Head & Face Medicine最新文献

Background: Squamous cell carcinoma of the lip (LSCC) is a relatively rare malignancy. The criteria for performing a neck dissection remain unclear, as reliable predictors for lymph node metastasis (LNM) have not been fully established. This study aimed to identify risk factors for LNM to guide the indication for elective neck dissection.

Methods: A total of 57 patients with LSCC were evaluated based on 81 clinical and pathological parameters, including three previously published pathological grading systems. Statistical analyses focused on identifying the most relevant and independent predictors of LNM using univariate and multivariate logistic regression, supplemented by the LASSO algorithm for feature selection.

Results: Tumor size (OR 1.008, p = 0.85) and peritumoral tumor budding (OR 1.43, p = 0.059) emerged as the most relevant independent predictors of LNM. Notably, the number of peritumoral tumor buds was significantly higher in lymph node-positive (pN +) patients compared to lymph node-negative (pN -) patients (p < 0.01). Receiver operating characteristic (ROC) curve analysis demonstrated that peritumoral tumor budding outperformed other classification systems, with the highest area under the curve (AUC = 0.86).

Conclusion: Peritumoral tumor budding shows strong predictive potential for lymph node metastasis in LSCC, offering valuable insights for the preoperative evaluation and indication for elective neck dissection.

Background: Surgical correction of unilateral cleft lip and palate (UCLP) aims to restore normal facial development and function. Achieving symmetry is essential for dental arch development and facial symmetry. The surgical treatment can result in midfacial retrusion, maxillary constriction, and alveolar segment collapse. The aim of this study was to develop a novel 3D analysis method for assessing possible effects on maxillary arch development following different surgical techniques for lip repair in UCLP patients.

Methods: The dimensions of the maxillary arch were analyzed and compared in children with UCLP who had undergone Delaire or Tennison-Randall/Pfeifer surgery before lip and palate closure using digitized dental plaster casts. Two different evaluation methods were used in the study: the 2D analysis was based on linear measurements using reference points in the OnyxCeph3™ software. The semi-automatic 3D analysis was based on the curve-fitting method and our self-developed customized software application (SMP).

Results: No significant differences were observed using the 2D method. However, the 3D analysis detected statistically significant differences in the Q coefficient (p = 0.001393) between the two surgical techniques, demonstrating the superior ability of the 3D method to assess morphological changes.

Conclusions: The 3D analysis did not depend on classical reference points. It provided new information for assessing the collapse of maxillary segments. This analysis is a valuable tool for evaluating the impact of surgical techniques on maxillary arch development in children with UCLP. These findings advocate the integration of advanced 3D imaging tools in cleft surgery planning and postoperative assessment.

Background and objectives: Oral squamous cell carcinoma (OSCC) is a highly aggressive malignancy with poor prognosis and limited treatment options. N6-methyladenosine (m⁶A) modification represents a pivotal layer of epitranscriptomic regulation in cancer. Fat mass and obesity-associated protein (FTO), an m⁶A demethylase, has been implicated in several malignancies. While FTO's involvement in OSCC is emerging, its regulation of glycolytic metabolism remains uncharacterized. This study aimed to investigate the biological function of FTO in OSCC and determine whether it modulates PKM2 expression through an m⁶A-dependent mechanism involving YTHDF2.

Materials and methods: FTO expression was analyzed in OSCC tissues by immunohistochemistry and Western blotting. Functional assays were performed in SCC25 and CAL27 cells with stable FTO knockdown or overexpression to assess proliferation, migration, invasion, and glycolytic activity. Global m⁶A levels, RNA-protein associations, and mRNA stability were examined using dot blot, RIP-qPCR, and actinomycin D treatment. NF-κB pathway activation was evaluated by Western blotting. In vivo tumorigenicity was assessed using xenograft models.

