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.

Patients with laryngeal cancer may necessitate tracheostomy placement to alleviate compromised airways. However, the impact of tracheostomy on thyroid gland invasion and its implications for prognosis in individuals who further undergo total laryngectomy remains unclear. This study aimed to assess thyroid gland invasion rates and explore the 5-years disease-free and overall survival in laryngectomized patients stratified by preoperative tracheostomy. All patients who underwent total laryngectomy for laryngeal cancer between 2003 and 2023 at a tertiary referral center were retrospectively reviewed. Logistic univariable and multivariable regressions were performed to identify factors associated with thyroid gland invasion. Survival analyses were performed using the Kaplan–Meier estimator. A total of 119 laryngectomized patients were included (mean age: 63 ± 10 years, range 35–89, 110 [92.4

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.

This paper aims to evaluate the healing capacity of bony lesions around biofilm-infected and non-infected gutta-percha (GP) points. Bony defects were created in the calvaria of 28 Wistar rats. The rats were divided into three groups: Group 1—Implantation of infected GP particles in the bony defect; Group 2—Positive control implantation of non-infected GP particles in the bony defect; and Group 3—Negative control, in which no GP particles were implanted. The biofilm consisted of three strains of bacteria: Enterococcus faecalis, Streptococcus sanguis, and Porphyromonas gingivalis. The animals were sacrificed 60 days postoperation, and histological assessments were performed. In Group 1, the biofilm-infected group, we observed a mild foreign body reaction with a few inflammatory cells adjacent to the capsule and a newly woven bone matrix surrounded by osteoblasts and mature bone. In Group 2, the non-infected GP particles group, minimal inflammatory cell reactions were observed in the adjacent tissue, and a newly woven bone matrix was surrounded by osteoblasts. This study shows that bone healing is possible around both sterile and infected GP points. This contradicts the claim that some root canal treatments fail because of non-microbial factors, including extruded root canal filling materials, which may cause foreign body reactions. The healing observed suggests that overextension should not be considered an indication for endodontic surgery.

Necrotizing sialometaplasia is a benign, self-limiting, inflammatory disease of salivary glands, mainly involving the minor salivary glands in the palate. This lesion can mimic a malignant neoplasm, both clinically and histopathologically, manifesting as a submucosal swelling or as an ulcer of the palate. This report presents a case of an otherwise healthy bodybuilder with anabolic androgenic steroids abuse with bilateral necrotizing sialometaplasia in the palate, and discusses computed tomography findings in the pre-ulceration phase. Literature review revealed another two cases of necrotizing sialometaplasia with preoperative imaging, both performed in the ulceration phase. The importance of radiographic findings as an aid in differential diagnosis is further discussed, as well as the role of possible predisposing factors including anabolic androgenic steroids abuse in the pathogenesis of necrotizing sialometaplasia.

