PURPOSE:Diagnostic accuracy of fine-needle aspiration cytology (FNAC) to discriminate between the target condition and health in the evaluation of salivary gland tumors is not perfected yet and thus, false-negative results are possible. The purpose of the present study was to measure and compare the diagnostic accuracy of FNAC performed with conventional B-mode ultrasound and ultrasound with shear wave elastography (SWE) FNAC navigation.METHODS:The investigators implemented a single-blind randomized study (sealed envelope method). The study population was composed of all patients presenting for evaluation and management of suspected benign or malignant tumors of the major salivary glands between July 2013 and December 2020. The involvement of SWE navigation was the primary predictor variable affecting FNA targeting. The method involved analysis of redistribution of SWE values within the affected gland expressed in kilopascals (kPa) and the four-point ES1 (soft tissue) to ES4 (stiff) scoring. The primary outcome variable was the success in obtaining diagnostic tissue resulting in a histologically confirmed FNAC diagnosis and coded as yes/no. Age and sex of the patients and topographical locations of lesions were covariates. Descriptive and bivariate statistics were computed and the P value was set at .05.RESULTS:The sample included 132 subjects (male/female 59/73; mean age 54 ± 11 years; 144 tumors). SWE + Group (n = 66) consisted of patients presurgically diagnosed with salivary tumors SWE-guided FNAC and SWE- Group (n = 66) was diagnosed with tumors by conventional ultrasound-(B-mode)-guided FNAC. The SWE-guided FNAC statistically significantly reduced the incidence of false-negative results (n = 0; P = .001) and nondiagnostic cases (n = 3 SWE FNAC vs n = 7 B-mode US FNAC; P = .04). For SWE + Group, the FNAC diagnosis was confirmed by postsurgical histology in 95.5% with 91.0% sensitivity (confidence interval [CI] 0.62 to 0.97) and 84.4% specificity (CI 0.58 to 0.96). For SWE- Group, 81.8% confirmation was obtained (P = .05) with 82.3% sensitivity (CI 0.54 to 0.90) and 74.0% specificity.CONCLUSION:SWE can increase success in obtaining diagnostic tissue when used for FNAC navigation purposes. We suggest combining both SWE and standard B-mode ultrasonography methods when the FNAC procedure is performed.

Purpose: Sialoendoscopic, orthodontic, and surgical interventions within the floor of the mouth require precise knowledge of the topography of the Wharton's duct orifices which is still lacking for the pediatric population. We aimed to establish a normative database for the topography of these orifices in children. Methods: The prospective cross-sectional analytic study was performed during January to December 2021. The distances between the mandible gonions and each orifice and the lingual frenulum were defined as primary outcome variables. The secondary outcome variables were the inter-position of the orifices and their location against the base of the tongue and the mandibular alveolar ridge. The segments of the cohort were classified by sex and age groups (4 to 7, 8 to 14, 15 to 17 years old) as the primary predictor variables. The data were evaluated by a 3-way ANOVA for analysis of selected distances with the level of significance at P <= .05. The correlation analysis between sex and locations of the orifices was performed using chi(2) cri-terion (95% confidence interval) and r >= 0.60 was counted as a strong correlation. Results: The study involved 3,000 healthy children from 4 to 17 years of age. The orifices were symmetrical (89.3%), frenulum-independent (78.0%) openings that were usually located in the middle part of the floor of the mouth. The distance between the orifices varied from 0 mm in the frenulum-attached cases to 4.6 +/- 1.8 mm for 4 to 7 years old, 7.6 +/- 1.9 mm for 8 to 14 years old, and 9.1 +/- 2.6 mm for 15 to 17 years old individuals. The orifices were attached to the frenulum (5.7%), were frenulum-related (16.3%), and frenulum-independent (78.0%). The sagittal asymmetry of the orifices was noted in 10.7%, and in 1.6% the lateral asymmetry was detected. No statistically significant sex-related differences were noted. Conclusion: In the pediatric population, the Wharton's duct orifices are usually symmetrical frenulum-independent openings that are located in the middle part of the floor of the mouth. The distance between the orifices normatively varies according to sex and age. The size of the mandible does not influence the positions of the orifices. The position of the duct orifices must be established prior to submandibular sialoendoscopy, orthodontic interventions, frenotomy, and other oral surgeries.(c) 2022 Published by Elsevier Inc. on behalf of the American Association of Oral and Maxillofacial Surgeons

