Oral Surgery Oral Medicine Oral Pathology Oral Radiology最新文献

Objective: To evaluate oral clinical and cytological changes in patients on HIV pre-exposure prophylaxis (PrEP).

Study design: Clinical evaluations and epithelial cell smears were done on ventral tongue, buccal, and labial mucosa before treatment (T0), after 30 (T30), and 120 days (T120) of PrEP use. Clinical changes were assessed using questionnaires and oral examinations, and a descriptive analysis was performed. Cellular changes were observed through liquid-based exfoliative cytology, and the Wilcoxon and McNemar tests were applied.

Results: Sixty-three patients (60 males, 3 females; mean age 29.65) were included; 36 returned at T30 and 20 at T120. Most frequent complaints were dry mouth and increased fluid intake. Wilcoxon test showed no systematic observer error (P > .05). Karyomegaly increased significantly in all sites at T30 and in ventral tongue and buccal mucosa at T30 and T120 (P < .05). Keratinization increased significantly in buccal mucosa at T30 and ventral tongue at T30 and T120 (P < .05).

Conclusion: Our findings indicate an increase in oral epithelial changes during the first 30 and 120 days of PrEP use. Although these changes are nonspecific, continuous oral health monitoring may support early detection of alterations and adherence among patients on HIV PrEP.

Objective: Programmed cell death-ligand 1 (PD-L1) expression and immune phenotype (IP) are potential predictive biomarkers for immune checkpoint inhibitors (ICIs) in recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC). This study evaluated the predictive value of combining PD-L1 expression and IP in R/M HNSCC.

Study design: Forty-one R/M HNSCC patients treated with ICI were included. PD-L1 expression was evaluated using the standardized 22C3 pharmDx assay. IPs were assessed using Lunit SCOPE IO, an artificial intelligence-powered tumor-infiltrating lymphocyte analyzer.

Results: Thirty-nine patients (95.1%) were classified as PD-L1 positive (combined positive score ≥1). Overall, 27 (65.9%) had desert IP. PD-L1 expression and IP were combined to classify patients into 3 groups: group A, negative PD-L1; group B, positive PD-L1 with desert IP; group C, positive PD-L1 with non-desert IP. The median progression-free survival (PFS) was 1.2 months in group A, 2.1 months in group B, and 12.1 months in group C (P = .015). In multivariate Cox analysis, PD-L1 expression combined with IP was an independent factor for PFS, with a hazard ratio of 0.14 (P = .018) in group C and 0.37 (P = .186) in group B, relative to group A.

Conclusions: In R/M HNSCC, integrating IP with PD-L1 expression may enhance prediction of ICI outcomes.

Coronectomy, a surgical procedure involving intentional crown removal with root retention of mandibular third molars at high risk of inferior alveolar nerve injury, represents a validated nerve-sparing alternative to complete extraction. This review summarizes evidence demonstrating its superior neuroprotective efficacy: Coronectomy reduces inferior alveolar nerve injury risk by 87% (0%-0.65% vs. 3.7%-19% in conventional extraction), with significantly lower rates of permanent sensory deficit (0.6% vs. 0.9%). Long-term outcomes (>5 years) reveal predictable root migration (>90% of cases; mean 2.5-4.6 mm, predominantly within 6-12 months), minimal chronic pain (0% after 3 years), and enhanced bone regeneration at the distal aspect of adjacent second molars (mean gain: 3.2-3.5 mm). Secondary extraction rates remain low (3.1%-5.4%), primarily indicated for root exposure (2.1%-3.5%) or infection (0.3%-1.6%). Key controversies include the contraindication of routine root canal treatment (failure rate: 87.5% vs. 12.5% without) and emerging two-stage extraction techniques. Strict cone beam computed tomography-guided selection criteria are critical to success. Future priorities include migration prediction models and bioactive material-enhanced healing. Taken together, coronectomy represents a clinically robust strategy for high-risk mandibular third molars when balancing nerve preservation against manageable complications.

Objective: The study purpose was to measure the association between demographic and socioeconomic factors in the management of nasal bone fractures.

Study design: This was a retrospective cohort study of 995 adult patients presenting to John H. Stroger Jr. Hospital of Cook County from 2016 to 2024 with nasal bone fractures. The primary outcome variable was operative versus non-operative management. Data analysis was performed using chi-squared, Pearson's correlation, Mann-Whitney U tests, and multivariate logistic regressions.

Results: Females were more frequently scheduled for follow-up (P = .015). Patients who attended follow-up (P < .001) and underwent surgery (P = .01) were younger on average. Detainees, or incarcerated/jailed patients, were more likely to attend follow-up (P < .001). High median household incomes and non-Chicago zip codes were associated with lower follow-up rates (P = .023). In bivariate analysis, Black/African American patients were less likely to undergo surgery than White patients (P = .035). In the subgroup, higher median household incomes were more likely to undergo surgery (P = .031).

Conclusions: Demographic and socioeconomic factors are associated with the management of nasal bone fractures, including likelihood of operative intervention. Surgeons should consider the role that these factors and unconscious bias play in treatment.