Oral Surgery Oral Medicine Oral Pathology Oral Radiology最新文献

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.

Objective: To investigate the association between self-reported race and ethnicity with oral potentially malignant disorders and oral cancer, considering environmental and genetic influences.

Study design: This was a case-control study including clinical information and DNA samples from 792 subjects from the University of Pittsburgh dental clinics. The cases were 264 subjects diagnosed with oral potential malignant disorders or oral squamous cell carcinoma. Controls were matched by sex and age in a 1:2 ratio. χ² tests detected differences between groups regarding ethnicity, race, and covariates. A Post-hoc test with Bonferroni and Holm corrections accounted for multiple comparisons between groups. A standard χ² residual test was used to investigate which ethnicity category contributed most to the association. Multiple logistic regression models were used to obtain the unadjusted and adjusted odds ratios (ORs) and to detect the association between single-nucleotide variants and outcomes, stratified by ethnicity and race.

Results: The risk of having the outcomes was 78% greater in those patients who self-reported as African American (OR, 1.78; P = .002; 95% confidence interval, 1.225-2.592). Minor allele G (rs9879992-GSK3B) increased the risk for the outcomes in patients who self-reported as African American (OR, 1.85; P = .002; 95% confidence interval, 1.236-2.772).

Conclusions: Self-reported race and ethnicity were associated with oral potential malignant disorder/oral cancer. Future studies using ancestry informative markers can confirm these findings.

Objective: This case series evaluates the impact of well-controlled human immunodeficiency virus (HIV) on the success of elective orthognathic osteotomies.

Methods: A retrospective review of HIV-positive patients undergoing elective orthognathic osteotomies was conducted. Inclusion criteria required patients to have an HIV diagnosis, undergo orthognathic surgery, and be treated with ART, leading to well-controlled HIV (viral load below 200 copies/mL). Those with incomplete records were excluded. Study variables were grouped into demographic (e.g., age, sex, dentofacial deformity), HIV-specific (e.g., viral load, CD4 count), and operative (e.g., procedure type). Perioperative management included continued antiretroviral therapy (ART), antibiotic prophylaxis, and strict infection control.

Results: Three patients (aged 34-59) with well-controlled HIV underwent Le Fort osteotomy and bilateral sagittal split osteotomy (BSSO). Two had developmental dentofacial deformities, one was post-traumatic. Two Le Forts were 2-piece, one was 3-piece; 2 patients had BSSO. All showed successful bone healing without increased infection or nonunion rates post-allogenic bone grafts.

Conclusion: Well-managed HIV-positive patients can achieve successful outcomes in elective orthognathic osteotomies, comparable to those in HIV-negative individuals. The small sample limits generalizability, warranting further research to assess long-term outcomes and refine perioperative guidelines.

Objective: This study aimed to identify whether immunonutritional biomarkers as prognostic factors are related to the prognosis of the conservative management of medication-related osteonecrosis of the jaw (MRONJ).

Study design: This retrospective observational study investigated the prognostic factors, including the immunonutritional biomarkers, that are associated with the conservative treatment outcomes of patients with MRONJ enrolled from 2010 to 2023.

Results: A total of 77 lesions were included, of which 38 (49%) showed complete healing of the MRONJ. On the multivariate logistic regression analysis, hemoglobin (>11.8 g/dL; odds ratio [OR] = 6.77; 95% confidence interval [CI], 1.95-23.50, P = .003), albumin (>4.0 g/dL; OR = 8.43; 95% CI, 2.12-33.60; P = .003), prognostic nutritional index (PNI; >46.6; OR = 6.53; 95% CI, 1.18-23.50; P = .004), and the hemoglobin, albumin, lymphocyte, and platelet (HALP) score (>20.46; OR = 4.77; 95% CI, 1.48-15.40; P = .009) were significantly associated with complete healing of MRONJ.

Conclusion: The results indicate that immunonutritional biomarkers such as albumin, hemoglobin, PNI, and HALP scores obtained from the laboratory data in daily clinical practice were found to be significantly associated with treatment outcomes of MRONJ.

