OBJECTIVE:To evaluate intraoral-ultrasound (ioUS) features of benign and malignant oral lesions. METHODS:In this prospective cross-sectional study, patients with oral soft tissue lesions underwent ioUS followed by biopsy within 2 weeks. Sonographic features: size, echogenicity, cystic areas, calcifications, margins, and vascularity were compared with histopathology. Associations between sonographic features and malignancy were explored using univariate and multivariable analyses. ROC analysis was used descriptively to explore discriminatory ability. RESULTS:Fifty-one patients with 52 lesions (24 females, 27 males; mean age 60.1 ± 16.7 years, range 18-90) were recruited. Following exclusions, the study comprised 23 histologically confirmed malignant cases (squamous cell carcinoma, SCC) and 23 benign cases. Multivariate analysis identified maximal diameter (> 12 mm; sensitivity 0.76 [95% CI: 0.53-0.90], specificity 0.77 [95% CI: 0.57-0.90]), ill-defined margins (p < 0.001), and increased vascularity (p = 0.002) as being associated with SCC in this cohort. Combinations of these features showed high apparent discrimination (AUC 0.92 [95% CI: 0.84-1.00]), but likely reflect optimistic bias given the small sample size and lack of validation. CONCLUSIONS:This pilot study describes ioUS features in benign and malignant oral lesions and identifies sonographic features potentially associated with malignancy. These findings are exploratory and hypothesis-generating and require validation in larger, more diverse cohorts before any clinical application.

A MASCC/ISOO Clinical Practice Statement (CPS) is aimed at generating a concise resource for clinicians that concentrates practical information needed for the management of oral complications of cancer patients. This CPS focuses on the use of imaging and clinical laboratory tests for the diagnosis, staging, monitoring, treatment decision, and prediction of medication-related osteonecrosis of the jaw (MRONJ) in cancer patients. This CPS was developed based on a critical evaluation of the literature followed by a structured discussion of a group of leading experts, members of the Oral Care Study Group (OCSG) of MASCC/ISOO. The information is presented in the form of succinct bullets and tables to generate a short manual about the best standard of care. Radiographs, cone beam computerized tomography (CT), conventional CT, magnetic resonance imaging (MRI), and nuclear imaging are often utilized in patients with MRONJ. The CPS describes the considerations for selecting each imaging modality. Laboratory workup in patients with MRONJ is often derived by comorbidities, with immune status and bleeding tendency being the key considerations. Imaging and lab tests have an important role in the diagnosis and management of MRONJ. The imaging modality and specific laboratory tests should be tailored to the patient’s needs.

This systematic review aimed to assess the updated literature for the prevention of salivary gland hypofunction and xerostomia induced by non-surgical cancer therapies. Electronic databases of MEDLINE/PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials (RCT) that investigated interventions to prevent salivary gland hypofunction and/or xerostomia. Literature search began from the 2010 systematic review publications from the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) up to February 2024. Two independent reviewers extracted information regarding study design, study population, cancer treatment modality, interventions, outcome measures, methods, results, risk of bias (RoB version 2), and conclusions for each article. A total of 51 publications addressing preventive interventions were included. Eight RCTs on tissue-sparing radiation modalities were included showing significant lower prevalence of xerostomia, with unclear effect on salivary gland hypofunction. Three RCTs on preventive acupuncture showed reduced prevalence of xerostomia but not of salivary gland hypofunction. Two RCTs on muscarinic agonist stimulation with bethanechol suggested a preventive effect on saliva flow rate and xerostomia in patients undergoing head and neck radiation or radioactive iodine therapy. Two studies on submandibular gland transfer showed higher salivary flow rates compared to pilocarpine and lower prevalence of xerostomia compared to no active intervention. There is insufficient evidence on the effectiveness of vitamin E, amifostine, photobiomodulation, and miscellaneous preventive interventions. This systematic review continues to support the potential of tissue-sparing tecniques and intensity-modulated radiation therapy (IMRT) to preserve salivary gland function in patients with head and neck cancer, with limited evidence on other preventive strategies, including acupuncture and bethanecol. Preventive focus should be on optimized and new approaches developed to further reduce radiation dose to the parotid, the submandibular, and minor salivary glands. As these glands are major contributors to moistening of the oral cavity, limiting the radiation dose to the salivary glands through various modalities has demonstrated reduction in prevalence and severity of salivary gland hypofunction and xerostomia. There remains no evidence on preventive approaches for checkpoint inhibitors and other biologicals due to the lack of RCTs.