The current study aimed to characterize the activity in orthodontic clinics during the COVID-19-induced lockdown and the inter-lockdown periods, as well as to evaluate patients' perspectives with respect to their fears, their extent of cooperation with treatment, and their emergency needs during the lockdown. The data were gathered from 11 private orthodontic clinics from 1 January 2020 to 8 March 2021, which included three lockdowns and inter-lockdowns. Information specifying the number of admissions, missed appointments, and emergency visits was gathered. Four hundred and twenty-nine orthodontic patients treated in those clinics agreed to complete a questionnaire that evaluated their concerns and expectations, the treatment emergency issues, implementation of the orthodontist's instructions, and contact with the clinical staff during lockdowns. There was a significant increase in the number of scheduled appointments during the inter-lockdown periods, compared with the pre-pandemic period (p = 0.001). No difference in the number of missed/canceled or emergency appointments was found between the different periods (p > 0.420). The majority (89.6%) of the emergency visits involved issues with appliances; 68.7% of the subjects were advised to present themselves at clinics. During the peaks of the waves of the COVID-19 pandemic, a sharp rise in the number of missed and urgent appointments was not found. Reducing the number of orthodontic emergencies may assist in reducing patient fears.

PURPOSE:We aimed to establish a normative database for the topography of Wharton's duct orifices and to indicate the localization and distances of the orifices against other oral structures. METHODS:The prospective study involved 3,000 healthy adults. We measured the cranial index, the distances between the mandible gonions and the orifices and between each orifice and the lingual frenulum, the position of the orifices against each other, and against the base of the tongue and the mandibular alveolar ridge. The segments of the cohort were classified by sex and the headform (dolichocephalic, brachycephalic, and mesocephalic). RESULTS:The distance between the orifices varied from 0 mm in the frenulum-attached cases to11.0 ± 2.3 mm in cases of the male brachycephalic skull. The correlation with sex was found for the localization of the frenulum-related orifices (r = 0.64 for females). The orifices were attached to the frenulum (5.9%), were frenulum-related (16.2%), and frenulum-independent (77.9%). The sagittal asymmetry of the orifices was noted in 11.8%, and in 2.1%, the lateral asymmetry was detected. CONCLUSION:In most of the cases, the Wharton's duct orifices are symmetrical frenulum-independent openings that are usually located in the middle part of the floor of the mouth or close to the mandibular alveolar ridge. The distance between the orifices varies according to sex and the type of the skull. The precise position of the duct orifices must be established prior to sialoendoscopy of the submandibular glands, a botulinum toxin injection around the mandible, tongue traction maneuvers, frenotomy, and other oral surgeries.

Background: We compared the curettage/bone grafting and the curettage/bone graft substitutes surgical techniques in their relation to functional outcomes, oncologic outcome (recurrence, malignant transformation), the rate of postsurgical complications, durations of surgery and of postsurgical immobilization for hand-localized cases of solitary and multiple enchondromas. Methods: The current prospective randomized trial analyzed 200 adult patients (2012-2017) with enchondroma who underwent surgical intervention. The cases were randomly divided into Group 1 (n = 100; F 56, M 44) for surgeries with curettage and autogenous bone grafting, and Group 2 (n = 100; F 55, M 45) for surgeries with curettage and bone graft substitutes. The placebo control Group 3 consisted of cases operated by curettage only (n = 56; F 31, M 25). The follow-up period was set at 30 months. Results: The duration of surgery was 51 +/- 4 min in Group 1 and 27 +/- 1 min in Group 2 (p = 0.008). In Group 1, the rate of recurrence was 6% against 1% in Group 2 (p = 0.005). No other statistically significant differences in postsurgical outcomes between three involved groups were noted. Conclusion: In cases of enchondroma of the hand, postsurgical functional outcomes, the rate of postsurgical complications, the duration of immobilization, and the time to complete recovery are not influenced by the type of chosen grafting material. The implementation of HAp-collagen bone substitutes in granules instead of autogenous bone grafting reduces the duration of surgery. The implementation of autogenous bone grafting may increase the rate of tumor recurrence.