Background Malignant non-Hodgkin lymphoma (NHL) represents approximately 5% of all malignancies of the head and neck region and is the third most common after squamous cell carcinoma (SCC) and salivary gland tumors. NHL originates from the B or T cells of lymphatic tissue. Only 24% of NHL affect extranodal locations. The head and neck region is the second most common site of extranodal manifestation. Only 0.1% to 5% present in the oral cavity, of which the majority are diffuse large B-cell lymphomas (DLBCLs). Intraoral cases manifestations appear as part of progressive or recurrent disease after treatment failure. Primary NHLs in the oral cavity are exceptionally rare. In our study, we conducted a retrospective clinicopathologic analysis of all cases of intraoral soft tissue malignant lymphomas. Case Summary Between 2008 and 2018, there were 11 cases of intraoral soft tissue NHLs, including extremely rare cases, such as natural killer/T-cell palatal lymphoma, mantle cell lymphoma, Burkitt lymphoma that transformed into DLBCL, and mycosis fungoides (cutaneous T-cell lymphoma) of the tongue. All patients were negative for human immunodeficiency virus infection. Age range was 14 to 77 years. The presentation of lesions was diverse, ranging from swellings mimicking dental abscesses to deep ulcers mimicking SCCs and even deep fungal infections. Thus, a fast and accurate differential diagnosis was of high importance. In some of the patients, the oral cavity was the primary site of the disease, which, in part, was a sign of relapse or part of disseminated illness. The most common location was the hard palate. In greater than 90% of cases, intraoral lymphoma was the first sign of relapse. Of these patients, 55% died within 6 months of the oral manifestation of NHL; therefore, early detection of intraoral relapses is critical and highly important. Conclusions Oral mucosal manifestation of NHL is rare and, in most cases, the first sign of relapse. Many NHLs can present in oral soft tissues, and most are fatal, so clinicians should take NHL into consideration when making their differential diagnosis. NHL lesions can mimic periodontal disease, acute abscess, or even other malignancies. Malignant non-Hodgkin lymphoma (NHL) represents approximately 5% of all malignancies of the head and neck region and is the third most common after squamous cell carcinoma (SCC) and salivary gland tumors. NHL originates from the B or T cells of lymphatic tissue. Only 24% of NHL affect extranodal locations. The head and neck region is the second most common site of extranodal manifestation. Only 0.1% to 5% present in the oral cavity, of which the majority are diffuse large B-cell lymphomas (DLBCLs). Intraoral cases manifestations appear as part of progressive or recurrent disease after treatment failure. Primary NHLs in the oral cavity are exceptionally rare. In our study, we conducted a retrospective clinicopathologic analysis of all cases of intraoral soft tissue malignant lymphomas. Between 2008 and 2018, there were 11 cases of intraoral soft tissue NHLs, including extremely rare cases, such as natural killer/T-cell palatal lymphoma, mantle cell lymphoma, Burkitt lymphoma that transformed into DLBCL, and mycosis fungoides (cutaneous T-cell lymphoma) of the tongue. All patients were negative for human immunodeficiency virus infection. Age range was 14 to 77 years. The presentation of lesions was diverse, ranging from swellings mimicking dental abscesses to deep ulcers mimicking SCCs and even deep fungal infections. Thus, a fast and accurate differential diagnosis was of high importance. In some of the patients, the oral cavity was the primary site of the disease, which, in part, was a sign of relapse or part of disseminated illness. The most common location was the hard palate. In greater than 90% of cases, intraoral lymphoma was the first sign of relapse. Of these patients, 55% died within 6 months of the oral manifestation of NHL; therefore, early detection of intraoral relapses is critical and highly important. Oral mucosal manifestation of NHL is rare and, in most cases, the first sign of relapse. Many NHLs can present in oral soft tissues, and most are fatal, so clinicians should take NHL into consideration when making their differential diagnosis. NHL lesions can mimic periodontal disease, acute abscess, or even other malignancies.

Objective: Proliferative verrucous leukoplakia is classified as a potentially malignant disorder because of its high rate of malignant transformation. PVL progresses in a series of clinical stages where the early stage represents multiple, multifocal leukoplakias with a high recurrence rate. The intermediate and late stages are clinically exophytic lesion, diagnosed microscopically as verrucous hyperplasia that often progresses into verrucous carcinoma and/or squamous cell carcinoma. There is no single histologic definition and the diagnosis is retrospective following observed progression of the disorder. The goal of the current study was to conduct a literature review and analysis of PVL in the later stages to gain further knowledge on their clinicopathologic features. Data sources: Medline's PubMed and Google Scholar were searched for adequately documented cases from 1985 to 2018. References of published articles were searched for additional cases. Review methods: Overall, 57 manuscripts were analyzed. 35/57 manuscripts provided adequate data on the clinicopathologic features in the premalignant and malignant stages. Results: Malignant transformation rate was 50% (average of 57 months). Gingiva, palate and buccal mucosa were the most common locations. Clinicopathologic features included; well differentiated carcinoma (78%), perineural invasion (3%), lymph node metastasis (4%); distant metastasis (0%), average duration of illness (65 months), DOD-dead of disease (44%). Moderate dysplasia, severe dysplasia and carcinoma in situ were exceptionally uncommon in the premalignant stages (0.8%). Conclusion: Prognostic factors such as perineural invasion, lymph node metastasis and distant metastasis were uncommon occurrences which may have practical implications on treatment. Further studies are needed to substantiate our findings.

Here, we describe the first reported case of osteosarcoma occurring postsurgically in a tracheotomy tract, highlighting the possibility of osteosarcoma seeding during head and neck surgery. Preventative measures such as performing the tracheostomy after the tumor resection while walling off the tracheostomy site from the operative field should be considered.

