Lesions Of Oral Cavity Research Articles

Association between Periodontal Disease and Oral Benign, Potentially Malignant, Malignant, and Chronic Immune-Mediated Disorders: A Clinical Study.

Background: Periodontal disease is an inflammatory, chronic, and multifactorial disease. The objective of this study is to analyze the association between periodontal disease and some disorders such as papillomas (benign lesions), lichen planus (a chronic immune-mediated disorder), leukoplakia (potentially malignant lesions), and oral cancer (malignant lesions). Methods: For this study, 42 patients were recruited whose supragingival and subgingival plaque was qualitatively analyzed using a phase-contrast microscope, which allowed for the detection of compatible bacterial flora (immobile and composed mainly of cocci) indicative of periodontal health and incompatible bacterial flora (mobile and composed mainly of spirochetes) indicative of periodontal pathology. Patients with incompatible bacterial flora were then subjected to a laser-assisted periodontal treatment with irrigation with hydrogen peroxide within the periodontal pockets (a non-surgical laser-assisted periodontal protocol which is referred to as dye-free photodynamic therapy). Results: Based on the 42 patients recruited, there was no association between oral cavity lesions and periodontal pathogenic bacteria. Four of them were found to have incompatible bacterial flora. Indeed, it was found that almost all the patients had been previously instructed in the proper techniques of home oral hygiene, and more than half of them reported that they carried out periodic check-ups by a dental hygienist. Of the four patients with signs and symptoms of periodontitis, two stated a willingness to undergo the non-surgical laser-assisted periodontal protocol and showed improvements in periodontal indices such as CAL, PPD, and BoP. Conclusions: hygienists and dentists are determining factors in the prevention of periodontal disease and for the maintenance of good oral health.

Damage to the organ of hearing and upper respiratory tract in vasculitis associated with antineutrophil cytoplasmic antibodies

Antineutrophil cytoplasmic antibodies associated vasculitis (ANCA-AV) is a systemic necrotizing granulomatous vasculitis affecting mainly small-caliber vessels. ANCA-AV occupy a special place among systemic vasculitis, which is characterized by a highly active life-threatening course of the disease, requiring rapid differential diagnosis and aggressive immunosuppressive therapy. The ANCA-AV group consists of 3 nosologies: granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis and microscopic polyangiitis. The “calling card” of ANCA-AV is the lesion of the upper respiratory tract, especially the ENT organs (70–100 % of patients). The nasal cavity and paranasal sinuses are the most common areas of lesion in the head and neck (85–100 %), whereas ear damage occurs in about 35% (range, 19–61 %) of cases. Lesion of the ENT organs is typical for the debut of ANCA-AV, which makes early diagnosis difficult, since diseases of the upper respiratory tract are extremely common in all age groups. Diagnosis verification occurs mainly at the stage of generalized involvement of many organs and systems, causing severe course with the development of pulmonary-cardiac and renal insufficiency, which lead to the death of the patient. The main ENT manifestations of ANCA-AV can be grouped into several groups: sinonasal, otological, tracheobronchial, oral cavity lesions and others. Pseudotumors are often found in ANCA-AV. They are characterized by the appearance of parapharyngeal, parotid, submandibular, paratracheal volumetric formations. As a rule, the appearance of tumor-like formations is observed at an early stage of the disease and is associated with the presence of antibodies to proteinase 3, systemic manifestations of vasculitis. Pseudotumor in the ENT region may be accompanied by secondary neuropathies of cranial nerves, destruction of bone tissue, which requires histological verification of the disease.

Evaluation of Immunohistochemical Marker Bcl-2 in Epithelial Dysplasia and Squamous Cell Carcinoma of the Oral Cavity.

