Journal of Maxillofacial & Oral Surgery最新文献

Introduction: Submental intubation allows for the passage of an endotracheal tube through the anterior floor of the oral cavity. This allows for adequate surgical access to the regions of the mouth and the nasal pyramid with minimal to no hindrance in airflow to the lungs.

Aim of the study: To explore the perception of an anaesthetist regarding the submental intubation.

Materials and methods: A questionnaire‑based prospective randomized analysis was formatted and carried out in Odisha, India, between 20 Jan 2023 and 20 may 2023. A self-structured questionnaire consisting of 16 questions was distributed to the anaesthetists of the medical colleges in Odisha.

Results: Out of 97, 42 (43%) male and 45 (46%) female were familiar with the submental infiltration technique. Among the participants, 56% females and 43% males have performed and assisted in a submental intubation procedure. None of them encountered any complications or adverse events related to submental intubation (p = 0.0001).

Discussion: Out of all, 20% females and 19% males were very confident in performing submental intubation.

Conclusion: Submental intubation is a simple, safe, quick, and relatively harmless alternative to tracheostomy for securing the airway in selected patients with craniofacial trauma. Familiarity with the submental intubation technique will help the anaesthetists to avoid tracheostomy in selected patients with craniofacial trauma who do not require long-term mechanical ventilation. But, this procedure is technique sensitive as well.

Objectives: To evaluate the positions of the mandibular foramen (MF) and mandibular canal (MC) between different skeletal classes to highlight the implications for bilateral sagittal split osteotomy (BSSO).

Methods: A cross-sectional study was performed using cone-beam computed tomography on 90 patients classified into classes I, II and III. Linear measurements were performed on multiplanar reconstructions as follows: from the MF to the edge of the mandibular ramus (1), to the mandibular notch (2), to the ramus width (3) and to the occlusal plane (4); and from the MC to the alveolar crest (A), to the lower border of the mandible (B) and to the mandibular buccal cortical bone (C). Mandibular thickness (D), width (E) and height (F) of the MC were measured. Intra-class correlation coefficient (ICC) checked the reliability. Two-way ANOVA and Tukey's test were used to compare measurements and classes.

Results: Linear measurements 2 presented a statistically significant difference between classes I and II. There was no statistically significant difference between the classes and measurements B, C, D, E and F. Linear measurements A were shorter in class III than in class II.

Conclusions: Although most measurements suggest that the BSSO technique does not need to be modified for each skeletal class, measurements from the MF to the mandibular notch in class II and from the MC to the alveolar crest on distal of the second molars in class III could help surgeons to recognize critical regions.

Introduction: Coronoid process of mandible is seldom fractured during maxillofacial trauma. Majority of the cases of coronoid fracture are treated conservatively, but some lead to complications which are often overlooked. At present, the literature on coronoid fractures is inadequate for meta-analysis. Also, there exists no standardized classification in the literature. Hence, the purpose of this study was to analyze the incidence and establish a novel 'tripartite' classification.

Material and methods: In this study carried out at level 1 trauma center, all patients with coronoid fracture with or without associated maxillofacial fractures were included. Relevant data were noted from Hospital records and CT scans (computer tomographic scans). These cases were classified according to 'tripartite' classification and treated. Data feed was given to IBM® SPSS® statistics (version 21) for analysis.

Results: Among 33 coronoid fracture patients, majority (57.57% cases) were from age group of 21-40 years with 82.85% cases attributed to road traffic accidents. 11.43% cases were bilateral, and the rest unilateral cases revealed right-side predilection.

Conclusion: Novel tripartite classification allows us to easily categorize and visualize the coronoid fractures. Horizontal types 1 to 3 and vertical types 4 to 6 are in increasing order of incidence, which makes it easy for communication, treatment approach and record maintenance.

Background: Oral carcinoma cuniculatum (CC) is a rare variant of squamous cell carcinoma. It exhibits a locally aggressive behaviour, and its histopathology poses a diagnostic challenge, as it can be mistaken for other conditions. We present five cases of oral CC treated at our institution and conduct a comprehensive review of the current literature.

