OBJECTIVE:Glandular odontogenic cyst (GOC) is a less frequent odontogenic cyst with unpredictable clinical behavior and relatively high recurrence rate, posing a diagnostic and therapeutical challenges in oral and maxillofacial surgery. This study evaluated retrospectively management and outcomes in a cohort of individuals suffering from GOC, in the Department of Dentistry and The Fingerland Department of Pathology in Hradec Králové, Czech Republic. STUDY DESIGN:. Retrospective assessment was performed on 10 individuals with histologically confirmed GOC treated between year 2015 and 2025. Clinical and radiologic findings, surgical approaches and postoperative care were documented and discussed. RESULTS:. Totally,10 individuals (8 males, 2 females: median age 51.5 years) were treated. Lesion were predominantly located in the mandible, with one maxillary case only. Surgical treatment consisted of cyst extirpation with extraction of involved teeth. Recurrence occurred twice in maxillary case, and a suspected recurrence was noted in another individual. CONCLUSIONS:. Surgical extirpation of GOC yielded satisfactory outcomes even in recurrences, without the need for radical resective procedures. Prolonged follow-ups including radiological examination are essential.

Purpose To evaluate treatment outcomes and toxicity in patients with stage T1-3N0M0 oral cancer treated with surgery followed by high-dose-rate brachytherapy (HDR-BT). Methods and materials Retrospective study of 50 patients with stage T1-T3N0 tongue and floor-of-mouth cancer who underwent tumour excision (+ elective neck dissection) followed by postoperative HDR-BT due to the presence of negative prognostic factors (close or positive resection margins, lymphovascular and/or perineural invasion, deep invasion). The plastic tube technique (dose: 18 x 3 Gy b.i.d.) was used. Survival outcomes, toxicity, and prognostic factors were evaluated. Results At a median follow-up of 81 months (range, 4-121), actuarial 5-year local control (LC), nodal control (NC) and progression-free survival (PFS) rates were 79%, 69%, and 64%. After salvage treatment (surgery + external beam radiotherapy), LC, NC, and PFS increased to 87%, 77%, and 72.3%, respectively. Five-year overall survival and cancer-specific survival (CSS) rates were 73% and 77%. Treatmentrelated toxicity included two cases of mandibular osteoradionecrosis and five cases of small soft tissue necrosis. T stage was significantly correlated with nodal control (p=0.02) and CSS (p=0.04). Tumour grade correlated with DFS (p=0.01). Conclusion Postoperative HDR-BT 18 x 3 Gy b.i.d. seems to be an effective method in patients with T1-3N0M0 oral cancer with negative prognostic factors after tumour resection.

Introduction and aim: The presented case study documents the course of diagnosis and treatment of plasma cell neoplasia of the lower jaw in a 79-years-old female patient. The aim is to highlight the possibility of plasmacytoma manifestation in the differential diagnosis of jawbone lesions and to emphasize the importance of interdisciplinary cooperation, in this case between the dentoalveolar/maxillofacial surgeon and the haematooncologist.Case description: The patient was first examined at our facility in November 2023 upon the request of a general dental practitioner due to recurrent difficulties following extraction of the right permanent lower second molar (tooth #47), which had been performed two months earlier. In 2021, the patient underwent surgery for ovarian carcinoma and had no history of diabetes, bleeding disorders, shortness of breath, or other illnesses. She was not using any medications affecting bone metabolism. Based on the clinical findings, duration of symptoms, OPG image showing noticeable poorly defined radiolucency of the mandibular body in the area of missing teeth, and laboratory tests, a working diagnosis of osteomyelitis of the mandibular body on the right side was established. Empirical treatment with oral broad-spectrum antibiotics of the penicillin class was initiated promptly and resulted in clinical improvement. Cone-beam computed tomography (CBCT) performed two days after the initial examination revealed osteolytic indistinctly demarcated changes causing lingual wall resorption of the mandibular body reaching to the lower edge of the mandible in the region of the molars on the lower right side. This radiological finding raised suspicion of malignant neoplasm of the lower jaw. Subsequent CT scan with contrast confirmed soft tissue infiltration and the osteolytic nature of the lesion described above. Based on these findings, a diagnostic biopsy of the pathological tissue was indicated and performed, revealing plasma cell neoplasia. In the differential diagnosis, it was necessary to distinguish whether it was a solitary bone plasmacytoma with extraosseous propagation or multiple myeloma infiltration. The patient was referred for haematological examination to a specialized clinic where a definitive diagnosis of multiple myeloma was established. There the patient was treated with a triple combination of bortezomide, lenalidomide, and dexamethasone. The first cycle of this treatment resulted in complete regression of the intraoral lesion and healing of the extraction socket at the site of tooth #47.Conclusion: This case study highlights the rare but possible occurrence of oral plasmacytomas and emphasizes the importance of interdisciplinary collaboration.