Background: Several types of human papillomavirus (HPV) have been found to be associated with oral squamous cell carcinoma (OSCC). Still, the significance of HPV infection and its relationship to patient prognosis remains an important matter of debate. Objectives: To investigate the incidence of HPV infection in OSCC patients in northern Israel populations to determine its role in the etiology and prognosis of OSCC. Methods: OSCC tissues were gathered from the pathology departments at Rambam and Padeh medical centers in northern Israel. HPV DNA typing and immunohistochemistry for p16INK4A antibodies were conducted to evaluate their incidence in OSCC tissues. Statistical analysis regarding its expression in the different sub-populations (Jews, Arabs, Druze) was conducted using chi-square and Fisher's exact tests. Results: The study included 82 patients: 53 men and 29 woman; median age 62.1 years; 54 Jews, 25 Arabs, and 3 Druze. The overall incidence of HPV expression was 45% (n=37). The median age of HPV-positive patients was 53 years vs. 65.8 in the negative group (P < 0.001). The 5 year overall survival of HPV-positive patients was not significantly higher than HPVnegative patients. A significant association was found between P16 expression and overall survival (log-rank P = 0.001). Conclusions: HPV infection in OSCC was not found to be significant in this study; however, P16 expression in the tumor tissue was found to be a positive prognostic factor for better survival"

A 79-year-old female presented to her oral surgeon with a 3 × 2 cm indurated ulcerated mass on her mandibular left alveolar mucosa and a palpable enlarged submandibular lymph node, which were present for 2 weeks (Figure 1). Four years earlier, the patient had been diagnosed with diffuse large B-cell lymphoma of the germinal center type, involving the liver and spleen. At that time, treatment consisted of 6 cycles of (R-CHOP) chemotherapy. The patient was in remission at the time of presentation. Fig. 2Epstein-Barr virus–positive mucocutaneous ulcer (EBV-MUC). A, Low-power view showing an ulcerated fragment of loose fibrous connective tissue with an intense inflammatory reaction without deep extension. (hematoxylin and eosin [H&E], original magnification × 40). B, Higher-power view of the polymorphous, dense, mixed inflammatory infiltrate (H&E, original magnification × 100). View Large Image Figure Viewer Download Hi-res image Fig. 3Epstein-Barr virus–positive mucocutaneous ulcer (EBV-MUC). High-power view of the inflammatory infiltrate with large atypical B lymphocytes and some large pleomorphic lymphoid blasts reminiscent of Reed-Sternberg cells (short black arrows), binucleated plasma cells (long black arrow), and numerous scattered eosinophils (black arrowhead). (hematoxylin and eosin [H&E], original magnification × 200) View Large Image Figure Viewer Download Hi-res image Fig. 4Immunohistochemical stains of LMP-1 (A) and CD30 (B) showing strong staining of the lesional cells, limited to the base of the ulcer without deep extension (original magnification × 100). View Large Image Figure Viewer Download Hi-res image Fig. 5Strongly and diffusely positive immunohistochemical stains of Epstein-Barr virus–positive mucocutaneous ulcer (EBV-MUC). A, CD3-T-cell marker (original magnification × 100). B, CD68-histiocyte cells marker (original magnification × 40). C, Ki67-proliferation marker (original magnification × 100). View Large Image Figure Viewer Download Hi-res image Fig. 6Panoramic radiograph confirming that the lesion is limited to the soft tissue without intraosseous extension. View Large Image Figure Viewer Download Hi-res image Fig. 7Clinical photograph from the left alveolar mucosa 6 months after the biopsy procedure showing nearly complete healing of the ulcer. View Large Image Figure Viewer Download Hi-res image

Surgical blades are common medical tools. However, blades cannot distinguish between healthy and diseased tissue, thereby creating unnecessary damage, lengthening recovery, and increasing pain. We propose that surgical procedures can rely on natural tissue remodeling tools enzymes, which are the same tools our body uses to repair itself. Through a combination of nanotechnology and a controllably activated proteolytic enzyme, we performed a targeted surgical task in the oral cavity. More specifically, we engineered nanoparticles that contain collagenase in a deactivated form. Once placed at the surgical site, collagenase was released at a therapeutic concentration and activated by calcium, its biological cofactor that is naturally present in the tissue. Enhanced periodontal remodeling was recorded due to enzymatic cleavage of the supracrestal collagen fibers that connect the teeth to the underlying bone. When positioned in their new orientation, natural tissue repair mechanisms supported soft and hard tissue recovery and reduced tooth relapse. Through the combination of nanotechnology and proteolytic enzymes, localized surgical procedures can now be less invasive.