Squamous cell carcinoma of the oral cavity is the most common malignancy noted globally.Pathogenesis of premalignant and malignant oral lesions is mainly attributed to the alteration in the molecular mechanisms that regulate apoptosis and cell proliferation. B-cell lymphoma gene 2 (Bcl-2) is the anti-apoptotic gene that prolongs cell survival by inhibiting apoptosis and is associated with the aggressive behaviour of malignant tumours. The aim of the study was to evaluate Bcl-2 expression in oral squamous cell carcinoma and dysplastic lesions of the oral cavity and to compare its expression with various grades of dysplasia and carcinoma. A hospital-based cross-sectional study was done on 80 clinically suspected cases of dysplastic and malignant oral cavity lesions received in the histopathology section of the Department of Pathology of Shri BM Patil Medical College Hospital and Research Center, Vijaypura, Karnataka. Out of 80 cases, 40 were squamous cell carcinoma, and 40 were dysplastic lesions of the oral cavity. For each case, two sections measuring 4 μm thickness were prepared. Hematoxylin and eosin staining was performed on one section, and Bcl-2 IHC staining was performed on another. Bcl-2 expression evaluation was done for each case of oral epithelial dysplasia and squamous cell carcinoma. Out of 40 cases of squamous cell carcinoma, 15 were well-differentiated, 22 were moderately differentiated, and three were poorly differentiated. In well-differentiated oral squamous cell carcinoma, Bcl-2 positivity was grade 0 in 66.7% of cases and grade 1 in 33.3% of cases. In moderately differentiated oral squamous cell carcinoma, Bcl-2 positivity was grade 1 in 63.6% of cases and grade 2 in 36.4% of cases. In poorly differentiated oral squamous cell carcinoma, Bcl-2 positivity was grade 1 in 33.3% and grade 2 in 66.7% of cases. Out of 40 cases of dysplastic lesions, 11 cases showed severe dysplasia, 11 cases showed moderate dysplasia and 18 cases showed mild dysplasia. grade 2 positivity was seen in 72.7% of cases of severe dysplasia and 63.6 % of cases of moderate dysplasia. In mild dysplasia, all of the cases showed grade 0 Bcl-2 expression. In poorly differentiated oral squamous cell carcinoma Bcl-2 positivity was high and low in well-differentiated oral squamous cell carcinoma. Bcl-2 expression was higher in severe dysplasia compared to moderate dysplasia, which may indicate aggressive behaviour of tumour in poorly differentiated oral squamous cell carcinoma and severe dysplasia.

Advancements in diagnosing oral potentially malignant disorders: leveraging Vision transformers for multi-class detection

ObjectivesDiagnosing oral potentially malignant disorders (OPMD) is critical to prevent oral cancer. This study aims to automatically detect and classify the most common pre-malignant oral lesions, such as leukoplakia and oral lichen planus (OLP), and distinguish them from oral squamous cell carcinomas (OSCC) and healthy oral mucosa on clinical photographs using vision transformers.Methods4,161 photographs of healthy mucosa, leukoplakia, OLP, and OSCC were included. Findings were annotated pixel-wise and reviewed by three clinicians. The photographs were divided into 3,337 for training and validation and 824 for testing. The training and validation images were further divided into five folds with stratification. A Mask R-CNN with a Swin Transformer was trained five times with cross-validation, and the held-out test split was used to evaluate the model performance. The precision, F1-score, sensitivity, specificity, and accuracy were calculated. The area under the receiver operating characteristics curve (AUC) and the confusion matrix of the most effective model were presented.ResultsThe detection of OSCC with the employed model yielded an F1 of 0.852 and AUC of 0.974. The detection of OLP had an F1 of 0.825 and AUC of 0.948. For leukoplakia the F1 was 0.796 and the AUC was 0.938.ConclusionsOSCC were effectively detected with the employed model, whereas the detection of OLP and leukoplakia was moderately effective.Clinical relevanceOral cancer is often detected in advanced stages. The demonstrated technology may support the detection and observation of OPMD to lower the disease burden and identify malignant oral cavity lesions earlier.

Examination of Ulcero-Proliferative Lesions of Oropharynx and Oral Cavity- A Clinical Perspective

