Oral Cavity Region Research Articles

FROM PLATE TO PALETTE: DIETARY PATTERNS AND THEIR ROLE IN MUCOSAL LESIONS AMONG NORTH INDIAN COMMUNITIES: A CROSS-SECTIONAL STUDY

Introduction: The global oral health scenario, as per WHO 2022 report, states that 3.5 billion people are affected by oral diseases. Despite oral mucous membrane's susceptibility to various diseases, scant information exists on oral lesions. This study aims to assess the impact of dietary habits on oral mucosal lesions in the North Indian population. Material and Methods: A community based cross-sectional survey was conducted in a rural area, involving 405 participants. Oral health questionnaires and clinical examinations were utilized for data collection. Chi-square test and Multivariate regression model were used for analysis. Results: Lesser fruit intake was associated with high prevalence of candidiasis (30%). Sweets consumption was linked with ulcerations (44.4%) an abscess (44.4%) and 4 to 9 times increased risk of oral lesions whereas soft drinks were linked with leukoplakia and candidiasis in 30.8% participants. Tea/coffee consumption was linked to malignant lesions. Conclusion: Significant proportion had oral mucosal lesions, notably influenced by diet and habits. Tea/coffee intake linked to malignant lesions; sweets to ulcers; soft drinks to leukoplakia. Tobacco showed significant associations. Oral lesion distribution varied across oral cavity regions, emphasizing diverse etiologies.

Influence of Rurality on Oral Cancer Trends among Organisation for Economic Co-Operation and Development (OECD) Member Countries-A Scoping Review.

Oral cancer is the general term used to describe cancers of the oral cavity and oropharyngeal region. These cancers are one of the leading causes of death in elderly residents within the Organisation for Economic Co-operation and Development (OECD) member countries in the 21st century. This scoping review was carried out to assess the influence of rurality on oral cancer trends and patterns among OECD member countries. Four online databases (Medline, PubMed, Scopus, and CINAHL) were searched for studies that reported on oral cancer trends in rural and remote areas in OECD member countries. A total of 1143 articles were obtained initially; among them, 995 papers were screened to include 18 articles for this scoping review. Studies have reported increasing incidence and prevalence in the United States, Australia, Canada, and European countries wherein risk factors such as tobacco, alcohol, and human papilloma virus (HPV) infections were associated with oral and oropharyngeal cancers. Awareness among people living in rural areas about HPV-related cancers was very low, while rates of tobacco and alcohol abuse were noted to be rising more rapidly than among their urban counterparts. Furthermore, the ageing population was most affected compared to the younger age groups of people with oral and oropharyngeal cancer that are prevalent in these regions. Overall, despite living in developed countries, rurality was noted to be a significant factor in the lower life expectancy of oral cancer patients, mainly due to the limited accessibility to tertiary cancer care centres and advanced medical care.

A Nutrigenomic View on the Premature-Aging Disease Fanconi Anemia.

Fanconi anemia, a rare disorder with an incidence of 1 in 300,000, is caused by mutations in FANC genes, which affect the repair of DNA interstrand crosslinks. The disease is characterized by congenital malformations, bone marrow failure within the first decade of life, and recurrent squamous cell carcinomas of the oral cavity, esophagus, and anogenital regions starting around age 20. In this review, we propose that Fanconi anemia should be considered a premature-aging syndrome. Interestingly, the onset and severity of the life-limiting clinical features of Fanconi anemia can be influenced by lifestyle choices, such as a healthy diet and physical activity. These factors shape the epigenetic status of at-risk cell types and enhance the competence of the immune system through nutritional signaling. Fanconi anemia may serve as a model for understanding the aging process in the general population, addressing research gaps in its clinical presentation and suggesting prevention strategies. Additionally, we will discuss how the balance of genetic and environmental risk factors-affecting both cancer onset and the speed of aging-is interlinked with signal transduction by dietary molecules. The underlying nutrigenomic principles will offer guidance for healthy aging in individuals with Fanconi anemia as well as for the general population.