We aimed to collect and analyze available cases of intraoral acantholytic squamous cell carcinoma (aSCC), that consisted of the authors’ cases and cases derived from the existing literature, with an emphasis on the pathological staging and patient outcome. Our research question was whether aSCC is more aggressive than conventional SCC. The literature was searched for documented cases of aSCC involving the intra-oral mucosa, excluding those from the lips and tonsils, and seven new cases were added from our files. The authors compared the obtained aSCC data to existing data for conventional SCC. Fisher Exact or Pearson’s χ2 tests were used for categorical variables. Fifty-five cases of intraoral aSCC were reviewed, of which 48 were retrieved from the literature. Analysis of the published cases was reinforced by contacting the authors of all the papers with incomplete data for further clarifications. The most common sites of aSCC were the tongue (24/55) and the maxilla/maxillary gingiva and/or palate (11/55). The overall survival rate was 36/53 (67.9%) with a mean follow-up period of 22 months against 62.5% for conventional SCC (p = 0.6). No statistically significant difference between the two variants of the tumor with respect to the oral cavity was detected. The differences in age, sex, survival rate, staging, and locations were not statistically significant. Based on the available data from 55 cases, there is no evidence to suggest that aSCC is more aggressive than conventional SCC in intraoral cases.

ABSTRACT:Orbital fractures account for up to 40% of craniofacial injuries. In this article, the authors present the transoral endoscopy-assisted plating technique for treating orbital blowout fractures (OBF). A retrospective analysis of 56 cases treated with transoral endoscopy-assisted approach was performed. Immediate versus delayed surgery decision-making was performed by using our 2-week algorithm. The surgical technique included only transoral incisions, forced duction and "pulse" tests, osteotomy, endoscopic inspections, the reduction with a curved elevator and an indwelling balloon, the retrieval of prolapsed fatty tissue back into the orbit, removal of sharp bony fragments, adaptation of the titanium mesh to the orbital floor and its fixation with screws to stable bony structures, reattachment of the osteotomized lateral wall, and postoperative computed tomography (CT) scan with 3D CT reconstruction. The overall success rate of surgeries was 96%. The resolution of comorbidities resulted in a normal globe position, normal eye movement, and the resolution of diplopia. Postoperative complications were insignificant with one case of surgical edema and one case of infection and sequestration that appeared six months after surgery. These results remained unchanged after 20 to 24 months of follow-up. The suggested minimally invasive transoral technique can be effectively implemented in cases of OBF as well as in cases when the medial wall of the orbit is involved. Our results presented a high success rate with minimal rate of complications, thus our technique is a safe way with minimal morbidity for treating OBF.

A retrospective multicenter chart review was conducted with the objective of evaluating the hypothesis that certain cases diagnosed as tension-type headache (TTH) in pediatric neurology are not stress-related or central sensitization-related conditions but may mimic an autoimmune disorder of the dura mater. Of the 29,642 patient charts reviewed, 12,424 charts (42%) were excluded because of incomplete data and 17,218 cases were analyzed. For all the 29,642 charts, TTH or chronic daily headaches were diagnosed in 29.2% of cases. Among the 17,218 cases subjected to detailed diagnostic procedures, TTH was diagnosed in only 5%. In 7,044 cases, the initial diagnosis of TTH was changed to headache attributed to infection (87.4%), which was supported by the presence of meningeal signs, high antistreptolysin-O titers, and, in 46% of cases, magnetic resonance imaging (MRI)-detected thickening of the cranial dura mater. The initial diagnosis of migraine was confirmed in 87.7% of cases (8,034/9,162). In some cases of treatment-resistant pediatric recurrent headaches, which are initially diagnosed as TTH, a secondary type of headache may be suspected as the underlying cause. Usually this type of headache has streptococcal infection-related laboratory findings, the meninges as the site of the lesion, and meningism as the clinical presentation.