 Introduction Patients often present with ulcero-proliferative lesions of the oropharynx and oral cavity in the outpatient department (OPD). These lesions have a negative impact on the patients' health, so it's critical to make an accurate diagnosis and administer the right care.  Aim of the Study: To determine the proportion of patients who exhibit different ulcero-proliferative lesions clinical characteristics in the oropharynx and oral cavity.  Patients and Methodology: This is prospective study done at Department of ENT, Guntur Medical College, spanning a period of 18 months. This study included patients with ulcero- membranous lesions in the oropharynx and oral cavity, regardless of age. This study excluded Patients who had radiation therapy soon before developing the illness and who had traumatic injuries but no infection. Detailed history including personal, family and medical history were noted. Local and general examination was done. Selected patients were subjected to investigations like routine blood investigations, gram stain, albert’s stain, KOH mount, culture and sensitivity, peripheral smear, serology, FNAC, HPE, USG, chest x ray, CT neck, MRI.  Results In the current study, men dominated women (65.69%) and the most prevalent age group participating was 41–60 years old (45.09%). The most typical symptoms of the throat were odynophagia, burning sensation, dysphagia, and throat pain. 5.9% of the patients had nose issues and 14.7% had associated ear complaints. General symptoms included fever in 10.7% of cases, weight loss in 23.5%, general weakness in 15.6% of cases, and skin lesions in 6.9% of cases. Systemic disorders such as HIV was present in 3.9%, hypertension in 25.4%, and diabetes in 34.3% of cases. Risk factors include chewing tobacco (17.6%), drinking alcohol (14.7%), smoking (43.1%), and having previously been exposed to radiation (0.9%). The tongue was the most frequently afflicted site in this study (44.1%), followed by the palate (29.4%), the buccal mucosa (15.6%), the tonsils (8.8%), the lips (7.8%), the alveolus (2.9%), and the RMT (1.9%). Neoplastic etiology accounted for 41.1% of the total etiology discovered. It was followed by inflammatory (31.3%), infectious (20.5%), and miscellaneous (6.8%) etiologies. 52.9% of patients had conservative care, 36.2% had oncosurgery team treatment through surgery, and 10.7% had radiation therapy. Of the patients with neoplastic etiology, 10.7% had radiation therapy.  Conclusion: The incidence of cancers rises in the adult population with increased habits like smoking and chewing nicotine in any form. A high degree of suspicion is required when treating oral ulcers, particularly those that are chronic. The gold standard for confirming the diagnosis is always a biopsy and a histopathological examination.

Reliability of Ultrasonographic Assessment of Depth of Invasion and Tumor Thickness in Intraoral Mucosa Lesions: A Preliminary Experience.

Introduction: Despite the progress made in multidisciplinary care, there has been little improvement in the oncologic outcomes of oral cavity squamous cell carcinomas (OSCCs). In the latest edition of the TNM staging, "depth of invasion" (DOI) has recently been introduced as one of the criteria for determining the T stage, alongside other factors. DOI is widely recognized as an independent risk factor for nodal metastases and is a crucial consideration in the preoperative staging of OSCCs, along with measurements of tumor thickness (TT). While various diagnostic methods exist for assessing DOI, intraoral ultrasonography (IOUS) has gained popularity for its efficacy in evaluating OSCCs. Methods: This study sought to evaluate the diagnostic accuracy and reliability of ultrahigh-frequency ultrasound (UHFUS) in assessing oral cavity lesions compared to histopathological analysis. Results: The results revealed strong reliability in ultrasonographic measurements (ICC TT: 0.94; ICC DOI: 0.97) and distinct ultrasonographic features specific to different oral pathologies. This highlights the potential of UHFUS as a non-invasive imaging tool for precise diagnostic evaluations. Conclusions: Despite limitations such as a small sample size and focus on specific lesions, these promising results suggest that UHFUS could significantly enhance oral lesion diagnostics. Further research involving larger cohorts is necessary to validate and build upon these initial findings.

Accuracy of Narrow-Band Imaging-Guided Histopathology and Ki-67 Index in Head and Neck Carcinoma.

All patients were first examined under white light and then under NBI endoscopy, and a biopsy was obtained from suspected lesions and sent for histopathological examination (HPE) and Ki-67 index. Eighty patients were examined out of which, 68 patients having lesions in the oral cavity, oropharynx, larynx, and hypopharynx were examined. The rate of detecting cancerous lesion by white light and NBI were respectively 92% and 100% for oral cavity lesions, 69% and 100% for oropharyngeal lesions, 38% and 100% for hypopharyngeal lesions, and 37% and 100% for laryngeal carcinoma. However, we have found no significant difference in detecting T2-T4 tumors. Hence, we concluded that NBI mode can be a significantly better diagnostic tool than white light mode in detecting early mucosal cancer in head and neck cancer. We have concluded that NBI combined with Ki-67 estimation is a very promising tool that helps in the early diagnosis of mucosal lesions in head and and neck cancer.

Construction and validation of an audio-visual tool to instruct caregivers of patients with pemphigus in photographing skin and oral cavity lesions during tele-consultation: A cross-sectional study.

