Journal of Oral and Maxillofacial Surgery Medicine and Pathology最新文献

An eosinophilic ulcer of the oral mucosa is a benign and self-limiting lesion that usually occurs on the tongue and rarely affects the gingiva. We report a case of an eosinophilic ulcer of the mandibular gingiva associated with osteonecrosis. A 43-year-old woman with swelling and pain in the left mandibular molar region was referred to our hospital. She had burned her left mandibular gingiva while eating a hot apple pie 4 days ago. Physical examination revealed diffuse swelling in the left perimandibular region, and intraoral examination revealed mucosal necrosis in the left mandibular molar region. Eosinophilic granulomatosis with polyangiitis was suspected based on the histopathological findings. However, systemic examination revealed no other abnormality, and the patient was finally diagnosed with eosinophilic ulcer. Although the swelling and pain resolved following antibiotic administration and local irrigation, we observed bone exposure in the left mandibular second premolar region 12 days after the patient’s initial visit. Sequestrectomy and tooth extraction were performed under general anesthesia. The patient had no recurrence at 15 months postoperatively. This case demonstrates that an eosinophilic ulcer can occur in the gingiva and alveolar mucosa and cause osteonecrosis. The features of eosinophilic ulcer resemble those of malignant tumors, and careful differential diagnosis is necessary.

Objective

The aim of this study was to evaluate the features of rare oral and maxillofacial benign and malignant tumors of fibroblastic, myofibroblastic and fibrohistiocytic origin in an attempt to contribute to the diagnosis of these tumors.

Methods

The sample consisted of 16 cases of benign fibrohistiocytic (BFH) tumor, myofibroma (MF), solitary fibrous tumor (SFT), fibrosarcoma (FS), dermatofibrosarcoma protuberans (DFSP), and myofibroblastic sarcoma (MFS), obtained from a laboratory of oral pathology. They were submitted to morphological, histochemical (Masson’s trichrome), and immunohistochemical (α-SMA, vimentin, desmin, CD34, Bcl-2, S100, CD68, CD99, and Ki-67) analysis.

Results

Morphological analysis revealed variable features in the tumors studied. Masson’s trichrome resulted in blue staining in most cases. Regarding the immunohistochemical features, all cases were positive for vimentin and negative for desmin. The BFH tumors exhibited positive staining for CD68 and S100, while MFs were positive for α-SMA and SFTs were positive for CD34, CD99 and Bcl-2. With respect to malignant tumors, DFSP was positive for CD34 and Bcl-2 and MFS was positive for α-SMA and Bcl-2, while FS was negative for most of the antibodies analyzed. A higher proliferation index (Ki-67) was observed in malignant tumors.

Conclusions

Considering their similarity, the use of auxiliary techniques might help in the differential diagnosis of these tumors.

Most of the previous studies have reported the treatment of ankylosed anterior teeth with surgical luxation. To the best of our knowledge, this is the first report in the English literature about the treatment of a mandibular first permanent molar with a single-tooth dento-osseous osteotomy. We report a case of surgical treatment and perioperative management of an ankylosed mandibular molar with a single-tooth dento-osseous osteotomy.

Objective

The study aimed to introduce the closure technique using palatal island flap with or without hinge flap for oroantral or oronasal fistula. We explained the surgical methods, assessed the efficacy of these techniques and compared with other closure methods.

Methods

This study included nine patients who were diagnosed with oroantral or oronasal fistula and underwent treatment; closure technique using palatal island flap with hinge flap (double flap closure) or that without hinge flap (single flap closure) between 2000 and 2022. Etiological factors included malignant tumors, benign tumors, cyst, and trauma. Double flap closure was performed in five cases, wherein primary closure was achieved with hinge flap created using surrounding palatal mucosa and secondary closure was achieved with palatal island flap. Single flap closure was performed in four cases.

Results

All nine patients were treated successfully, and follow-up showed no evidence of flap necrosis or major postoperative complications.