PURPOSE: Low-dose-rate brachytherapy (LDR-BT) is a well-established treatment for lip cancer. High-dose-rate (HDR)-BT is a promising alternative to LDR-BT, but data are limited. In this context, we retrospectively evaluated treatment outcomes in a series of patients who underwent HDR-BT for lip carcinoma between 2003 and 2021.MATERIALS AND METHODS: A total of 32 patients were included in this study, with a median age of 73.5 years (range, 61 - 88). The indications for HDR-BT were as follows: primary treatment ( n = 17), adjuvant treatment ( n = 3), and recurrent disease after surgery ( n = 12). The prescribed dose was 18 fractions of 3 Gy administered twice daily. RESULTS: At a median followup of 45 months (range, 12 -232), the 5-year local recurrencefree interval was 96.9% (95% CI: 90.9-100%), the disease-free interval was 85% (95% CI: 70.9-99.1), and 5-year overall survival was 64.7% (95% CI: 44.7-84.8). Eleven patients died, all on age related comorbidities. Acute toxicity manifested as G1 dry desquamation in 6 patients (18.8%), G2 erythema in 10 patients (31.2%) and G3 confluent moist desquamation in 16 patients (50%). Late complications included G1 fibrosis (100% of cases). G1 and G2 depigmentation was observed in 8 (25%) and 6 (18%) patients, G1 telangiectasia occurred in 5 patients (16%).CONCLUSIONS: These data support the use of HDR-BT for lip cancer. The dose and fractionation schedule used in this study (18 fractions x 3 Gy twice daily) seems to be effective and safe.& COPY; 2023 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

A case report on a 70-year-old male patient with atypical candidal infection on the palate that was misdiagnosed for a tumour based on clinical examination. The lesion was an accidental finding when the patient was at a registered dentist for a preventive check-up.

Brachytherapy (BT) involves the direct application of radioactive sources to the tumour. This technique is characterised by a steep dose gradient, the delivery of high-dose radiation to the target volume centre, and the sparing of surrounding healthy tissues. Low-dose-rate (LDR) BT and manual afterloading played an important role in the treatment of early-stage oral cancer, with treatment outcomes that were comparable to surgery. Interest in BT as a primary treatment for oral cancer has declined in recent years due to the emergence of better surgical techniques, the switch from LDR BT to high-dose-rate (HDR) BT (which has a higher risk of complications), and to advances in external beam radiotherapy (EBRT). At present, the main indications for BT are in the postoperative setting due to the superior dose conformity and better quality of life offered by BT versus EBRT. Postoperative BT can be administered as monotherapy in early-stage (T1N0) cancers and in combination with elective neck dissection or EBRT to treat larger or deeper tumours. BT yields excellent results for lip carcinoma in older patients and in tumours with unfavourable localisations. BT is an effective salvage therapy for local recurrences in previously-irradiated areas. Despite its many advantages, brachytherapy is a complex treatment requiring meticulous technique and close cooperation between the radiation oncologist, physicist, and surgeon.

Despite the huge research into stem cells and their regenerative properties for bone healing, there are still unanswered questions including the recipient's respond to the presence of the stem cells, the fate of stem cells inside the bone defect and the possible advantage in utilizing pre-differentiated cells. To address these problems, we used human multipotent mesenchymal stromal/stem cells (MSCs), GMP Grade, in a rat model of bone formation. In a "bioreactor concept" approach seven Wistar rats were implanted with 0.2 g of synthetic bone scaffold seeded with 2 × 106 MSCs, seven Wistar rats were implanted with 0.2 g of synthetic bone scaffold seeded with 1 × 106 predifferentiated osteoblasts and 1 × 106 pre-differentiated endothelial cells and 14 Wistar rats were implanted with 0.2 g of synthetic bone scaffold without seeded cells into an intramuscular pocket on the left side of their back. The right side of each rat was used as a control, and 0.2 g of synthetic bone scaffold was implanted into the intramuscular pocket alone. To see the early stage healing the samples were harvested 14 days after the implantation, MSCs were detected by positive DAPI and MTCO2 staining in 43% of all the samples implanted with MSCs, and no inflammation signs were present in any implanted animal. New vessels could be found in both groups implanted with MSCs, but not in the control group of animals. However, hematoxylin-eosin staining could not detect newly created bone within the implant in any of the groups. These results were in line with COLL1 staining, where we could detect positive staining only in three cases, all of which were implanted with un-differentiated MSCs. According to our findings, there were no benefits of using the pre-differentiated of MSC.

