐2R). Pus was observed upon aspiration due to suspected abscess formation, so an incision and drainage procedure was performed. Regarding the elevated IL‐2R levels, the patient was referred to our hospital's hematology department, where it was diagnosed as being due to inflammatory changes. However, during that consultation, a CT scout scan revealed left‐sided pleural effusion, leading to a referral to the respiratory medicine department on the same day. Thoracentesis was performed, and a subsequent diagnosis confirmed typical pneumonia‐associated pleural effusion caused by a dental infection. The causative tooth, the maxillary right first molar, was extracted in the same month following resolution of inflammation. Pleural effusion improved, and facial swelling resolved. Conclusions Dental infections require caution as they can lead to pulmonary complications such as empyema. Utilizing information incidentally captured in CT scan images can be useful as an aid to diagnosis.
ABSTRACT Introduction and Aim Oral lichen planus (OLP) is a chronic inflammatory disorder with a known risk of malignant transformation, often linked to epigenetic changes like DNA hypermethylation. This study aimed to evaluate the epigenetic potential of melatonin in preventing the malignant transformation of OLP. Methods A randomized clinical trial was conducted on 50 patients with OLP. Patients were assigned to either a control group, which received conventional treatment with topical corticosteroids and antifungals, or a test group, which received melatonin for 8 weeks. All patients were assessed for DNA hypermethylation levels of the ZNF582 gene. Epigenetic evaluations were conducted before and after the 8‐week treatment period. Results A notable reduction in the methylation index (MI) was observed in the melatonin group ( p = 0.001). Furthermore, only the melatonin group showed a significant intragroup change in MI before and after treatment ( p = 0.011). Conclusion When combined with conventional therapy, melatonin may help prevent the malignant transformation of OLP by reducing DNA hypermethylation of the ZNF582 gene in a period of 8 weeks. Trial Registration: ClinicalTrials.gov number: NCT06533033
ABSTRACT Background Dentigerous cysts are typically associated with unerupted teeth with normal morphology, and their occurrence in dysmorphic teeth is poorly documented. Case Presentation A 76‐year‐old man presented with maxillary swelling. Imaging revealed a cystic lesion occupying the maxillary sinus with a tooth‐like radiopaque structure. The lesion was surgically removed. Histopathology supported a diagnosis most consistent with a dentigerous cyst associated with a dysmorphic tooth‐like structure with no clearly identifiable root formation and a pulp chamber. Conclusion This case suggests that dentigerous cysts may arise in association with severely dysmorphic teeth, even without root formation or a pulp chamber, and may indicate that internal tooth structure is not indispensable for cyst development.
Aim To investigate the effect and suitability of mouthpiece materials for proton therapy (PT) of head and neck cancer (HNC).Methods Computed tomography (CT) numbers and the stopping power ratios (SPRs) of six dental materials were measured. The SPRs were converted to CT numbers, and the materials with the highest, lowest, and closest to the CT numbers of surrounding normal tissue were identified. To investigate how mouthpiece CT numbers affect the dose distribution for HNC, treatment plans of 17 patients were recalculated by changing the mouthpiece CT numbers to these three CT numbers, and doses to normal tissues were measured.Results Vinyl polysiloxane had the highest CT number, and thermoplastic ethylene vinyl acetate copolymer splints had the lowest CT number. Temporary relining resin had the CT number closest to normal tissue. Temporary relining resin had the smallest difference in the CT of the CT image, and the CT converted from SPR. The plans of temporary relining resin did not differ significantly from the actual plan, and the patient with the largest dose difference had a 1.75 gray equivalent (GyE) in the mandible max dose. However, that of vinyl polysiloxane and that of thermoplastic ethylene vinyl acetate copolymer splints differed significantly from the actual plans in several of the measured items, with the maximum difference of 5.43 GyE in the oral mean dose.Conclusion We confirmed that changing the material of the mouthpiece could cause the dose to normal tissues to vary by approximately 5 GyE.