Background Owing to the lack of standardised audio-visual (A-V) instructions to take photographs, patients with pemphigus faced difficulties during tele-consultation in COVID-19 pandemic. Objective To construct and validate an A-V instruction tool to take photographs of skin and oral cavity lesions of pemphigus. Methods In this observational study, we included patients with pemphigus of either gender seeking tele-consultation, aged 18 years or older. A-V instructions demonstrating skin and oral cavity photography were designed and shared with the patients. They were requested to send pictures of lesions that complied with the instructions. They were then required to complete a 10-item questionnaire for face validation in the two following rounds. The videos were content validated by 14 experts in the field of clinical dermatology. Results Forty-eight patients took part in face validation. A majority of patients, 47 (97.9%) and 45 (93.8%); rated the audio and video quality as being above average, respectively. Forty-seven patients (97.9%) said the instructional videos were useful, and 42 patients (87.5%) said they did not need to take any further images to show how severe their disease was. The average scale content validity index for the instructions on skin imaging and the oral cavity imaging during round 1 of content validation was 0.863 and 0.836, respectively. Limitation Validated instruction videos are in Hindi language and need to be further translated and validated in other local languages for use in non-Hindi speaking regions. Conclusion A-V instructions were useful to take photographs during tele-consultation.

Oral and Maxillofacial Manifestations of Tuberculosis Presented to Primary Health Care Centres in Port Sudan, Sudan

Tuberculosis is a chronic granulomatous disease caused by various strains of mycobacteria, usually Mycobacterium Tuberculosis in humans. Robert Koch, a German physician, discovered the Tuberculosis bacillus in 1882 [1]. It has been a worldwide major health problem for centuries. Although the disease’s prevalence reduced decades ago, it still has extremely high prevalence in Asian and African countries. It may take any form clinically, but with decline in number, these tuberculosis lesions of oral cavity have become so rare that they are frequently overlooked in the differential diagnosis of oral lesions. Although, oral manifestations of tuberculosis has a rare occurrence, but it has been considered to account for 0.1-5% of all TB infections.

Lesiones bucales, estado serológico y carga viral de portadores del VIH sin tratamiento en Chiapas, México

Objective:To determine the frequency of oral cavity lesions and their relationship with the CD4 cell countand viral load in patients with a recent diagnosis of HIV/AIDS in a reference unit for the care of HIV carriers.Methods: Cross-sectional epidemiological study in patients diagnosed with HIV, which included oral clinical examination and analysis of laboratory data. Bivariate statistical techniques Chi2 and Student's t were used.Results: 58 patients diagnosed with HIV infection who attended the center during the study period were included. The most frequent diagnoses were pseudomembranous candidiasis and hairy leukoplakia. The variables associated with the CD4 cell count (both in absolute value and as a group) were the number of lesions and the presence of angular cheilitis. The absolute viral load was found to be associated with the number of lesions found, the presence of pseudomembranous candidiasis and hairy leukoplakia. When this parameter was grouped, the number of injuries was found associated.Conclusions: The viral load was associated with the appearance of lesions mostly related to HIV, so its presence could indicate progression of the infection and consequently that the oral health status of this group of subjects is lower than that of the general population. this zone

Tracing human papillomavirus in skin and mucosal squamous cell carcinoma: a histopathological retrospective survey.

Worldwide, squamous cell carcinoma (SCC) incidence is rising. The literature debates the human papillomavirus (HPV)'s role in cutaneous SCC development. We examined HPV histopathology in SCC samples in this study. Retrospective study at tertiary referral skin center in 2020. Histopathological features of HPV, including koilocytosis, hyperkeratosis, acanthosis, hypergranulosis, parakeratosis, solar elastosis, papillomatosis, and tumor grade, were examined in SCC specimens. Two dermatopathologists independently reevaluated all samples. We examined 331 SCC cases (male:female ratio = 3.9:1). The mean age was 68.1, with 15.1 standard deviation. Lesions were most common on the face (40.5%), scalp (22.7%), and extremities (20.8%). Koilocytes were found in 50 (15.1%) lesions. Nail (38.1%, p=0.007), oral cavity (36.8%, p=0.014), and genitalia (60.0%, p=0.026) lesions had higher koilocytosis rates. SCCs were found in 6.6% of specimens, but in situ tumors had the highest koilocytosis (64.7%), significantly higher than other grades (p<0.001). SCC pathology often shows HPV and specific koilocyte histopathology. Well-differentiated SCC has a stronger association with nail, oral, and genital lesions.

Mpox Virus in the Pharynx of Men Having Sex with Men: A Case Series.