Case series: Five patients (two women and three men) were treated in our institution with a final diagnosis of oral CC. Ages ranged from 9 to 85 years at the time of diagnosis. Four patients had mandibular involvement requiring mandibulectomy and reconstruction using an osseous free flap. The diagnosis of oral CC was straightforward in the most recent cases. However, for the first two cases, the diagnosis of oral CC was established after thorough discussions between the surgeons and the pathologist regarding the similarities with recent cases. Consequently, the pathological specimens had to be retrospectively re-evaluated to confirm these diagnoses.

Conclusions: Oral CC is a locally aggressive tumour that can present a challenge for pathologists, often leading to misdiagnosis. According to the existing literature, surgical resection with clear margins is the preferred treatment approach.

Objectives: The primary aim is to determine the accuracy of contrast-enhanced computed tomography (CT) in evaluation of depth of invasion (DOI) and detection of cervical node metastasis. We also analysed the relation between radiographic DOI (rDOI) and cervical lymph node metastasis.

Materials and methods: We have retrospectively reviewed 201 oral squamous cell carcinoma (SCC) patients. The rDOI was compared with histological DOI. Sensitivity, specificity, accuracy, and negative (NPV) and positive (PPV) predictive values were evaluated for CT scan in predicting nodal metastasis. The relation between rDOI and lymph node metastasis was analysed using ROC curve.

Results: rDOI correlated significantly with histologic DOI for oral tongue, buccal mucosa, gingiva, and mucosal lip SCC (P < 0.05) and for tumours with rDOI > 5 mm. The sensitivity, specificity, PPV, NPV and accuracy rate of CT scan were found to be 84.71%, 50.86%, 55.81%, 81.94% and 65.17%, respectively. Tumours with rDOI > 16 mm had significant (P < 0.001) chance of having neck node metastasis.

Conclusion: CT-derived DOI correlates significantly with pathological DOI although both are not similar. CT scan can predict nodal metastasis in fairly accurate manner using the four radiographic criteria used in this study. Radiographic depth of invasion can be used as predictor of cervical node metastasis.

Background: Hematoxylin & Eosin (H & E) stains have been conventionally used to establish the status of safe margins following resection of primary Oral Squamous Cell Carcinoma. Due to non-specificity of this stain, there is a possibility of false negative results. In this study, we have assessed the role of Immunohistochemistry (IHC) in establishing the status of safe margins.

Aim: To compare Hematoxylin & Eosin (H & E) and Immunohistochemistry (IHC) staining in identification of tumor cells in establishing the status of safe margins.

Methodology: This study included 14 cases diagnosed with OSCC. Following resection, the primary lesion was subjected to Histopathological analysis. 2 sets of HP slides were prepared from serial sectioning of the wax block prepared for each of the four margins. Both sets of slides were stained with H &E stain. One set of these slides was further stained with Pan CK marker (IHC) which is a cytokeratin marker to identify tumour cells.

Results: All the slides with H & E staining reported negative for tumor infiltration and 4 slides (3 patients) out of 56 were reported positive with PanCK marker. There was a statistically significant difference in the number of patients with positive margins using IHC as compared to H & E stain.

Conclusion: Immunohistochemistry using PanCK marker proved to be more efficient in the determination of status of safe margins than routine H & E staining.

Introduction: Nanotechnology has shown potential in treating different types of cancers. In particular, nano-drug delivery systems (DDSs) offer a promising strategy for treating oral cancer. By customizing therapy and improving drug delivery, these systems can improve outcomes for patients. Hence, a review was conducted to assess the current evidence and explore the use of DDSs for treating oral cancer.

Aim: To comprehensively explore the nano-drug carriers and target delivery for oral cancer therapy and to discuss the benefits, challenges, and potential to guide future research and clinical practice.

Methodology: A systematic search of articles archived in PubMed, Scopus, and Cochrane using keywords such as Nano, drug carrier, target drug delivery, and oral cancer was performed to fulfill the objectives from inception till February 2, 2024. Articles providing insights into nano-drug carriers in oral cancer were included.

Results: The results revealed a total of 156 articles. After duplicate removal, 136 articles were screened for title and abstract as per the inclusion and exclusion criteria. A total of 113 articles were excluded with reasons. Out of the remaining 23 articles, only 11 were included for qualitative data synthesis.