Conclusions

The main advantages of this double flap closure technique include effective primary closure with hinge flap, which can prevent perforation into the nasal cavity and/or sinus even if the secondary flap (palatal island flap) becomes loose due to palatal mucosa irritation, and rich blood supply in the palatal island flap from the greater palatine artery. These factors confirm the validity of this technique. Secure closure with single palatal island flap was achieved; however, more secure closure can be achieved by using double flap closure technique. Therefore, it is important to choose single or double flap closure technique depending on the case.

Introduction

Immune checkpoint inhibitors (ICIs) have been clinically used to treat various cancers. This has resulted in a paradigm shift in the treatment of cancers, including recurrent/metastatic oral squamous cell carcinoma (R/M OSCC); however, response rate to treatment with ICIs is limited to 20–30%, and the treatment efficacy varies among patients. Therefore, developing a stratification method to accurately select patients expected to respond to the treatment would be beneficial. Extracellular vesicles (EVs) are important mediators of intercellular communication. Notably, programmed death-ligand 1 (PD-L1) is expressed on the surface of EVs in several malignancies. Herein, we focused on the clinical significance of PD-L1-expressing EVs (PD-L1 EVs) circulating in the serum of patients with R/M OSCC treated with ICIs.

Methods

Overall, 37 patients with R/M OSCC who were treated with ICIs at our institution were evaluated, and the optimum cutoff level of PD-L1 EVs was determined using a receiver operating characteristic analysis. Furthermore, we evaluated the association between PD-L1 EV levels and various clinicopathological features as well as the effects of PD-L1 EVs status on prognosis.

Results

The optimum cutoff level of PD-L1 EVs was 2.90 ng/mL. Further, Kaplan–Meier curve analysis revealed that high PD-L1 EV level was significantly associated with poor overall survival. Moreover, multivariate analysis indicated that high PD-L1 EV level was independently correlated with poor 5-year overall survival.

Conclusion

These findings indicate that assessing levels of PD-L1 EVs in serum before treatment may be a valuable prognostic indicator for patients with R/M OSCC following ICIs treatment.

Objective

Evaluation of the osteoconductive p otential of the nanocomposite tricalcium phosphate/hydroxyapatite (TCP/HA) bi-doped with zirconium (Zr) and silver (Ag) ions versus TCP/HA & 4AgTCP/HA in induced defects.

Methods

Fifteen dogs were divided into four groups in 12 weeks duration before euthanasia: 1-control, 2- TCP/HA, 3- TCP/HA doped with Ag and 4-TCP/HA bi-doped with Ag & Zr groups. Four surgically created defects were randomly allocated in each animal on the left and right mandibular sides, three defects were grafted with mentioned alloplasts and one empty control. Clinical, radiographic, and histological evaluations were performed for the newly formed bone.

Results

Clinical results revealed no infection or inflammatory conditions. All graft groups revealed a significant increase (P<0.05) in mature bone mean density versus controls. TCP/HA bidoped with Ag and Zr group elucidated a highly significant increase (P <0.01) in mature bone density compared to other groups while the TCP/HA was statistically insignificant (P > 0.05) compared to the Ag-doped TCP/HA. The bactericidal action of both Zr and Ag nanoparticles was evident by antibacterial testing.

Conclusion

Bi-doping of TCP/HA with Ag and Zr has a synergistic osteoconductive effect to enhance bone formation as an excellent modality for defective bone reconstruction. Histomorphometric investigation clarified that Ag and Zr doped TCP/HA stimulated osteogenesis and bone remodeling as compared to un-doped TCP/HA. Therefore, this nanocomposite has promising clinical significance in grafting maxillofacial bone defects for optimal healing compared to un-doped TCP/HA. Moreover, Zr and Ag nanoparticles are effective bactericidal materials with optimal biological safety on the animals.