The recent Mpox virus (MPV) outbreak in Europe and North America, primarily among men who have sex with men (MSM), raised concerns about various transmission sources. We examined patients with Mpox from an urban STI center in Lombardy, Italy, between May and August 2022. Demographic, transmission, and clinical data were collected using a standardized form. Initial and subsequent tests were conducted using the RealStar Orthopoxvirus PCR Kit 1.0 (Altona Diagnostics, Hamburg, Germany) for skin lesions and oropharyngeal swabs. A total of 15 patients were recruited, all MSM, with 40% being HIV-positive. Almost all reported recent unprotected sexual activity. Oropharyngeal symptoms were observed in a minority, and oral cavity lesions were present in 20% of cases. MPV DNA was detected in skin lesions of 93% of patients and in oropharyngeal swabs of 87%. Skin samples exhibited a higher viral load than pharyngeal samples, with the latter persisting longer. Prospective follow-up of 11 individuals revealed an average pharyngeal persistence of 5.3 days beyond skin lesion clearance, reaching up to 80 days in an immunosuppressed case. Our findings indicate that MPV replication can persist in the pharynx asymptomatically and for an extended period.

Rates of Occult Invasive Disease in Patients With Biopsy-Proven Oral Cavity Squamous Cell Carcinoma in Situ

The likelihood that an oral cavity lesion harbors occult invasive disease after biopsy demonstrating carcinoma in situ (CIS) is unknown. While de-escalated treatment strategies may be appealing in the setting of CIS, knowing whether occult invasive disease may be present and its association with survival outcomes would lead to more informed management decisions. To evaluate rate of occult invasive disease and clinical outcomes in patients with oral cavity CIS. This was a retrospective population-based cohort study using the National Cancer Database and included adults with biopsy-proven oral cavity CIS as the first diagnosis of cancer between 2004 and 2020. Data were analyzed from October 10, 2022, to June 25, 2023. Surgical resection vs no surgery. Analyses calculated the rate of occult invasive disease identified on resection of a biopsy-proven CIS lesion. Univariate and multivariate logistic regression with odds ratios and 95% CIs were used to identify significant demographic and clinical characteristics associated with risk of occult invasion (age, year of diagnosis, sex, race and ethnicity, oral cavity subsite, and comorbidity status). Kaplan-Meier curves for overall survival (OS) were calculated for both unresected and resected cohorts (stratified by presence of occult invasive disease). A total of 1856 patients with oral cavity CIS were identified, with 122 who did not undergo surgery (median [range] age, 65 [26-90] years; 48 female individuals [39.3%] and 74 male individuals [60.7%]) and 1458 who underwent surgical resection and had documented pathology (median [range] age, 62 [21-90] years; 490 female individuals [33.6%] and 968 male individuals [66.4%]). Of the 1580 patients overall, 52 (3.3%) were Black; 39 (2.5%), Hispanic; 1365 (86.4%), White; and 124 (7.8%), other, not specified. Among those who proceeded with surgery with documented pathology, 408 patients (28.0%) were found to have occult invasive disease. Higher-risk features were present in 45 patients (11.0%) for final margin positivity, 16 patients (3.9%) for lymphovascular invasion, 13 patients (3.2%) for high-grade invasive disease, and 14 patients (3.4%) for nodal involvement. For those patients with occult disease, staging according to the American Joint Committee on Cancer's AJCC Cancer Staging Manual, eighth edition, was pT1 in 341 patients (83.6%), pT2 in 41 (10.0%), and pT3 or pT4 disease in 26 (6.4%). Factors associated with greater odds of occult invasive disease at resection were female sex, Black race, and alveolar ridge, vestibule, and retromolar subsite. With median 66-month follow-up, 5-year OS was 85.9% in patients who proceeded with surgical resection vs 59.7% in patients who did not undergo surgery (difference, 26.2%; 95% CI, 19.0%-33.4%). This cohort study assessed the risk of concurrent occult invasion with biopsy-proven CIS of the oral cavity, demonstrating that 28.0% had invasive disease at resection. Reassuringly, even in the setting of occult invasion, high-risk disease features were rare, and 5-year OS was nearly 80% with resection. The findings support the practice of definitive resection if feasible following biopsy demonstrating oral cavity CIS.