Objective: To identify deep neck infection factors related to life-threatening complications.Methods: This retrospective multi-institutional study comprised 586 patients treated for deep neck infections between 2002 and 2012. The statistical significance of variables associated with life-threatening complications of deep neck infections was assessed.Results: During treatment, life-threatening complications occurred in 60 out of 586 cases. On univariate analysis, life-threatening complications were linked to: dyspnoea, neck movement disturbance and dysphonia (all p < 0.001); and parapharyngeal, anterior visceral or pretracheal deep neck involvement (all p < 0.002). Aetiology was significantly linked to tonsils (p < 0.001). Regarding infection type, fasciitis was a significant factor (p < 0.001). Candida albicans was a significant bacterial culture (p < 0.001). A multivariate step-wise model disclosed fewer significant variables: retropharyngeal space (p = 0.005) and major blood vessels area (p = 0.006) involvement, and bacterial culture C albicans (p < 0.001).Conclusion: It can be predicted that patients with deep neck infections, with neck movement disturbances, dysphonia, dyspnoea and swelling of the external neck, accompanied by severe pain, and inflammatory changes in the retropharyngeal space and large vessel areas, with culture-confirmed infection of C albicans, are likely to develop life-threatening complications.

Penile strangulation is an infrequent clinical condition, it usually results following placement of a constriction device to enhance sexual stimulation. Early treatment is essential to avoid potential complications. We report a case of a 14-year-old boy who presented with a 12-hour history of a steel ring constricting. Attempts to remove it with clasical maneuvers were unsuccessful. After all, the ring was cut along two sides with dental diamond Burs. The ring was successfully removed and the patient was discharged without complication.

The aim of the study was to test the hypothesis that oral plasma cell granuloma may represent a mucosal manifestation of immunoglobulin (Ig)G4-related disease (IgG4-RD) in the oral cavity. The study sample comprised two males and four females, aged 54–79 years (median 62 years). The lesions were localized on gingival/alveolar mucosa (four cases), hard palate, and floor of the mouth, measuring 17–40 mm (median 31 mm). The duration of the lesions ranged from 3 months to several years. Information on IgG4 serum levels was available for two patients, and these were increased to 1.85 and 1.65 g/L, respectively. The follow-up period ranged 11–30 months (median 13 months). None of the lesions recurred, and none of the patients developed any manifestation of IgG4-RD. Microscopically, all cases presented as nodular lesions composed of numerous polyclonal plasma cells admixed with lymphocytes, histiocytes, mast cells, and eosinophils, set within collagenized stroma in variable proportions. Obliterative phlebitis was observed in two cases. The number of IgG4-positive plasma cells ranged between 51 and 142 per HPF (median 114), while the IgG4/IgG ratio values ranged between 0.16 and 0.72 (median 0.44) and were above 0.40 in three cases. Based on international criteria, two cases were diagnosed as definite and one as probable IgG4-RD. Oral plasma cell granuloma is a heterogenous group of lesions, and a subset may represent a mucosal manifestation of IgG4-RD in the oral cavity.