Selective neck dissection enables us to reduce the morbidity of neck dissection while maintaining the same oncological results, mainly in clinically negative neck N0. The most common morbidity associated with selective neck dissection is spinal accessory nerve dysfunction and related shoulder disability, which are encountered during dissection of level IIB.The aim of authors' study is to evaluate the incidence of sublevel IIB lymphatic metastasis in clinically N0 oral squamous cell carcinoma (OSCC) patients.The study group comprised 48 men (68%) and 22 women (32%). The median number of the lymph nodes removed from level IIB was 6.5. All the investigated necks were clinically classified as N0, of which 14 (20%) turned out to have an occult nodal metastasis, including only 1 patient (1.42%) of level IIB occult metastasis, which originated from the primary tumor located in the tongue and also metastasized to level IIA. The most associated morbidity was shoulder pain and dysfunction, which presented in 60% of the patients.Also, an electronic search was conducted to find relevant studies investigating the prevalence of level IIB metastasis in OSCC. Ten studies were included for full text review, including the current study. The overall incidence of level IIB metastasis is 4% (17 patients); of these 17 patients, only 4 patients had isolated level IIB nodal metastases (2%).To conclude, neck dissecting, including dissecting level IIB, remains the keystone of treating OSCC. Its prognostic and therapeutic value exceeds its associated morbidity; therefore, dissecting level IIB is recommended in treating OSCC in clinically N0 patients.

BACKGROUND Cancer-associated fibroblasts (CAFs) are generally associated with negative prognostic factors. This study compares the clinicopathologic impact of CAFs in oral squamous cell carcinoma in patients with a history of proliferative verrucous leukoplakia (p-scca) and patients with conventional squamous cell carcinoma of the buccal mucosa, gingiva, and palate (c-scca). METHODS A retrospective clinicopathologic and immunohistochemical analysis of 97 tumor specimens from 78 patients (13 patients with proliferative verrucous leukoplakia-associated squamous cell carcinoma (n = 32) and conventional squamous cell carcinoma from the buccal mucosa, gingiva, and palate (n = 65) was conducted. Immunostaining with anti-alpha-smooth muscle actin (α-SMA) antibody was used to evaluate the presence of CAFs. RESULTS α-SMA expression was an infrequent finding in p-scca and seen in only 6% of p-scca compared to 40% of c-scca (P < 0.0004). In the c-scca subgroup, α-SMA significantly correlated with tumor size (T) (P = 0.009), tumor thickness (P < 0.0009), perineural invasion (P = 0.009), and microscopic grade (P = 0.018). CONCLUSIONS The presence of CAFs was an infrequent finding in our p-scca cohort which may contribute to its seemingly slower growing and less invasive growth pattern. In the cohort of c-scca patients, higher levels of CAFs correlated with microscopic invasiveness, tumor size, and perineural invasion. Practically, these are important observations as targeting strategies are being developed to combat carcinoma types where CAFs significance has been validated.

The role of human papillomavirus (HPV) infection in oropharyngeal cancer (SCC) is well established. The annual incidence of oropharyngeal SCC in Israel is considerably lower than that in the United States. The purpose of this study was to assess the rate of HPV‐related oropharyngeal SCC in Israel.

Purpose: Dentinogenic ghost cell tumor (DGCT) is a very rare odontogenic lesion, with most knowledge based on single case reports. Therefore, a comprehensive analysis was performed of the clinical and radiologic features of reported cases of DGCT with an emphasis on treatment modalities.Material and Methods: This is a case series of DGCTs collected from the literature after a systematic search of Medline's PubMed and Google Scholar. Three additional cases were included from the authors' files. Demographic data of the patients, lesion site and size, and radiologic features were analyzed. Treatment approach and events of recurrence were recorded.Results: Forty-five cases (42 from the literature) were included. The mean age of patients was 39.7 +/- 19.3 years (range, 12 to 79 yr) and the male-to-female ratio was 1.8:1. The mandible-to-maxilla ratio was 1.14:1, with the posterior region of the jaws being the most commonly involved site. Radiographically, 78% lesions were unilocular, 67% were mixed radiolucent and radiopaque, and 68% had well-defined borders. The mean lesion size was 4.0 cm (range, 1.8 to 13.0 cm). The primary treatment for 21 patients was conservative surgery consisting of enucleation or curettage. Follow-up information for longer than 1 year (mean, 6.2 +/- 8.3 yr; range, 1 to 31 yr) was known for 15 patients, of whom 11 (73%) had recurrences. The primary treatment in 19 patients was radical surgery consisting of marginal or segmental resection. Follow-up information for longer than 1 year (mean, 3.3 +/- 2.6 yr; range, 1 to 10 yr) was known for 12 patients, of whom 4 (33%) had recurrences.Conclusions: This study highlighted the potentially aggressive biological behavior of DGCTs that demands extensive surgery and long follow-up. However, owing to the rarity of DGCT, more well-documented cases with long follow-up periods are needed to further define the optimal treatment modalities and prognosis. (C) 2016 American Association of Oral and Maxillofacial Surgeons