A Clinicopathological Evaluation of Oral Cavity Lesions and the Role of Cytokeratin 8/18 as a Marker in Oral Premalignant and Malignant Lesions: A Hospital-based Cross-sectional Study

Introduction: The oral cavity is affected by a wide range of pathologic lesions that may originate from squamous mucosa, salivary glands, mesenchymal structures and lymphoid tissue. Alterations in Cytokeratin (CK) patterns have been reported in oral potentially malignant and malignant lesions, and its expression is a hallmark of tumour progression. Aim: To evaluate different oral cavity lesions, with an emphasis on using Cytokeratin 8/18 (CK8/18) to differentiate between benign, premalignant and malignant lesions. Materials and Methods: The present hospital-based crosssectional observational study was conducted in the Departments of Pathology and Otorhinolaryngology, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Guwahati, Assam, India, from September 2020 to August 2021. A total of 93 biopsied or resected specimens clinically presenting in the Otorhinolaryngology Department with oral cavity lesions were submitted to the Department of Pathology, Fakhruddin Ali Ahmed Medical College and Hospital for histopathological examination followed by Immunohistochemistry (IHC) with CK8/18 in all the tissue samples as per IHC protocol. Age, gender, clinical presentation and sites of lesions were also assessed, as well as, histopathological evaluation and IHC. All data were collected, compiled and subjected to suitable statistical analysis, such as one-way Analysis of Variance (ANOVA) and Fisher’s exact tests using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) software version 28.0. Microsoft Office Word and Excel 2019 were used to generate graphs and tables. Results: The age of the patients ranged from 9-90 years and mean±Standard Deviation (SD) age was 52.69±15.81 years. Males, 59 (63.4%), were more commonly affected than females 34 (36.6%), with a male-to-female ratio of 1.73:1. Among the 93 various oral cavity lesions, 24 were located on the buccal mucosa, making it the most common site in our study. Of the 42 malignant oral cavity lesions, the most frequent was moderately differentiated Squamous Cell Carcinoma (SCC) with a frequency of 21 cases (50%), followed by well-differentiated SCC with 18 cases, including one case of Verrucous carcinoma. Poorly differentiated SCC was the least frequent, with three cases (7.14%). CK8/18 was positive in 33 of the 42 malignant cases, four out of the 20 dysplasia cases, and all the benign cases were negative for IHC of CK8/18. The maximal intensity of CK8/18 was seen in 13/21 (62%) cases of moderately differentiated oral SCC. Conclusion: In conclusion, the present study on oral cavity lesions in the lower Assam region highlighted the significance of clinical, histopathological and immunohistochemical evaluations, particularly with CK8/18 staining. A predominance of lesions on the buccal mucosa was found, with moderately differentiated SCC being the most common malignant type. CK8/18 expression showed a notable association with malignant lesions, especially in moderately differentiated SCC, suggesting its potential as a diagnostic marker. These findings contribute to a better understanding of oral cavity pathologies and may aid in early detection and management strategies.

A Cross-sectional Study on Spectrum of Oral Cavity Lesions with Emphasis on Soft-tissue Tumours: A Lesser Dealt Domain

Introduction: The oral cavity, the beginning of the digestive system, has diverse lesions affecting it other than Oral Squamous Cell Carcinoma (OSCC). Soft-tissue Tumours (STT) are uncommon lesions. Overlapping of the signs and symptoms in diverse conditions creates significant problems for reaching their definitive diagnosis. Histopathological Examination (HPE) plays a central role in giving their final diagnosis. Assessment of the clinical features, histopathology, along with Immunohistochemistry (IHC), helps in reaching an accurate diagnosis in these cases, which further aids in the proper management of the patient. Aim: To study the spectrum of oral cavity lesions and tumours with emphasis on STT. Materials and Methods: A retrospective cross-sectional study was conducted at the Department of Pathology and Otolaryngology, Dr. Ulhas Patil Medical College, Jalgaon, Maharashtra, India included the oral cavity lesion samples received over two years (from January 2021 to December 2022) in the histopathology section of a Medical College in Maharashtra, India. A total of 170 cases were included in the study. Complete clinical information including age, sex, anatomical location, clinical diagnosis, and histological subtypes were compiled. The HPE diagnosis were classified into four categories-Non neoplastic, Benign, Epithelial Proliferative lesions {including viral/Human Papillomavirus (HPV) related}/Intraepithelial neoplastic lesions/Precursor or Pre-malignant, and malignant with special emphasis on STTs found. The data was statistically analysed and the results were presented as percentages. Full details of the soft-tissue lesions were recorded, entered into an Excel sheet, and studied for the percentage-wise distribution of various recorded parameters. Results: A total of 170 cases were found. Male:female distribution was 2.78:1, and most patients were in the seventh decade, n=38 (22.35%). The most common lesions other than SCC, n=110 (64.71%) found were mucocele, chronic inflammatory lesion and wart. The Buccal Mucosa/Gingivo-buccal Sulcus (GBS) were the most commonly involved site, n=82 (48.24%). Malignant lesions were more common in the sixth and seventh decades, with a male preponderance of 2.71:1. The uncommon STTs found were-Benign: Haemangioma/pyogenic granuloma (n=2), a Schwanomma, and a Proliferative Fasciitis (PF); Malignant: two fibrosarcomas and a high-grade sarcoma. All three malignant STTs were found in males of the sixth decade involving the buccal mucosa. Conclusion: Among the variety of lesions found in the oral cavity, HPE facilitates the recognition of the STT, especially the malignant ones, aiding in proper management. Being an extremely uncommon entity at this site, the documentation of these findings is of utmost importance.