Papillary thyroid carcinoma is the most common pathological type of thyroid cancer. Lymph node metastasis in patients with papillary thyroid carcinoma is common. We report a case of cervical lymph node metastasis of papillary thyroid carcinoma in a patient with maxillary gingival squamous cell carcinoma. A 77-year-old man presented with swelling and pain on the left side of the maxilla. Maxillary gingival squamous cell carcinoma without cervical lymph node metastasis was suspected from the CT images of the lesion in addition to panoramic radiography. A partial biopsy of the maxillary region was performed. Histopathological diagnosis was well to moderately differentiated squamous cell carcinoma. Chemoradiotherapy (CDDP: 400 mg and external radiation: 60 Gy) was performed for the maxillary tumor, and post-chemoradiotherapy outcomes were good for the maxillary tumor. However, contrast-enhanced CT taken 4 months after the primary treatment showed increase of the superior internal jugular node with heterogeneous enhancement and the mid internal jugular node with homogeneous enhancement and flecks of calcification on the left side of the neck. Cervical lymph node metastasis of the left maxillary gingival carcinoma after chemoradiotherapy was suspected from the CT images. Neck dissection was performed. Histopathological diagnosis was cervical lymph node metastasis of the left maxillary gingival squamous cell carcinoma and papillary carcinoma of the thyroid.

Objective

In the general management of postoperative pain after third molar surgery under intravenous (IV) sedation, a nonsteroidal anti-inflammatory drug (NSAID) or acetaminophen is usually prescribed. However, there is no concrete evidence regarding whether an NSAID or acetaminophen is more effective. In this study, we assessed the efficacy of a single dose of IV NSAIDs (50 mg flurbiprofen axetil) compared with that of a single dose of 1000 mg acetaminophen in reducing pain when administered after impacted mandibular third molar surgery.

Methods

In this retrospective observational cohort study, we collected data from medical records of patients who underwent single mandibular molar surgery in a hospitalization setting under IV sedation from 2017 to 2021. We defined patients who received IV flurbiprofen axetil after surgery as the FLB group and those who received IV acetaminophen as the AA group. The primary study outcome was the maximum postoperative pain score during the first 5–15 h post-surgery. The secondary outcome was pain suppression time (the time of initial adjuvant analgesic dose [60 mg loxoprofen]) and the number of doses within 17 h post-surgery.

Results

The FLB group had significantly lower pain levels at 1, 2, and 3 h postoperatively than the AA group. In addition, the FLB group showed significantly lower adjunct analgesic consumption.

Conclusions

IV NSAID administration after impacted mandibular third molar surgery provided more effective pain control than IV acetaminophen. This information can be used by clinicians, especially those working with patients with post-surgical pain, to improve patient care and recovery.

Objectives

Many investigators are looking into the possibility of using platelet-rich. hemoderivatives as a source of the protein structures and cytokines necessary for. periodontal healing of wounds. The objective of the study was to evaluate and. compare the structural, mechanical, and histochemical characteristics of L-PRF and TPRF. membranes prepared by using three different centrifugation protocols.

Methods

Thirty participants around the ages of 20 and 35 who were in good overall. health had their antecubital veins pricked for ten milliliters of the blood. Venous blood. was centrifuged immediately after collection in silica-coated glass tubes and titaniumcoated. tubes utilizing the APRF machine. The mechanical properties of PRF. membranes (n = 30) for L-PRF and T-PRF each protocol) were assessed using a. desktop universal testing machine.

Results

The forces around 700 g (3200 rpm, 15 min) yielded a PRF membrane with. desirable mechano-degradation characteristics for its clinical application. Histochemical examination revealed mixed inflammatory infiltrate with predominantly. platelets followed by lymphocytes, neutrophils& monocytes in T-PRF. Whereas, in. LPRF thin strands of mixed inflammatory infiltrate predominantly neutrophils &. monocytes are seen in the connective tissue stroma.

Conclusion

This study demonstrated that centrifugation speed, force, and time. influenced the structural, and mechanical properties of PRF membranes prepared with. various protocols. This is the first study to reveal the marked impact of glass and. titanium-reinforced centrifugation tubes on the final production of PRF. It was further. found that a significant difference was observed between L-PRF and T-PRF at. 3200 rpm and 2700 rpm protocols.