Radiation-induced oral mucositis (OM) and dermatitis (RD) are common debilitating toxicities of radiotherapy (RT) for head and neck cancer (HNC) patients. While photobiomodulation (PBM) has shown promise in reducing severity of these adverse effects, in-clinic treatments pose logistic and financial challenges. This study assessed the feasibility and compliance of a home-use, self-applied near-infrared PBM device for the prevention and treatment of RT-induced OM and RD. This prospective, single-arm trial enrolled 20 HNC patients scheduled for intensity-modulated RT (IMRT) with or without concurrent chemotherapy. Seventeen patients were analyzed following exclusions. Participants self-administered PBM at home twice daily for 9–11 weeks, from RT initiation to four weeks post-RT. The primary outcome was compliance (≥ 50

The use of Cone-Beam-Computed-Tomography (CBCT) is rapidly increasing in dentistry. This study aimed to evaluate CBCT use among dentists across various fields and how it is affected by various measures. We sent an anonymous questionnaire to Israeli dentists, which assessed the clinical use (including requested output: cross-sectional-images (CSI), DICOM-files, interpretation report), knowledge, and medico-legal issues of CBCT imaging. Our survey was distributed to dentists in conferences and via e-mails with a response rate of 38

Background and Objectives: Diabetes mellitus (DM) and hypertension (HTN) continue to increase and pose a significant burden on the health system worldwide. These patients comprise a significant portion of the hospitalized Oral and Maxillofacial Surgery (OMFS) department. Addressing and controlling DM and HTN during hospitalization should thus be one of the treatment goals. This study aims to investigate the management and outcomes of DM and HTN during the hospitalization period in the OMFS department. Materials and Methods: A retrospective analysis of patients with community-diagnosed DM and/or HTN admitted to the OMFS department between 2017 and 2019 was conducted at Rambam Healthcare Campus, Haifa, Israel. Linear regression analysis was used to determine trends in changes in blood pressure and blood glucose levels during hospitalization. The impact of consults from internal medicine experts and endocrinologists was tested using a paired-samples t-test. Results: A statistically significant reduction was observed in all systolic HTN patients categorized as stages 1 and 2, p = 0.012 and p = 0.001, respectively. A statistically significant (p = 0.012) reduction in blood glucose levels in all DM patients with initial values higher than 250 mg/dL was observed. A statistically significant reduction in blood glucose levels was observed in the DM group of patients who received endocrinologist consultations (p = 0.012). Conclusions: Addressing patients with systemic conditions during hospitalization in the OMFS department is mandatory. External medical consulting can be of great value for short-term treatment during hospitalization and may also have long-term benefits after discharge to the community. The main limitations of this study include retrospective data acquisition, a small sample size, and a lack of data regarding the impact of pain management on blood pressure and glucose levels.

Objectives To compare long-term results of different treatment modalities in central giant cell granuloma of the maxillofacial-skeleton. Primary resection may result in major defects. Alternative treatments include pharmacological agents. As yet there has been no consensus on the use of the variety of treatment options, and few studies have reported clarifying long-term results. Materials and methods This retrospective study on 22 patients with 25 lesions evaluated clinical, radiological and histological features, treatment preformed and lesion recurrence. Success was defined as regression/calcification and failure as recurrence, progression or un-responsiveness. Results Of the presenting patients, 77% were under age 40. Lesion prevalence was higher in the anterior mandible and left posterior maxilla. Most cases exhibited pain, tooth-mobility or mucosal-expansion. The appearance was predominantly unilocular in the maxilla and multilocular in the mandible, which also exhibited higher prevalence of cortical perforation. Up to 80% of lesions were classified as aggressive. Intralesional steroids/calcitonin were used in 7 cases. Mean follow-up was 39.8 months. Two cases showed recurrence. In 71% of the cases treated pharmacologically, calcification/regression were observed. Conclusions Our analysis indicates better outcomes using a combined approach, including both pharmacological and surgical treatments in large aggressive lesions. Pharmacological treatment resulted in decreased size or well-defined lesions, thus reducing the need for extensive bone resection. Dual treatment with corticosteroids and calcitonin showed no superior outcomes, but a larger cohort should be assessed. Clinical Relevance There are several protocols for treatment of central-giant-cell-granuloma lesions, but most are not fully established. It is important to report results that contribute to the establishment of proven protocols. This report attempts to establish the relevance of the combined approach: pharmacological treatment followed by surgical resection.