Clinical Characteristics and Survival of Pemphigoid and Pemphigus Patients in a Thai Population

Objective: Pemphigoid and pemphigus are skin diseases with high morbidity and mortality. The research aims to study the clinical presentations, comorbidities, and medications used prior to diagnosis, as well as the survival rates and prognostic factors for pemphigoid and pemphigus patients. Materials and Methods: The cohort study was conducted on retrospective data of patients who were treated at Naresuan University Hospital between 1 October 2012 and 30 September 2022. Results: There were 30 pemphigoid patients and 44 pemphigus patients. Pemphigoid patients were on average older than pemphigus patients (76 years vs 52 years), have more skin blisters, and less oral cavity lesions. Neurological disease increases risk of being diagnosed as a bullous pemphigoid (odds ratio=4.6, p-value =0.051). After adjustment by neurologic disease and age at diagnosis, pemphigoid was not significantly associated with the use of any medications. The survival rate of pemphigus was 91.1% at 1 year and 82.2% at 5 years, while the survival rate of pemphigoid was 69.9% at 1 year, and 47.7% at 5 years. In multivariable Cox regression analysis, there was worse prognosis among pemphigoid and pemphigus patients that have comorbidity disease (adjusted HR= 3.13, p-value=0.057) and were older than 70 years (adj HR= 6.93, p-value=0.015). Conclusion: Clinical characteristics of bullous pemphigoid and pemphigus were different such as age of onset, presence of blister and oral lesion. Neurological disease was a risk factor for developing bullous pemphigoid than pemphigus. Survival of pemphigoid patients was worse than pemphigus patients. However, this finding could be confounded by older age of pemphigoid patients.

A Study on the Efficacy of Autologous Platelet-Rich Plasma Therapy in Erosive Lesions of Oral Cavity

ABSTRACT Autologous platelet-rich plasma (PRP) enhances the recruitment, proliferation, and differentiation of cells involved in tissue regeneration. Platelets contain a number of growth factors (GFs) including platelet-derived GFs and transforming GF which stimulate the proliferation of mesenchymal cells and vascular endothelial GFs and fibroblast GF which stimulate new blood vessel formation. This study evaluates the efficacy of intralesional injection of PRP in erosive lesions of the oral cavity. Five patients who attended the dental outpatient department of a tertiary care hospital were selected irrespective of age and sex diagnosed with erosive lichen planus, pemphigus, and three with desquamative gingivitis. Initial assessment including blood investigations and evaluation of extent, severity, activity, and pain was done. Autologous was prepared from 30 milliliters of whole blood collected into a 350 ml blood collection bag after modifying the anticoagulant to whole blood ratio. A soft spin followed by a hard spin in Thermo Scientific™ Heraeus™ Cryofuge™ was used for PRP preparation. On the same day, 0.5 mL PRP was directly injected onto the base and edge of the erosions using a 31 gauge needle. Patients were followed up and evaluated weekly. In pemphigus and desquamative gingivitis, PRP therapy relieved pain, burning sensation, and bleeding which was proven from Visual Analog Scale score and severity score. No adverse reactions were noted in patients. Autologous PRP poses no risk of allergic reaction and natural collagen is formed in response to the presence of activated platelets. The use of PRP is safe, efficient, and economic. The inability to prevent recurrent lesions and the inability to heal the lesion completely are the major drawbacks.