The aim of the study was to investigate prevalence of high-risk human papillomavirus (HR-HPV) infection in sinonasal carcinomas by immunohistochemistry, in situ hybridization, and polymerase chain reaction, detecting p16INK4a protein (p16) expression and presence of both HPV DNA and HPV E6/E7 messenger RNA (mRNA). The study comprised 47 males and 26 females, aged 23–83 years (median 62 years), mostly (67 %) with a squamous cell carcinoma (SCC). Of the tumors, 53 % arose in the nasal cavity, 42 % in the maxillary sinus, and 5 % in the ethmoid complex. The follow-up period ranged 1–241 months (median 19 months). HPV16, HPV18, or HPV35 were detected in 18/73 (25 %) tumors, 17 SCCs, and 1 small cell neuroendocrine carcinoma. There was a strong correlation between results of HPV detection methods and p16 expression (p < 0.005). HPV-positive SCCs occurred more frequently in smokers (p = 0.04) and were more frequently p16-positive (p < 0.0001) and nonkeratinizing (p = 0.02), the latter occurring more commonly in nasal cavity (p = 0.025). Median survival for HPV-positive SCC patients was 30 months, while for HPV-negative SCC patients was 14 months (p = 0.23). In summary, we confirm that HR-HPV is actively involved in the etiopathogenesis of a significant subset of sinonasal SCCs. p16 may be used as a reliable surrogate marker for determination of HPV status also in sinonasal SCCs. Although we observed a trend toward better overall survival in HPV-positive SCCs, the prognostic impact of HPV status in sinonasal carcinomas needs to be elucidated by further studies.

INTRODUCTION:Cellulitis remains a very serious disease even today. Mortality, which varied between 10-40%, has been reduced owing to the standard securing of airway patency and use of an appropriate surgical treatment approach.MATERIALS AND METHODS:A total of 195 patients were hospitalised for cellulitis at the University Hospital in Hradec Králové during 2007-2011. The following parameters were evaluated: age, gender, dependence of incidence of the disease on the season of the year, frequency of attacks of the particular areas and their clinical characteristics, aetiology of the inflammation, types of patient complaints, prevalence of current systemic diseases, results of microbiological and selected laboratory analyses, socio-economic status of the patients, and duration of patient stay at the hospital. Statistical analysis was performed by using Pearson's correlation coefficient, the statistical significance level was p < 0.05.RESULTS:The mean age of the patients was 39.8 years. The group of 195 patients included 108 (55%) males and 87 (45%) females. The mean time between the first symptoms of the disease and admission to the Department was 5 days. From among the 195 patients, 116 (59.5%) were working persons, 79 (40.5%) were non-working (children, students, unemployed persons, women on maternity leave, retired people). The odontogenic origin of the disease was verified in 173 (88.7%) patients. In total, 65 (33.3%) patients had no coinciding complicating systemic disease, 22 (11.3%) patients had diabetes mellitus. The most frequent symptom of cellulitis was painful swelling, found in 194 (99.5%) patients, followed by jaw contracture, found in 153 (78.5%) patients.CONCLUSION:The results are largely very similar to those of previous studies performed in other countries, except that we found no correlation between the prevalence of cellulitis and the socio-economic status, nor have we confirmed Klebsiella pneumoniae sp. as the cause of cellulitis in patients with diabetes mellitus.

BACKGROUND:The aim of this study was to review the bacteriology of deep neck infections (DNI) and identify the factors that influence the incidence of causative bacteria.METHODS:A retrospective analysis of 634 patients with DNI was performed. Statistical analysis was used to compare the incidence of common pathogens in various conditions such as age of the patients, aetiology and associated diabetes mellitus.RESULTS:Bacteria were isolated in 514 cultures (81%). Aerobic bacteria were isolated from 246 cultures (39%) and anaerobic bacteria from 61 cultures (10%). Both aerobic and anaerobic bacteria were isolated from 207 cultures (32%). The most common aerobic bacteria were Streptococcus pyogenes (41%) and Staphylococcus aureus (32%). The most common anaerobic bacteria were Peptostreptococcus species (28%), followed by Prevotela species (8%) and Proprionibacterium species (7%). The incidence of anaerobic bacteria was higher in adults, in patients with infections of dental origin and in non-diabetic patients.CONCLUSIONS:The bacteriology of DNI is polymicrobial, including both aerobic and anaerobic bacteria. The incidence of anaerobic bacteria is higher in adults, in patients with infections of dental origin and in non-diabetic patients.

The authors report a rare case of complete traumatic avulsion of the eyeball with the optic nerve at the level of chiasm. The case report retrospectively describes a year-long monitoring of a young woman who was injured in fire-fighter races. Avulsion Of the globe and optic nerve combined with injured chiasm resulted in contralateral hemianopic visual field defect. The trauma led to subarachnoid hemorrhage in cisterns of chiasm, which spontaneously resolved. There was no development of vascular spasms in the brain. Systemic corticosteroid therapy and neuroprotection did not affect the course of the disease. During the observation period, descending atrophy of the corresponding axons and retinal ganglion cells developed. There is currently no effective therapy of chiasm injuries.