Oral mucositis (OM) is a common and debilitating toxicity of cancer treatments - chemotherapy, radiotherapy, hematopoietic cell transplant, or combinations. OM is associated with severe oral pain and has negative impacts on patient function and quality of life. Additionally, OM has accompanying systemic complications that may have critical implications. These local and systemic consequences can alter cancer treatment, and add an economic burden. This review covers the clinical presentation and course of OM, differential diagnosis, clinical and economic impacts, pathogenesis, risk factors, assessment measures, biomarkers and prediction of OM, management, research advances in the development of new drugs and treatments, and big data.

Background Mucositis is a common and highly impactful side effect of conventional and emerging cancer therapy and thus the subject of intense investigation. Although common practice, mucositis assessment is heterogeneously adopted and poorly guided, impacting evidence synthesis and translation. The Multinational Association of Supportive Care in Cancer (MASCC) Mucositis Study Group (MSG) therefore aimed to establish expert recommendations for how existing mucositis assessment tools should be used, in clinical care and trials contexts, to improve the consistency of mucositis assessment. Methods This study was conducted over two stages (January 2022 - July 2023). The fi rst phase involved a survey to MASCC-MSG members (January 2022 - May 2022), capturing current practices, challenges and preferences. These then informed the second phase, in which a set of initial recommendations were prepared and re fi ned using the Delphi method (February 2023 - May 2023). Consensus was de fi ned as agreement on a parameter by >80% of respondents. Findings Seventy-two MASCC-MSG members completed the fi rst phase of the study (37 females, 34 males, mainly oral care specialists). High variability was noted in the use of mucositis assessment tools, with a high reliance on clinician assessment compared to patient reported outcome measures (PROMs, 47% vs 3%, 37% used a combination). The World Health Organization (WHO) and Common Terminology Criteria for Adverse Events (CTCAE) scales were most commonly used to assess mucositis across multiple settings. Initial recommendations were reviewed by experienced MSG members and following two rounds of Delphi survey consensus was achieved in 91 of 100 recommendations. For example, in patients receiving chemotherapy, the recommended tool for clinician assessment in clinical practice is WHO for oral mucositis (89.5% consensus), and WHO or CTCAE for gastrointestinal mucositis (85.7% consensus). The recommended PROM in clinical trials is OMD/WQ for oral mucositis (93.3% consensus), and PRO-CTCAE for gastrointestinal mucositis (83.3% consensus). Interpretation These new recommendations provide much needed guidance on mucositis assessment and may be applied in both clinical practice and research to streamline comparison and synthesis of global data sets, thus accelerating translation of new knowledge into clinical practice.

IntroductionThe introduction of targeted therapy and immunotherapy has tremendously changed the clinical outcomes and prognosis of cancer patients. Despite innovative pharmacological therapies and improved radiotherapy (RT) techniques, patients continue to suffer from side effects, of which oral mucositis (OM) is still the most impactful, especially for quality of life.Areas CoveredWe provide an overview of current advances in cancer pharmacotherapy and RT, in relation to their potential to cause OM, and of the less explored and more recent literature reports related to the best management of OM. We have analyzed natural/antioxidant agents, probiotics, mucosal protectants and healing coadjuvants, pharmacotherapies, immunomodulatory and anticancer agents, photobiomodulation and the impact of technology.Expert OpinionThe discovery of more precise pathophysiologic mechanisms of CT and RT-induced OM has outlined that OM has a multifactorial origin, including direct effects, oxidative damage, upregulation of immunologic factors, and effects on oral flora. A persistent upregulated immune response, associated with factors related to patients' characteristics, may contribute to more severe and long-lasting OM. The goal is strategies to conjugate individual patient, disease, and therapy-related factors to guide OM prevention or treatment. Despite further high-quality research is warranted, the issue of prevention is paramount in future strategies.