Сучасні методи діагностики захворювань тканин пародонта в концепції системного підходу лікування (Огляд літератури. Частина 2)

Resume. Diagnostics is one of the most urgent tasks of modern medicine, the latest achievement of which inspire the for new methods of detecting and predicting the course of diseases. Careful diagnosis is the key to successful prevention and treatment of such an extremely common and complex disease as periodontitis. The diagnosis of periodontitis includes several stages and has different levels of research depth, which in practice strongly depends on the professional training of the doctor, the capabilities of the clinic, the availability of the laboratory and the motivation of the patient. But, despite the wide possibilities, all diagnostic, treatment and preventive activities of the doctor are related to forecasting, timely prediction of complications, possible development of disease relapses. Therefore, implementation of the system of diagnostic monitoring with the definition of predictors of disease, its biological markers, criteria for evaluating its course, forecasting possible results and the effectiveness of treatment measures is absolutely necessary. From this point of view, the development of laboratory methods and the possibility of their application in the diagnostics of periodontal diseases is a very urgent problem and requires not only technical perfection, but also considering the peculiarities of the etiopathogenesis of oral cavity lesions. The optimal choice of biomarkers is closely related to the choice of the source and method of sampling the material for diagnostics. Based on the requirements for an ideal biomarker, saliva, gingival fluid (GCF), peri-implant sulcus fluid (PISF) and residual mouthwash can be reliable sources of biomarkers in the oral cavity. Our review of foreign literature describes the following biomarkers contained in oral fluids: interleukin 1-beta (IL-1â), interleukin 6 (IL-6) and matrix metalloproteinase-8 (MMP8). The advantages and disadvantages of such immuno-biochemical methods for determining the level of biomarkers as immunoblotting and enzyme-linked immunosorbent assay (ELISA) were also analyzed. Given that biomarkers can be used as a basis for early detection of periodontal diseases, prediction of further progression and response to treatment, their use can provide better treatment planning, particularly with the use of a personalized approach, and a stable positive outcome, even in patients with complex general somatic pathologies. Key words: periodontitis, non-invasive diagnostics, biomarkers, interleukins, matrix metalloproteinases.

INFECTIOUS STOMATITIS IN CAPTIVE SALVATOR MERIANAE LIZARDS

Infectious stomatitis is a common ailment in captive reptiles, it arises from a combination of predisposing factors such as poor nutritional conditions, habitat issues or stress, where normal oral flora microorganisms act as pathogens, facilitating the disease development. This study aims to describe infectious stomatitis in a captive population of adult Salvator merianae lizards and to propose prophylactic measures for their maintenance in captivity. Within a population of 57 animals, a morbidity rate of 19.2% and a mortality rate of 7% were estimated. Microbiological analysis of oral mucosa revealed Pseudomonas aeruginosa susceptible to ceftazidime, ciprofloxacin, gentamicin, and amikacin. Symptoms ranged from asymptomatic to animals with mild oral cavity lesions or severe stomatitis, with some cases exhibiting respiratory complications. Histopathological examination of lung samples was consistent with caseous pneumonia. Intramuscular ceftazidime treatment and oral disinfection yielded excellent results for lizards with stomatitis, although a favorable response was not observed in animals with pneumonia.

Repercussions of Smokeless Tobacco on Buccal Mucosa: A Community Based Observational Study at a Tertiary Care Centre in Western Rajasthan.

Tobacco is consumed mainly as smoking or smokeless tobacco [SLT]. "Smokeless tobacco" (SLT) term is used for the consumption of tobacco mixed with other constituents in form of chewing, spitting and dipping. Consumers of smokeless tobacco chew the products and spit out the juice that builds up in oral cavity which leads to various malignant and pre malignant lesions of oral cavity. Descriptive observational study was conducted in the city of Jodhpur through department of ENT, Head & Neck Surgery, Dr. SN medical college, Jodhpur. Male to female ratio of smokeless tobacco usage was almost same. Increasing age was associated with occurrence of oral lesions and 43% patients developed oral lesions in the group > 64 yrs of age. Duration was another associating factor and 66% developed symptoms within < 10 years of usage. Oral submucous fibrosis is the most common lesion. Malignant lesions were seen in 0.3% cases. Around 78% cases developed dependency. Diabetic patients were seen more prone to development of oral lesions. Development of lesions in the oral cavity by smokeless tobacco depends on various factors such as quantity of tobacco usage per day, place of putting tobacco and duration. Awareness regarding its fatal effects and timely diagnosis and management can save many lives.