Effective bleeding control during dental extractions is an increasing clinical challenge in patients receiving oral antithrombotic therapy (OAT). Previous systematic reviews have grouped various local hemostatic interventions together, potentially obscuring subtle differences in their true efficacy. To clarify the comparative effectiveness of individual interventions, we conducted a network meta-analysis (NMA) evaluating local hemostatic methods in patients undergoing dental extractions while on OAT. A comprehensive literature search was performed in PubMed, the Cochrane Central Register of Controlled Trials, and Ichu-shi from January 1 to July 30, 2024, without language restrictions. Two independent reviewers screened studies, assessed the risk of bias using a standardized tool, and extracted data on bleeding events, which were synthesized using a frequentist NMA model. Four randomized controlled trials (RCTs) were ultimately included. Although interventions incorporating tranexamic acid achieved relatively high statistical ranking scores, none of the individual interventions provided a statistically significant improvement in bleeding control compared with simple gauze compression. The overall certainty of evidence was very low due to small sample sizes and methodological limitations. Although these findings suggest that simple gauze compression may provide adequate bleeding control as an initial treatment, the very low certainty of evidence precludes definitive clinical recommendations. Further high-quality RCTs are urgently needed to optimize bleeding management protocols in this patient population.
Background Metastatic tumors of the oral cavity are rare and generally associated with poor prognosis. Durable disease control after immune checkpoint inhibitor discontinuation is uncommon in clinical practice. Case Presentation Two patients with biopsy-proven gingival metastases from lung adenocarcinoma received first-line platinum, pemetrexed, and pembrolizumab. Pembrolizumab was discontinued after planned completion in one and because of immune-related pneumonitis in the other. In both, gingival lesions completely regressed, and disease control persisted for more than 51.9 and 52.1 months without further systemic therapy. Conclusion These cases show that exceptionally durable disease control after pembrolizumab discontinuation can occur in patients with gingival metastases, both following planned treatment completion and after toxicity-related discontinuation.
Purpose The canalis sinuosus (CS) is a canal that originates from the infraorbital canal. Failure to detect this variation might lead to complications during surgical procedures. Therefore, this study aims to assess the features of CS using cone beam computed tomography (CBCT). Materials and Methods In this cross-sectional study, 230 CBCT images taken in a private radiology center were included. The images were examined in cross-sectional, axial, and coronal sections, and the parameters of the presence or absence of the CS; its diameter, location, side; and unilateral or bilateral CS were recorded. Data were analyzed using ANOVA, chi-square, and independent t-tests using SPSS V.22. The level of significance was considered 0.05. Results CBCT images of 104 males (54.8%) and 126 females (45.2%) with an average age of 42.53 +/- 13.17 years were studied. There was no significant difference in the prevalence of CS in terms of sex or age (p = 0.169 and p = 0.812, respectively). The mean diameter of the right and left CS had no significant relationship with age (p > 0.05); however, the mean diameter of the right CS in men was significantly greater than in women (p = 0.037). Most CSs were located in the central, lateral, and canine teeth. Moreover, the frequency of accessory canals (AC) was higher on the right side than on the left side, but the difference was not statistically significant (p > 0.05). Conclusion According to the current findings, the ACs are more frequent on the right side and adjacent to the central teeth.
Background: Leptotrichia trevisanii is an oral commensal bacterium, capable of causing invasive infection. Although typically associated with hematologic malignancies, bacteremia may occur in solid tumor cases with mucosal barrier disruption. Case Presentation: A 76-year-old woman undergoing chemotherapy for maxillary gingival squamous cell carcinoma and lung adenocarcinoma developed fever on hospitalization Day 2. Examination revealed an ulcerated gingival tumor with bone exposure, without neutropenia. Blood cultures yielded L. trevisanii. Intravenous ampicillin-sulbactam (16 days) resolved the infection. Conclusion: L. trevisanii can cause bacteremia in gingival carcinoma cases with mucosal injury and a history of antineoplastic therapy, even in the absence of marked neutropenia, and should therefore be considered a potential pathogen in febrile patients.
Background/Objective: Zinc deficiency is a major cause of taste disorders. The effectiveness rate of zinc replacement therapy is approximately 70%, irrespective of the cause of deficiency. However, the effectiveness of this therapy in our department is lower than that reported in the field of otolaryngology. In this study, we examined the effectiveness of zinc replacement therapy in patients with taste disorder. Methods: We administered zinc preparations (zinc acetate dihydrate [Nobelzin], 50 mg/day) to 22 patients (7 men and 15 women) who visited our hospital for > 12 weeks. The cause, time to effect, serum zinc level, and other parameters were evaluated to assess improvement in taste disorder. Improvement in taste disorder was defined as a subjective expression comparing conditions before and after the 12-week administration of zinc acetate dihydrate. Results: The overall improvement rate among the patients was 77% (17/22). Serum zinc levels were elevated in 86% (19/22) of patients. Conclusions: Zinc acetate dihydrate is a promising treatment for zinc-deficiency-associated taste disorders.