This study aimed to develop an algorithm to automatically segment the oral potentially malignant diseases (OPMDs) and oral cancers (OCs) of all oral subsites with various deep convolutional neural network applications. A total of 510 intraoral images of OPMDs and OCs were collected over 3 years (2006-2009). All images were confirmed both with patient records and histopathological reports. Following the labeling of the lesions the dataset was arbitrarily split, using random sampling in Python as the study dataset, validation dataset, and test dataset. Pixels were classified as the OPMDs and OCs with the OPMD/OC label and the rest as the background. U-Net architecture was used and the model with the best validation loss was chosen for the testing among the trained 500 epochs. Dice similarity coefficient (DSC) score was noted. The intra-observer ICC was found to be 0.994 while the inter-observer reliability was 0.989. The calculated DSC and validation accuracy across all clinical images were 0.697 and 0.805, respectively. Our algorithm did not maintain an excellent DSC due to multiple reasons for the detection of both OC and OPMDs in oral cavity sites. A better standardization for both 2D and 3D imaging (such as patient positioning) and a bigger dataset are required to improve the quality of such studies. This is the first study which aimed to segment OPMDs and OCs in all subsites of oral cavity which is crucial not only for the early diagnosis but also for higher survival rates.

A developing maxillary central erupts at the age of 7 years and the apical third of its root apexifies 3 years later, at age 10 years. During this period, an impacted incisor root develops its root in a restricted area, above the alveolar bone, high up in the cortex of the floor of the nose. The aim of this study was to radiographically assess whether the root development of the unerupted incisor is affected by its lack of eruption. A cross-sectional retrospective split mouth study was designed. The sample consisted of 30 consecutive patients (20 males, 9 females) aged 830 years (mean 11.6 years), who attended the Orthodontic Department between 2016 and 2019 for treatment of a unilateral impacted maxillary central incisor due to obstruction. Root length, volume and morphology (presence and angle of dilaceration) were evaluated on CBCT scans by 2 calibrated observers using OnDemand3DTM application software to compare the impacted and normally erupted incisors. The effects of dental age at diagnosis, type and location of obstruction and 3D position of the impacted tooth were evaluated. The impacted central incisors had significantly shorter roots (mean 3.1 mm, p < 0.001) and significantly more dilacerations (40%), while their root volume was only slightly reduced. Advanced dental age closed apex and buccally located obstruction were each found to be associated with more root dilacerations. Closed apex was also associated with an increased angle of dilaceration. Odontomas affected root volume more than supernumerary teeth. A more angulated horizontal position of the impacted tooth in sagittal and transverse dimensions resulted in less dilacerations. Non-eruption of a maxillary central incisor due to obstruction prevents normal root development and causes malformation of the apex, due to its proximity to anatomical borders. These findings suggest that interventional procedures aimed at encouraging timely eruption should be initiated early before development of the apical third of the root.

OBJECTIVES When performing CBCT sialography (sialo-CBCT), space-occupying lesions may be identified incidentally. The objective was to describe their radiologic-clinical-histopathologic correlations. METHOD AND MATERIALS The archive of sialo-CBCT scans was retrospectively searched for suspected space-occupying lesions. Based on the scan and clinical-histopathologic data, the cases were divided into "pathologic" vs "normal," "intra-parenchymal" vs "extra-parenchymal," and "benign" vs "malignant." Two precalibrated, blinded radiologists performed a survey of the radiographic features of each scan. Cohen kappa, chi-square, Kruskal-Wallis, and Mann-Whitney tests assessed inter-observer agreement and radiologic-clinical-histopathologic correlations. RESULTS In total, 27 (1.5%) suspected space-occupying lesions were found in 1,758 reports. Full follow-up data were available for 15 cases: four were "malignant," six were "benign," and the remaining five were "normal." Kappa showed substantial inter-observer agreement (0.8 to 1.0). Constant swelling correlated with "pathologic" cases (P = .003). Lesion diameter was greater in "pathologic" than "normal" (P < .001) cases, with a cut-off of 12.6 mm. Clinical and radiographic features were similar in "benign" and "malignant" lesions. "Intra-parenchymal" and "extra-parenchymal" space-occupying lesions correlated with "no-fill-region" (P = .01) and "main-duct-displacement" (P = .002), respectively. CONCLUSIONS Suspected space-occupying lesions in sialo-CBCT with a diameter greater than 12.6 mm are likely to be "pathologic." No radiographic features were able to differentiate between "malignant" and "benign" space-occupying lesions.