Results: FTO was markedly upregulated in OSCC tissues and correlated with aggressive clinical features. Silencing FTO attenuated malignant phenotypes and glycolytic flux. Mechanistically, FTO stabilized PKM2 mRNA by reducing YTHDF2-mediated degradation via m⁶A demethylation. FTO expression also coincided with enhanced NF-κB signaling activity.

Conclusion: These findings define an FTO/m⁶A/YTHDF2/PKM2 axis that promotes OSCC progression through glycolytic reprogramming and tumor growth, highlighting a potential metabolic vulnerability for therapeutic intervention.

Objectives: The objective of this prospective, randomized, parallel-group clinical study was to compare the 6- and 12-month clinical performances of direct composite restorations with or without fiber-reinforced composite applied to endodontically treated posterior teeth (ETpT) in bruxists.

Materials and methods: Thirty-two ETpT were randomly restored with only posterior composite (gneal posterior, GC; CR group) or fiber-reinforced composite (EverX flow, GC) + posterior composite (FRCR group) in bruxists aged 18-65 years (n = 16). The inclusion criteria were as follows: bruxists with ETpT; class 1/2 cavities; the remaining functional wall at least 3 mm thick; teeth with a natural tooth in the opposite arch; and adjacent teeth on both approximal sides. The presence of periapical symptoms, posterior teeth with tubercule loss, and teeth with root canal fillings at least 2 mm short of the radiographic apex were excluded.

Results: All restorations were evaluated at 6 and 12 months on the basis of the World Dental Federation (FDI) criteria. No failure was reported, and clinical success was recorded for all aesthetic, functional, and biological criteria at 6 and 12 months of follow-up in both groups.

Conclusions: Small/medium-sized direct composite restorations with or without fiber-reinforced composites demonstrated excellent and similar clinical performances at 12 months in bruxists.

Clinical relevance: Since parafunctional forces can be significantly higher than normal chewing forces, the study focused exclusively on patients with bruxism. The 12-month clinically successful outcomes of direct composite restorations both with and without SFRC in this study will guide future long-terms studies in evaluating restorations of ETpT in bruxists.

Date of registration: 2025-03-11 (retrospectively registered).

Clinical trial registration: This prospective, randomized, parallel-group clinical study was registered in a publicly accessible database with clinicalTriald.gov.ID No. NCT06870188.

Radiotherapy is a crucial treatment for head and neck squamous cell carcinoma but is associated with several complications, particularly the onset of radiation-related caries (RRC), which severely compromises patients' oral health and quality of life. Most studies have focused on the direct effects of radiation on host organs. Such as radiotherapy/Concurrent Chemoradiotherapy (CCRT) contributing to RRC primarily by inducing salivary gland hypofunction and directly damaging tooth structure. However, emerging evidence implicates additional mechanisms including dietary modifications and oral microbial dysbiosis in driving pathogenic microbial shifts characterized by cariogenic bacterial/fungal proliferation, thereby exacerbating RRC progression. In particular, changes in common cariogenic bacteria/fungi after radiotherapy remain poorly understood. Furthermore, clinical translation of microbial ecology principles into effective RRC prevention strategies remains underexplored. This review centers on radiation-induced oral microbiota alterations, critically analyzing documented microbial shifts characterized by marked proliferation of cariogenic taxa including Streptococcus mutans, Lactobacillus, Prevotella melaninogenica, Veillonella, and Actinomyces, alongside fungal overgrowth of Candida albicans. We propose a dual-focused intervention protocol: initiating probiotic supplementation at radiotherapy commencement to stabilize microbial ecology and preserve salivary function, combined with standardized oral care encompassing mechanical plaque removal, fluoride therapy, and natural anticariogenic agents. While mechanistically plausible, this paradigm requires rigorous validation through multicenter randomized controlled trials assessing ecological stability maintenance and caries incidence reduction.

Objective: This study aimed to evaluate whether adjunctive vitamin D supplementation enhances the efficacy of conventional therapy in treating sudden sensorineural hearing loss (SSNHL) in patients with vitamin D deficiency, and to assess both short-term and long-term clinical outcomes.