Aim The high incidence of second primary cancers (SPCs) among patients with head and neck squamous cell carcinoma (HNSCC) is well-recognized. Both recurrence and SPCs are routinely assessed during posttreatment follow-up. Occasionally, secondary cancers develop long after treatment for the first primary cancer (FPC). However, the details of such cases remain unclear. Therefore, this study was conducted to retrospectively elucidate the clinical characteristics of SPCs occurring long after FPC treatment.Methods We investigated the clinical characteristics of SPCs in the head and neck among 443 patients with HNSCC treated at our department.Results A total of 41 (9.3%) patients had metachronous SPCs occur in the head and neck. Twenty-eight patients underwent surgery to treat SPC, while all four patients who received chemotherapy had previously undergone surgery and radiotherapy. Seven patients were diagnosed outside the follow-up, and all occurred more than 5 years after FPC treatment. Fifteen patients (3.4%) had SPCs in the head and neck more than 5 years after FPC treatment. Six (40%) patients presented with advanced-stage disease, which was a higher proportion than those who developed an SPC within 5 years (30.1%). Following SPC treatment, only six patients remained alive without evidence of recurrence.Conclusion Given the poor prognosis associated with SPC, optimizing follow-up strategies after FPC treatment is crucial to facilitate early detection and improved outcomes. However, owing to limited medical resources, continuous surveillance solely for early SPC detection remains challenging, highlighting the need for further research into practical and sustainable survivorship care for patients with HNSCC.
Aim Lingual nerve injury (LNI) is a known complication of mandibular third molars. However, its relationship with factors such as mandibular morphology or the surgical technique remains unclear. This study aimed to assess the preoperative risk of LNI by evaluating mandibular morphology using cone beam computed tomography data.Methods The LNI group (n = 41) and the control group (n = 410) comprised patients who underwent third molar extraction. Three reference points (A, B, and C) were defined around each mandibular third molar to calculate the surrounding area, which was compared between the two groups. The etiology of LNI in the affected group was also investigated. The data were analyzed using statistical methods.Results The LNI cohort (n = 41) was mainly female (35/41), mean age 31.7 years; all injuries followed mandibular third molar extraction. Twenty patients received conservative therapy and 21 nerve repair, and most index extractions were by general dentists. LNI molars were mostly vertical (18) or horizontal (10). Lingual cortical bone was usually thin (30/41) or defective (4/41), with high agreement (kappa = 0.95). Versus controls, vertical and horizontal LNI cases had significantly shorter BC width, and vertical cases showed a smaller ABC area.Conclusion The results suggest that LNI associated with mandibular third molar extraction is related to the buccal width of the mandible. Preoperative assessment of tooth position, particularly the inclination of tooth axes, using x-ray imaging is crucial and provides a valuable reference for the safe removal of mandibular third molars.
Objective: Autologous bone grafts using the iliac crest or fibula are considered standard treatment for jawbone defects and cleft palate, but these approaches are clinically not considered to be mild invasion, and there is a risk of complications at the donor site. This study was designed to evaluate the efficacy of a novel bone regeneration technique involving seeding bone marrow cells onto cotton-like artificial bone made of beta-TCP/PLGA. Methods: Bone marrow cells harvested from the femora and tibiae of 6-week-old BALB/c nu/nu mice were seeded onto cotton-like artificial bone and implanted into a 3.5-mm cranial bone defect. CT and histological evaluations were performed at 4 and 8 weeks postimplantation to compare bone regeneration capacity. Results: The group implanted with cotton-like artificial bone seeded with bone marrow cells exhibited a significant increase in new bone volume and bone mineral density (BMD) compared with the cotton-like artificial bone alone (8-week BMD: 846.49 +/- 48.45 mg HA/cm(3) vs. 577.56 +/- 28.79 mg/cm(3,) p < 0.05). Histological analysis also confirmed the formation of new bone tissue, suggesting enhanced osteoinductive potential due to bone marrow cell seeding. Conclusion: The cotton-like artificial bone demonstrated excellent morphological adaptability and spatial retention and served as an effective source of cells and cytokines. Overall, cotton-like artificial bone seeded with bone marrow cells was shown to be a minimally invasive and effective bone regeneration method with high potential for clinical application.