Objectives: Determine the utility of low-flip angle "black bone" magnetic resonance imaging (MRI) for cortical mandibular bone assessment compared to computed tomography (CT).

Methods: Quantification of cortical mandibular bone width was performed per Hamada et al. at 15 cross-sectional interdentium locations on pretreatment black bone MRI and CT for 15 oropharyngeal cancer patients, with interobserver analyses on a subset of three patients by 11 observers. CT and MRI measurements were compared using Bland-Altman analysis, Lin's concordance, and Deming regression; interobserver variability was assessed with absolute variance and intraclass correlation coefficient (ICC).

Results: Bland Altman and Deming regression analyses showed CT and black bone MRI measurements were comparable within ±0.85mm limits of agreement, and systematically smaller for MRI. ICC (0.60[0.52;0.67]) showed moderate equivalence between modalities. The average absolute variance between the observers was similar on CT (1.13±0.06mm) and MRI (1.15±0.06mm). ICC analysis showed that measurement consistency was significantly higher (p<0.001) for black bone MRI (0.43[0.32;0.56]) than CT (0.22[0.13;0.35]); nonetheless, ICC was poor for both modalities.

Conclusion: Black bone MRI is a viable alternative to CT for assessing mandibular cortical bone and early detection of anatomical changes like osteoradionecrosis. Both modalities showed similar interobserver variability, which may be reduced through (semi)automated measurement.

Objective: This randomized, double-blind, split-mouth clinical trial evaluated the effects of oral vitamin C supplementation on early wound healing and postoperative complications following the surgical extraction of impacted mandibular third molars.

Study design: Fifty-six healthy individuals underwent bilateral extractions, with vitamin C and placebo randomly assigned to each side. Supplementation began 1 day before surgery and continued for 7 days. Clinical outcomes, including pain, analgesic consumption, wound healing, facial swelling, and trismus, were measured preoperatively and on postoperative days 2 and 7.

Results: Pain scores were significantly lower in the vitamin C group on day 2, while analgesic use and wound healing showed favorable trends, although these differences did not reach statistical significance. Facial swelling was significantly reduced on day 2 in the vitamin C group across all measurements. Trismus did not differ significantly between groups.

Conclusions: Oral vitamin C supplementation may reduce early postoperative pain and swelling and may support early wound healing following third molar surgery. As a safe, accessible, and low-cost intervention, vitamin C could serve as a useful adjunct in oral surgical practice to improve patient recovery and comfort. Further randomized controlled trials with longer follow-up and optimized dosing protocols are warranted.

Objective: Surgical site infections (SSI) are a common but clinically significant postoperative complication in oral squamous cell carcinoma (OSCC) surgery with center-specific microbiology. This study aimed to quantify SSI incidence, identify independent predictors as a pre-ERAS baseline, with an exploratory estimate of ERAS impact.

Study design: Retrospective cohort at a major Italian center, including 575 adults undergoing OSCC resection. SSI were defined per Centers for Disease Control and Prevention (CDC/NHSN) criteria with a 30-day surveillance window. Cultures/susceptibility testing were obtained when infection was suspected. Multivariable logistic regression with Lasso and Cox models estimated odds and hazard ratios; receiver operating characteristic analyses assessed discrimination.

Results: SSI occurred in 24.3% patients with a median onset 7 days. Independent predictors were age per 10 years, smoking, alcohol use, and radical neck dissection (RND) as supported by Cox estimates. Exploratorily, the ERAS period (late-2022 onward) was associated with lower SSI hazard. Microbiology was predominantly polymicrobial (71.4%), led by Staphylococcus aureus and Pseudomonas aeruginosa.

Conclusion: s: Age, smoking, alcohol use, and RND predict SSI. ERAS pathway was introduced in 2022. Future prospective studies are needed to improve outcomes, considering that microbiological findings and resistance rates reflect the local ecology of a tertiary Italian center and may differ in other settings.