Methods: In this prospective randomized controlled trial, 101 SSNHL inpatients with vitamin D deficiency (serum 25-hydroxyvitamin D < 75 nmol/L) were enrolled at Yinchuan First People's Hospital (January-December 2024). Participants were randomized into a control group (n = 51, receiving conventional therapy: methylprednisolone and ginkgo biloba extract) and an experimental group (n = 50, conventional therapy + oral vitamin D3 [1500-2000 IU/day] for 10 days). Hearing and tinnitus outcomes were assessed via pure tone audiometry (PTA) and the Tinnitus Handicap Inventory (THI) at baseline, 10 days, and 3 months.

Results: Baseline characteristics were comparable between groups (all P > 0.05). At 10 days, the experimental group demonstrated significantly higher total effective rates for hearing recovery (82.0% vs. 52.9%, P < 0.001) and tinnitus improvement (83.3% vs. 71.1%, P = 0.007) compared to the control group. Mean PTA improvement was 29.3 dB HL vs. 14.2 dB HL (P < 0.001). At 3 months, the experimental group maintained significantly better outcomes, with a mean PTA improvement of 25.1 dB HL versus 12.5 dB HL in the control group (P < 0.001) and a greater reduction in THI scores (27.5 vs. 13.9, P < 0.001). The total effective rate for hearing remained superior in the experimental group (76.0% vs. 47.1%, P = 0.002).

Conclusion: Vitamin D supplementation combined with conventional therapy significantly improves both short-term and sustained long-term hearing and tinnitus outcomes in SSNHL patients with vitamin D deficiency. These findings support its role as a safe and effective adjuvant treatment, warranting further validation through multicenter trials.

Background: In patients with medication-related osteonecrosis of the jaw (MRONJ), the use of nasogastric tubes (NGTs) after surgery is recommended to allow adequate nutrition without food interfering with oral wound healing. However, NGT therapy is often perceived as irritating and rejected by some patients. This study evaluates the effect of NGT feeding on oral wound healing and patients' oral health-related quality of life (OHRQoL) after surgical treatment of MRONJ.

Methods: We assessed early wound healing in 68 patients after Surgery for MRONJ. Postoperative comparison was made between patients with NGT feeding and a matched control group receiving an oral clear liquid diet. At 14 days postoperatively, the healing of the surgical site was morphologically classified as "complete" or "incomplete". The Early Healing Score (EHS) and the Inflammatory Proliferative Remodeling (IPR) Scale were examined on Days 1, 5 and 14 after surgery. The German version of the Oral Health Impact Profile-14 (OHIP-G 14) was used to assess OHRQoL.

Results: No significant difference was observed in the rate of complete wound healing in patients receiving NGT feeding (61.1%) compared to patients receiving an oral clear liquid diet (62.5%) at 14 days postoperatively. The mean total EHS and the IPR Scale were not significantly different between patients on NGT feeding (EHS: 18.08 ± 5.35, IPR Scale: 14.36 ± 3.08) and patients on an oral clear liquid diet (EHS: 18.03 ± 5.26, IPR Scale: 14.66 ± 3.24). Furthermore, there was no significant difference in the mean OHIP-G 14 total score regardless of NGT therapy or consumption of an oral clear liquid diet.

Conclusions: The results indicate that postoperative NGT feeding has no beneficial effect on wound healing after surgical treatment of MRONJ. It can be assumed that NGT feeding can be replaced by an oral clear liquid diet after surgery for MRONJ without compromising oral wound healing. Additionally, our data suggest that there is no difference in OHRQoL between patients treated with an NGT and those treated with an oral clear liquid diet. Therefore, patients' negative perceptions of NGTs do not appear to affect OHRQoL.

Trial registration: The trial was retrospectively registered with the German Clinical Trials Register on February 26, 2024 (DRKS00033706).