To assess clinical use and patient outcome of photobiomodulation (PBM) for oral mucositis (OM) prevention and treatment among specialized practitioners. A poll was emailed to the members of the Mucositis Study Group of MASCC/ISOO. The PBM parameters used by the respondents were analyzed using exploratory statistical methods to identify combinations of PBM parameters (patterns) that characterize the variance in the protocols (principal component analysis). Responses were received from 101 MSG members, with 78 providing analyzable data. Most of the responders were dental practitioners or oral medicine specialists. PBM was used by 59

Rationale:Neurofibroma (NF) is the most common benign peripheral nerve sheath tumour that most often occurs as a solitary tumour. A clinical and imaging diagnosis may be challenging since no distinctive features are unique for this lesion. Solitary NFs are treated by complete resection that may sometimes require a nerve sacrifice, ending with a neurological deficit.Patient Concerns:A 5-year-old girl with mild asymptomatic slow-growing swelling in the vestibulum of her right mandible.Diagnosis:A solitary variant of extraosseous NF involving the right mental branch of the inferior alveolar nerve.Treatment:Surgical removal of the lesion while fully preserving the mental branch.Outcomes:No sensory deficit was identified during a 3-month follow-up.Take-Away Lessons:Ultrasonography is a valuable tool for evaluating soft-tissue masses of the oral cavity. A solitary extraosseous NF involving the mental branch can be surgically removed without nerve deficit.

Abstract Objectives: This study aimed to develop an automated deep-learning algorithm for the detection and 3D segmentation of incidental jaw lesions in maxillofacial CBCT scans.Materials and Methods: The dataset included 82 CBCT scans with and without histologically confirmed benign bone lesions, obtained from three CBCT devices using different imaging protocols. The dataset consisted of axial CBCT images and was divided into training dataset (20,214 axial images), validation dataset (4,530 axial images) and testing dataset (6,795 axial images). A Mask-RCNN based deep-learning algorithm segmented the bone lesion in each axial image. The analysis of sequential slices improved the mask RCNN performance and assisted in classifying each CBCT case as containing bone lesions or not. Thereafter, the algorithm generated a 3D segmentation of the lesions. Results: The accuracy of the algorithm for classifying each CBCT case as either containing bone lesions or not, was 100%. The algorithm performance for detecting lesions in individual axial images showed high sensitivity (95.9%) and high precision (98.9%).Conclusions: Our deep learning algorithm can detect incidental bone lesions in CBCT scans with high accuracy, high sensitivity and high precision and is highly recommended for bone lesion detection and follow-up in CBCT imaging. Clinical relevance: The increasing number of CBCT scans performed worldwide dictates a clinical need for developing an automated tool, which will review, detect and volumetrically demonstrate incidental bone lesions in CBCT scans with high accuracy and low false-positive rate.

Point-of-care-ultrasound (PoCUS) is performed by the clinician at the patient's bedside and is an essential diagnostic tool in many medical subspecialties, in hospital-based care, emergencies, trauma, and in general practice. A simple, novel approach for implementation of PoCUS of the oral cavity and maxillofacial complex is introduced. Relevant indications include differentiating abscess from cellulitis, detecting jaw and facial fractures, assessment of surgical complications, removing foreign bodies, and evaluating soft tissue masses. Intraoral and transcutaneous approaches may be used alone or in combination. This pilot series shows the capability of PoCUS to improve diagnostic accuracy, speed diagnosis, guide procedures, and improve management. Prospective studies are underway to determine the strengths and weaknesses of the method and its impact on patient outcomes.

Abstract Titanium plats are the gold-standard for fracture fixation. Titanium is considered biocompatible, corrosion resistant with an elasticity-modulus closest to bone. Nonetheless, titanium plates are not always as inherent as hoped. The authors investigated morbidity associated with titanium plates in mandibular fractures. A retrospective study of mandibular fractures treated between 2000 and 2018 using internal-fixation was conducted. Data included age, gender, complications, and location. Predictor-variable was location. Outcome-variable was plate removal. A total of 571 patients were included, 107 resulted in plate removal (18.7%). Body was the most prevalent location of fracture (29.3%). Symphysis/para-sym-physis showed the highest removal rate (24.1%), followed by body and angle (21.3/19.8%). A total of 23.4% of double-plating cases resulted in plate removal, upper-border in 15% and lower-border in 8.8%, all reconstruction-plates. Exposure was the most frequent complication leading to removal. Although titanium plates are the gold standard, almost every fifth patient returns for plate removal. Age-distribution emphasizing 41 to 50 with decrease towards extremities may imply better healing in the young and soft-tissue elasticity and less complaints in the elderly. Significantly more complications in double-plating compared to lower border suggests proximity to the oral-cavity as a risk-factor for removal. Complication rates and patterns are not negligible and perhaps should encourage clinicians to consider using biodegradable-systems for upper-border plates.