Conclusion: The literature revealed scarcity of oral cancer-related work using DDSs. Qualitative synthesis of data revealed that nano-drug carriers demonstrated a promising avenue for targeted therapeutic approaches in oral cancer, despite the challenges and their potential benefits. Continued research and development in this field are crucial to overcoming these challenges and fully realizing the potential of nano-drug carriers in revolutionizing oral cancer therapy.

Supplementary information: The online version contains supplementary material available at 10.1007/s12663-024-02251-z.

Objective: Cellular cannibalism (CC) is a prime metabolic event to determine the aggressive potential of oral squamous cell carcinoma (OSCC). However, the etiology and mechanism behind this degradation are still ambiguous. The aim of the study was to explore the etiopathogenetic mechanism behind CC, along with its association with degree of differentiation, angiogenic, phagocytic and antiapoptotic activity in OSCC.

Design: Seventy-three tissue sections of various histological grades of OSCC were retrieved from departmental archives and scanned for cannibalistic cells. Immunohistochemical analysis using CD31, CD68, and BCL2 was performed. The data obtained were analyzed using Chi-square, Spearman's correlation test and multiple regression analysis (p < 0.05).

Results: CCs were present significantly in various grades of OSCC (p < 0.00). Immunohistochemical analysis revealed a significant difference in CD68, BCL2 (p < 0.05 in both), and CD31 (p < 0.001) expression with CC. The internalized cells showed positivity for CD68 and negativity for BCL2. Regression analysis revealed that tumor grade, CD31 and BCL2 immunoreactivity were significant predictors of frequency of CC.

Conclusion: The association of CC with degree of differentiation, CD31, CD68, and BCL2 expression could predict the biological behavior of OSCC and might serve as a promising histopathological parameter in future.

Objectives: The presence of lymphovascular invasion (LVI), perineural invasion (PNI) and extranodal extension (ENE) have shown adverse outcomes in oral squamous cell carcinoma (OSCC). This study evaluated the impact of LVI, PNI and ENE, individually and in combination, on survival outcomes in OSCC.

Material and methods: A retrospective analysis of a prospectively maintained oral cancer database was done from January 2017 to March 2023. All consecutive OSCC patients who underwent curative intent surgery were included. The triple-positive group was defined by the presence of all three features (LVI/PNI/ENE), while the double-positive group had the presence of two features. The disease-free survival (DFS) and overall survival (OS) analysis was done between different study groups.

Results: A total of 255 patients were included in the analysis. The LVI, PNI and ENE positivity was 13%, 26% and 11%, respectively. There were 19 patients (7%) with double-positive and ten patients (4%) with triple-positive disease. The triple-positive group had lower DFS than non-triple-positive (0% vs 57%, p-value 0.001) and lower OS (0% vs 72%, p-value 0.003). The median DFS and OS of the triple-positive group were eight months and 24 months, respectively. Similarly, the double-positive group also had statistically significant inferior DFS (p-value 0.007) and OS (p-value 0.002) compared to the single-positive/triple-negative group.

Conclusion: The triple-positive disease had poor outcomes, with no patients achieving disease-free or overall survival at the 5-year follow-up. The presence of multiple adverse factors necessitates modification of adjuvant therapy and therapeutic strategy, which may enhance survival outcomes.

Aim: To evaluate the surgical and postoperative management strategies that contribute to minimizing the need for prophylactic tracheostomy for airway management in advanced oral cancer surgery.

Methods: A retrospective review of the patients who underwent surgery for advanced oral cancer, in our institution from February 2015 to January 2024.

Results: In the present review, 66 patients (males, n = 54; females, n = 12; mean age 50.3 years) who were operated for advanced oral cancer (T3, T4 oral squamous cell carcinoma and osteosarcoma of the mandible requiring mandibular resection) in our institution were included. 60 patients (90.9%) had reconstruction after segmental resection of the mandible without the need for prophylactic tracheostomy. Out of these, eighteen patients (27.27%) required segmental resection of the mandible crossing midline. Six patients (9.1%) underwent prophylactic tracheostomy, of which two patients had unilateral tumor and four patients had tumor crossing midline. Comparison of hospital stays between patients who underwent prophylactic tracheostomy and those who did not yielded mean durations of 13.3 days and 7.6 days, respectively.

Conclusion: Except a subset of patients with old age, obesity, bulky neck, and those with respiratory compromise, following the present guidelines, prophylactic tracheostomy can be avoided in patients undergoing surgery for advanced oral cancer.