A positive margin is among the most significant factors that affects the outcome in head and neck squamous cell carcinoma (SCC). The purpose of this study was to compare the negative margin rates between 2 methods of intraoperative margin assessment in patients with oral cavity SCC.

BACKGROUND:Peri-implant soft tissue reactive lesions (I-RLs) may jeopardize implant success and survival. To the best of the authors' knowledge, its pathogenesis is unknown. The objective of this study is to conduct a clinicopathologic and polarized light microscopy (PLM) analysis of 14 new I-RLs and compare them with comparable tooth-associated cases (T-RLs) to better understand I-RL pathogenesis.METHODS:Fifty-eight new cases of I-RL and T-RL were retrieved from the pathology department archives of Rambam Health Care Campus, Haifa, Israel. Retrospective analysis of histopathologic and clinical features was conducted, documented, and then compared for: 1) I-RL (n = 14), 2) peri-implant pyogenic granuloma (I-PG) (n = 5), 3) peri-implant peripheral giant cell granuloma (I-PGCG) (n = 9), 4) T-RL (n = 44), 5) tooth-associated pyogenic granuloma (T-PG) (n = 21), and 6) tooth-associated peripheral giant cell granuloma (T-PGCG) (n = 23). Presence of foreign bodies was assessed using PLM.RESULTS:Foreign bodies were found more commonly in I-RLs (n = 13/14; 93%) when compared with T-RLs (n = 18/44; 41%), which was a statistically significant difference (P = 0.01) with an odds ratio of 7.9. Microscopically, I-PGCG was associated with: 1) lower multinucleated giant cell count (P = 0.04); 2) lower density of mesenchymal cells (P = 0.05); and 3) more diffuse, non-lobulated stromal morphology (P = 0.001). Clinically, I-RLs were found in patients who were older, and all cases were located in the posterior region: mandible (n = 12/14; 86%) and maxilla (n = 2/14; 14%).CONCLUSIONS:In cases of implant failure, implantation of foreign bodies may play a role with subsequent development of I-PG and I-PGCG-like lesions. Clinicians should be aware of this risk so they can implement measures to minimize adverse implant outcomes.

Purpose To present a series of rare and serious complications associated with endosseous implant therapy. Materials and methods Five cases of mandibular osteomyelitis emerging in dental implant insertion sites are presented. In three cases, the clinical signs and symptoms of osteomyelitis occurred almost immediately following implant insertion. All cases occurred in patients with stable pre-existing medical conditions. Three of the patients were females and two were males, all of whom were in their sixth and seventh decades of life. Results Clinical symptoms such as pain and local infection were observed in all cases, despite long-term antibiotic treatment. All cases underwent progressive surgical treatment including corticotomy, saucerization, sequestrectomy and drainage. Two cases exhibited spreading of bone infection in the mandible which required segmental mandibulectomy and fixation using reconstruction plates. The symptom-free state was only achieved following surgical intervention and antibiotic treatment in four patients. A minimal follow-up of 1 year revealed complete resolution of the infection and symptoms in four out of five patients. The outcome of the fifth patient is unknown. Conclusions Osteomyelitis related to dental implants is a rare and serious complication. Prolonged antibiotics at high dosage together with aggressive surgical treatment is required. Increasing the awareness among dental surgeons and maintaining correct surgical principles are essential in order to reduce the risk of osteomyelitis. Conflict of interest statement: We have no conflict of interests to report.

To determine if the clinical and histological features of squamous cell carcinoma associated with proliferative verrucous leukoplakia (p-scca) are distinct from conventional squamous cell carcinoma (c-scca) to better understand patients with proliferative verrucous leukoplakia (PVL).