Resorbable plates are widely used in maxillofacial surgery; however, delayed inflammatory foreign body reactions have occasionally been reported. We describe a case of a delayed inflammatory foreign body reaction to poly-L-lactic acid (PLLA) resorbable plates following genioplasty. An 18-year-old woman underwent genioplasty using PLLA resorbable plates and screws. Approximately 2 years after surgery, she developed progressive swelling and tenderness in the chin region. Computed tomography (CT) revealed localized bone resorption around the fixation device. Surgical removal of the degraded plate remnants, sequestrum, and surrounding inflammatory tissue was performed. Histopathological examination demonstrated granulation tissue containing PLLA fragments with a foreign body giant cell reaction. The postoperative course was uneventful, and bone regeneration was confirmed 1 year after removal. This case highlights that delayed inflammatory foreign body reactions to PLLA plates can occur years after genioplasty, particularly in regions with thin soft tissue coverage, and underscores the importance of long-term follow-up.
Background: Metachronous oral squamous cell carcinomas may develop within a persistent field of cancerization, and the risk of additional primaries extends beyond the conventional follow-up period. Case Presentation: A 38-year-old man developed 10 subsequent metachronous squamous cell carcinomas after initial mucoepidermoid carcinoma on the bilateral lateral tongue over 42 years. After initial treatment for mucoepidermoid carcinoma with nodal metastasis, subsequent lesions were detected at early stages, mainly triggered by the patient's reports of subtle symptoms, and were treated by local excision. Conclusion: This case emphasizes the importance of long-term surveillance that prioritizes patient-reported symptoms, facilitating early detection and functional preservation.
Background Ferroptosis, an iron-dependent form of regulated cell death driven by lipid peroxidation, has recently emerged as a therapeutic vulnerability in resistant cancers. While glutathione peroxidase 4 (GPX4) has been established as a central ferroptosis suppressor, ferroptosis suppressor protein 1 has been identified as a parallel pathway that reduces ubiquinone to ubiquinol, thereby preventing lipid peroxidation. The upregulated expression of FSP1 has been linked to therapy resistance in several cancers; however, its clinical and biological significance in oral squamous cell carcinoma (OSCC) remains largely unknown.Methods To address this gap, we herein combined bioinformatic analyses of The Cancer Genome Atlas with functional studies on OSCC cell lines and xenograft models. Survival was analyzed using the expression of GPX4 and FSP1. Functional assays included pharmacological inhibition, CRISPR/Cas9 knockout, and rescue with cell death inhibitors.Results GPX4 expression showed no survival association, whereas high FSP1 expression correlated with poor long-term outcomes, establishing its prognostic value in OSCC. Mechanistically, GPX4 inhibition induced the compensatory upregulation of FSP1, conferring ferroptosis resistance. GPX4-deficient cells were highly sensitive to FSP1 inhibition, confirming dual dependency. Dual blockade suppressed proliferation in vitro, whereas systemic iFSP1 failed to significantly reduce xenograft growth, underscoring drug-delivery limitations.Conclusions FSP1 acts as both a prognostic biomarker and compensatory survival factor in OSCC. Combined GPX4/FSP1 targeting represents a promising therapeutic strategy; however, translation will require innovative delivery systems and integration with redundant ferroptosis-regulatory pathways.
Kissing molars (KMs) are two impacted molars sharing a follicle and facing opposite directions. Although described in the mandible, bilateral maxillary KMs have not been reported. We present a 14-year-old girl with bilateral maxillary KMs (#18 and #19, and #28 and #29) distal to impacted second molars. Serial imaging revealed simultaneous crown formation. All KMs were extracted under general anesthesia, and concentrated growth factor (CGF) was applied. Healing was uneventful, with spontaneous eruption of teeth #17 and #27 and stable occlusion. This case underscores the value of serial imaging and CGF-assisted healing in KM management.
Background: Septic pulmonary embolism (SPE) is a rare complication of infection. Odontogenic sources are uncommon and easily overlooked, especially when typical symptoms are absent. Case Presentation: A 43-year-old man with poorly controlled diabetes presented with mandibular swelling and trismus without fever or respiratory symptoms. CT revealed a masticator space abscess and multiple peripheral cavitary pulmonary nodules consistent with SPE. Blood cultures were negative, but abscess culture identified Streptococcus constellatus and Parvimonas micra. Surgical drainage and intravenous antibiotics achieved full recovery. Conclusion: SPE can arise from odontogenic infection even without classic symptoms, requiring early imaging and multidisciplinary care.