Objective: To evaluate the efficacy and safety of endoscopic navigation-guided 3D printing combined with absorbable materials for individualized minimally invasive reconstruction of orbital blowout fractures, comparing outcomes to preformed titanium mesh controls to validate clinical value in achieving anatomical reduction, improving visual function, and reducing complications.

Methods: This retrospective study enrolled 87 patients receiving absorbable implants (Trial Group) and 19 patients treated with preformed titanium mesh (Control Group). Preoperative CT scans were processed using Mimics 21.0 and Geomagic Studio 12.0 for 3D reconstruction, generating patient-specific guides and 3D-printed orbital models based on mirror-imaged healthy orbits. In the Trial Group, absorbable plates were thermo-molded using surgical guides and implanted; controls underwent titanium mesh trimming followed by screw fixation. Statistical analyses employed SPSS 26.0 with Python-automated covariate control: propensity score weighting (PSW) balanced baseline covariates (gender, age, fracture extent; SMD < 0.1 confirmed balance). Longitudinal continuous data (exophthalmos difference, logMAR BCVA) were analyzed via generalized estimating equations (GEE) modeling time-group interactions, while ordinal outcomes (diplopia severity, ocular motility restriction) used weighted ordinal logistic regression to compute marginal effects. All analyses controlled for timepoint interactions with statistical significance defined at α = 0.05.

Results: The absorbable material group demonstrated superior diplopia resolution (residual rate: 9.2% vs. 31.6%, P = 0.018) with significant long-term recovery interaction (β = 1.59, P = 0.039). Both groups showed significant time-dependent improvements in ocular motility and exophthalmos (P < 0.001), though intergroup differences were non-significant. Trial group BCVA improved an additional 42% at 6 months (interaction β = 0.05, P = 0.028). No implant-related complications (infection/displacement) occurred in the absorbable group.

Conclusion: Endoscopic navigation-guided 3D printing with absorbable materials enables precise, individualized orbital reconstruction, significantly improving diplopia and visual acuity with superior safety, strongly supporting clinical adoption.

Objective: The goal of this paper is to explore the value of choroidal vascular and oropharyngeal morphological indicators in predicting the efficacy of Continuous Positive Airway Pressure (CPAP) treatment in patients with severe Obstructive Sleep Apnea Syndrome (OSAS).

Methods: A total of 245 patients with severe OSAS between January 2022 and June 2024 from a hospital, treated with CPAP, were enrolled. Patients were divided into two groups based on treatment efficacy: the Good response group and the Poor response group. Choroidal vascular indicators [subfoveal choroidal thickness (SF-CT), choriocapillaris vessel density (CC-VD), choroidal vascularity index (CVI)] and oropharyngeal morphological indicators [posterior nasal spine to menton distance (PNS-Me), hyoid-mental distance (HMD), soft palate length (posterior nasal spine to uvular tip point, PNS-P1)] were compared between the two groups. Receiver Operating Characteristic (ROC) curves were drawn to analyze the predictive efficacy of these indicators for CPAP treatment in severe OSAS patients. A nomogram and calibration curve were created to develop a prediction model for CPAP treatment efficacy in severe OSAS patients.

Results: In the Poor response group, the longest apnea duration (LAD), percentage of time with oxygen saturation < 90% (TS90%), and apnea-hypopnea index (AHI) were all significantly higher than those in the Good response group. The lowest arterial oxygen saturation (LSaO2) was notably lower in the Poor response group compared to the other one (P < 0.05). The area under the curve (AUC) values of SF-CT, CC-VD, and CVI for predicting the outcome of IBD patients were 0.835, 0.805, and 0.910, respectively. The AUC values of PNS-Me, HMD, and PNS-P1 were 0.897, 0.937, and 0.898, respectively. In addition, the nomogram prediction model constructed with choroidal vascular and oropharyngeal morphology indicators had high accuracy.  CONCLUSION: Choroidal vascular and oropharyngeal morphological indicators have a good predictive effect on CPAP treatment efficacy in patients with severe OSAS.