PURPOSE: Retrospective evaluation of high-dose-rate brachytherapy (HDR BT) in early oral cancer and factors influencing tumor control.METHODS AND MATERIALS: A total of 30 patients with T1-T3N0 tongue and floor of mouth cancer were treated with tumor excision elective neck dissection and HDR BT 18 x 3 Gy b.i.d. The Kaplan-Meier model was used for survival analyses, and the log-rank test and Cox regression analyses were used to evaluate the influence of T-stage, histologic grade, resection margin, depth of invasion, and vascular endothelial growth factor (VEGF) intensity on local control (LC), nodal control (NC), disease-free survival (DFS), and overall survival (OS). Median followup was 40 months (6-145).RESULTS: Actuarial 3-year LC, NC, DFS, DFS after salvage treatment, and OS were 85.4%, 69.2%, 65.4%, 75.6%, and 73.0%, respectively. The log-rank test and univariate Cox regression analysis revealed the following correlations, namely tumor grade correlated with LC, DFS, and OS; T-stage with NC and DFS; depth of invasion and VEGF intensity with NC, DFS, and OS. Associations detected on the multivariate analysis were as follows: tumor grade with LC, depth of invasion with NC, depth of invasion and tumor grade with DFS, and VEGF intensity with DFS after salvage treatment. Only one case of osteoradionecrosis and two cases of soft tissue necrosis occurred.CONSLUSION: The HDR BT 18 x 3 Gy b.i.d. is a safe treatment of early oral cancer with a good LC. The T-stage, tumor grade, depth of invasion, and intensity of VEGF were significant predictors of locoregional control. (C) 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

The goal of the study was to find out the risk factors for the development of mediastinitis in patients with deep neck infections (DNI) and describe the differences in symptoms and clinical image between uncomplicated DNI and infections with mediastinal spread. Our study represents the retrospective analysis of 634 patients with DNI. The file was divided into two groups. There were 619 patients (97.6%) in the first group who had an uncomplicated course of DNI without spread of infection into mediastinum (DNI group). The second group included 15 patients (2.4%) with descending mediastinitis as a complication of DNI (mediastinitis group). The most frequent comorbidities were cardiac and pulmonary diseases, which were more frequent in the mediastinitis group comparing to DNI group. Dental origin of the infection was more frequent in DNI group than in the mediastinitis group. On the other hand, tonsillar origin of the infection was more frequent in the mediastinitis group than in DNI group. In both mediastinitis and DNI groups, the typical presenting symptoms were pain, oedema and dysphagia. Furthermore, dysphagia, dyspnoea, dysphonia and restriction of neck movements were more significant in the mediastinitis group than in DNI group. The incidence of airway obstruction, sepsis, pneumonia and death was significantly higher in the mediastinitis group than in DNI group. Due to our results, the predisposing factors for mediastinal extension of DNI are cardiovascular and pulmonary diseases. Mediastinitis is associated with higher morbidity and mortality than DNI. The most common complications are airway obstruction, pneumonia and sepsis.

Aim: Brachytherapy is an alternative to surgery in the treatment of the early stages of oral tongue cancer. The aim of this retrospective study was to analyze the clinical risk factors and possible candidate biomarkers of local and regional tumor control. Patients & methods: Twenty-four patients were treated between the years 2001 and 2010. Median follow-up was 37.4 months. Correlation between disease-free survival and clinical stage, tumor grade, resection margin, depth of invasion, and p16, EGF receptor, NF-κB, HIF-1α, HER2, Ku-80, COX-2 and VEGF expression was evaluated. Results: The estimated 5-year local control was 81% and locoregional control was 62%. Depth of tumor invasion (p = 0.018) and higher VEGF expression (p = 0.016) were significantly predictive for worse disease-free survival in Cox multivariate analysis. Conclusion: Intensity of VEGF expression and depth of tumor invasion may be significantly negative predictors of disease-free survival in tongue cancer patients treated by brachytherapy alone. Predictive value of VEGF deserves evaluation in larger studies.