This study was performed to test a protocol for trans-implant treatment of chronic recurrent maxillary sinusitis (CRS), via implants with an internal removable sealing screw. The appropriate indications for treatment, optimal number of treatment sessions, and general schedule of treatment and follow-up were assessed. This was a retrospective study of 31 patients with CRS who were managed with trans-implant lavage. Of these patients, 28 (referred for a sinus elevation procedure) underwent a simultaneous implantation procedure and treatment of the sinusitis. Three patients received treatment for sinusitis via an already existing implant. The suggested sinusitis treatment protocol includes the drainage of pus through the punctured sinus floor and three sessions of antral irrigation/lavage, four cone beam computed tomography scans, and four transnasal endoscopic observations. The suggested combined protocol includes the simultaneous evaluation of the implant status and the sinusitis treatment results on days 30 and 60 after surgery. Of the 31 patients, 28 (90%) had complete relief of most of their symptoms (nasal obstruction/discharge, anosmia/hyposmia) up to day 30 postoperative. Follow-up nasal endoscopy demonstrated no evidence of active sinus disease. Twenty-seven implants were well-osseointegrated and were still in use for prosthetic purposes. In one case, the implantation failed because of poor bone quality. For the remaining 30 cases, both clinical and radiological results showed stability of the implants and no CRS recurrence during the whole follow-up period. The dental implant with an internal central port and an integral sealing screw may be used for drainage, irrigation, observation, and further treatment of the maxillary sinus in cases of CRS.

Chondroma is a benign hyaline cartilage tumor and is a relatively common skeletal neoplasm. Uneven distribution of this tumor among the various bones and regions of the skeleton is known but no explanation of this phenomenon followed. The current research aimed to document the exact chondroma distribution in the body. We hypothesized that the cases of all subtypes of chondroma have to be investigated in complex and that obtaining combined data from a large cohort of cases may explain the logic of chondroma distribution and may answer the question of why the hand is the main target of the tumor. We retrospectively analyzed 1529 cases of various subtypes of chondroma. Enchondroma was the most frequent type (65.4%) and the hand was the main target location (49.8% of all cases). The right side of the body was affected in 900 cases (58.9%) and in 629 cases (41.1%) the left side was affected (p = 0.03). The general results for tumor distribution are as follows: head and extremities - 92.8%; head, hands, and feet - 71.8%; and hands and feet - 62.8%. In the hand and the feet, multiple chondromas were distributed along the same digital ray in all cases. The anatomical distribution of various subtypes of chondroma follows "the periphery of the being", the uneven lateral distribution, and the "same digital ray" patterns that permits to suggest that genetic mutations affecting the development of the body during the embryonic period are the main etiological component for this tumor.

Background Sonoelastography (SEG) is a non-invasive, relatively new imaging modality that maps the elastic properties through stiffness of soft tissue. Pathological conditions such as inflammation and neoplasia can change tissue elasticity; as a result, when used in the major salivary glands, this non-invasive modality may provide information that could be useful for diagnosis. Objective Two preliminary studies are presented; both assess the diagnostic utility of SEG: the first in primary Sjogren's syndrome (pSS) and the second concerns major salivary gland tumors. Methods and materials The first study included fifteen patients with pSS that underwent SEG of the major salivary glands before starting pilocarpine treatment versus diffused sialadenitis and normal glands. The second study included nineteen benign and malignant tumors, just before ultrasound-guided needle aspiration for cytology and excisional biopsy. Quantitative indices of the shear elastic modulus were compared with cytological and histopathological results. Elastography was scored on color-scaled elastograms. Results Mean elasticity/stiffness values for pSS were not significantly different from those of diffused sialadenitis and normal salivary gland tissue. As for salivary gland tumors, scores showed clustering according to pathological condition. For example, pleomorphic adenomas were firmer than Warthin's and adenoid cystic carcinoma was firmer than polymorphus adenocarcinoma. Conclusions SEG did not show a diagnostic advantage in regard to the assessment of pSS. Nevertheless, it might serve as a tool in the evaluation of benign and malignant major salivary glands tumors. Our studies should be continued to confirm these preliminary observations.

Acantholytic squamous cell carcinoma (ASCC) is an uncommon variant of squamous cell carcinoma (SCC). It is characterized by a combination of typical SCC and pseudoglandular structures, dyskeratotic cells and prominent acantholysis. The purpose of this study was to analyze the histochemical and immunohistochemical characteristics of the intraoral variant of ASCC. Cases of intraoral ASCC were retrieved from the English language literature. Four new cases from our files were added. In total, 35 cases were included and analyzed in this study. The mean age of the patients was 61.5 + 13 years (age range 38-92 years), with a male-to-female ratio of 1.7:1. According to the available data, histochemical and immunohistochemical stains for mucins were found to be consistently negative. E- cadherin, a marker of adherens junctions, was usually reported to be expressed in areas of "typical" (non acantholytic) SCC, but reduced in the acantholytic areas. We examined for the first time the expression of claudin 1, a marker of tight junctions, and found it to be reduced in the acantholytic areas, similar to E-cadherin. Several cases of oral ASCC also expressed vimentin and cytokeratin (CK) 19, markers associated with epithelial-mesenchymal transition. A wide range of non-epithelial markers yielded negative immunoreactions. In conclusion, ASCC is an uncommon variant of squamous cell carcinoma. The acantholytic process appears to involve reduced expression of molecular components of both adherens junctions and tight junctions. These findings could suggest a relation to the epithelial mesenchymal transition process and therefore further studies are needed in order to establish such a link and the subsequent possible impact on the clinical outcome of the patients.

Background: Minimal invasive techniques have an increasing role in all surgical fields because they result in improved morbidity rates and better aesthetic outcomes. We present a minimally invasive technique for treating orbital blowout fractures. Objectives: This article describes the endoscopic approach for orbital floor fractures, reduction, and fixation and reports the clinical results of long-term experience of 32 cases. Methods: 32 patients who sustained either a comminuted or trap door orbital floor fracture were treated in our medical centre following the same surgical protocol. The indications for orbital reconstruction were limited eye movement, diplopia, and significant enophthalmos. The approach is discussed in detail. Results: All patients healed uneventfully, one patient with no resolution of diplopia after surgery because of late intervention (two weeks) and one patient with chronic sinusitis due to anterior antral wall bony sequester. No major complications were noted in the postoperative period, and good functional and aesthetic results were obtained. Prolonged infraorbital paraesthesia was the most common mild long-term complication. Conclusions: Our results presented a high success rate with minimal complications thus our technique is a safe way with minimal morbidity for treating orbital floor fractures.

The aim of the study was to characterize the prevalence, diameter and course of intraosseous anastomosis between the posterior superior alveolar artery and the infraorbital artery (bony canal) involved in the sinus floor augmentation procedure. Data from 208 sinuses were analyzed from reconstructed computed tomography (CT) images. The presence of the intraosseous anastomosis in the lateral antral wall was detected using sagittal plane sections, in addition, the intraosseous course and the diameter of the bony canal were examined. The bony canal was identified in 114 (55%) of the 208 maxillary sinuses, with a mean distance of 16.9 mm from the alveolar ridge. From the examined canals, in 7% the diameter was 2-3 mm wide, in 22% 1-2 mm and in 26% it was less than 1 mm. wide. Because only in 50% of cases the vessel was large enough to be detected by a CT scan, it is recommended, to place the superior border of the osteotomy up to 15 mm from the alveolar crest in A to C type ridges to avoid penetration of the artery.