The fate of an inhaled cigarette puff in the human respiratory tract

Objective Cigarette smoking can lead to a host of adverse health effects such as lung and heart disease. Increased lung cancer risk is associated with inhalation of carcinogens present in a puff of smoke. These carcinogenic compounds deposit in the lung at different sites and trigger a cascade of events leading to adverse outcomes. Understanding the site-specific deposition of various smoke constituents will inform the study of respiratory diseases from cigarette smoking. We previously developed a deposition model for inhalation of aerosol from electronic nicotine delivery systems. In this study, the model was modified to simulate inhalation of cigarette smoke consisting of soluble and insoluble tar, nicotine, and cigarette-specific constituents that are known or possible human carcinogens. Materials and Methods The deposition model was further modified to account for nicotine protonation and other cigarette-specific physics-based mechanisms that affect smoke deposition. Model predictions showed a total respiratory tract uptake in the lung for formaldehyde (99%), nicotine (80%), and benzo[a]pyrene (60%). Results The site of deposition and uptake depended primarily on the constituent’s saturation vapor pressure. High vapor pressure constituents such as formaldehyde were preferentially absorbed in the oral cavity and proximal lung regions, while low vapor pressure constituents such as benzo[a]pyrene were deposited in the deep lung regions. Model predictions of exhaled droplet size, droplet retention, nicotine retention, and uptake of aldehydes compared favorably with experimental data. Conclusion The deposition model can be integrated into exposure assessments and other studies that evaluate potential adverse health effects from cigarette smoking.

Foreign-body Impaction in Oropharynx Region

Abstract Fish bone impaction in the oral cavity and oropharynx region involving the palatopharyngeus, tonsillar fossa, base of the tongue, and migration into the gastrointestinal tract has all the possibilities of causing no symptoms or life-threatening outcomes. Foreign-body impaction is very common in adults, especially in coastal areas and the eastern region of the India. The delay in the removal of fish bone can cause serious complications and rarely life-threatening consequences. Radiographs and conventional computed tomography may be needed in migrated fish bone in deeper soft tissue and further downward displacement in the gastrointestinal tract.

The Use of Three Iliac Crest Muscles for Head and Neck Soft Tissue Reconstruction: Technical Note.

This technical note describes a novel approach to reconstructing soft tissue in the head and neck region by diverting a flap originally intended for hard tissue reconstruction. We present a case of a 79-year-old woman with a large tumor on the left side of the mobile tongue, where the use of a radial free flap was challenging. Instead, we used the muscular portion of the iliac crest as a reliable alternative for reconstruction, offering a suitable oral lining. Using a muscular free flap, we achieved effective tongue reconstruction while minimizing donor site morbidity. The deep circumflex iliac artery muscular free flap demonstrates promising outcomes for large defects in the oral cavity and facial regions. However, a comprehensive case series with functional assessments and long-term follow-up is necessary to evaluate potential complications, such as hernia formation.

Oral Cavity Cancer Tissues Differ in Isotopic Composition Depending on Location and Staging.

The aim of this paper was to characterise the isotopic composition of oral squamous cell carcinoma (OSCC) specimens of different areas of the oral cavity. Secondly, we assessed whether there was a correlation between clinical stages of OSCC and isotopic abundance. The IRMS procedure was performed on 124 samples derived from 31 patients with OSCC of 15 N and 13 C to assess the isotopic composition. From each individual, four samples from the tumour, two from the margins, and two samples of healthy oral mucous membranes were derived. The two samples from the tumour and two samples from the margin were additionally subjected to histopathological assessment. Then, statistical analysis was conducted. Tumour infiltration tissues of the lower lip were characterised by higher mean δ13C values compared to samples derived from cancers of the other oral cavity regions (-23.82 ± 1.21 vs. -22.67 ± 1.35); (p = 0.04). The mean percentage of nitrogen content in tumour tissues was statistically higher in patients with the most advanced cancers (11.89 ± 0.03%) versus the group of patients with II and III stage cancers (11.12 ± 0.02%); (p = 0.04). In patients at stage IV, the mean δ13C value in the cancer samples equalled -22.69 ± 1.42 and was lower than that in patients at less severe clinical stages (p = 0.04). Lower lip cancer tissues differed in the isotopic abundance of carbon in comparison with tissues derived from the group of combined samples from other locations. Values of δ13C observed in specimens derived from lower lip cancers were similar to those observed in healthy oral mucous membranes. Cancer tissues obtained from patients in the last stage of OSCC had a different isotopic composition in comparison with those obtained from earlier stages. To confirm these observations, further research on larger groups of patients is needed.

Melanotic Neuroectodermal Tumor of Infancy: A Case Report and Literature Review

Melanotic neuroectodermal tumor of infancy (MNTI), first described almost a century back, is of neural crest origin, locally aggressive, a rare biphasic neoplasm of infancy with a slightly higher male preponderance. In the last 100 years since the first description of MNTI, only around 500 cases have been described from 32 countries. We present a 7-month-old female child with 3 × 2 cm hard swelling in the oral cavity and right-side facial region for 3 months. Contrast-enhanced computed tomography scan and contrast-enhanced magnetic resonance imaging scan revealed a hypodense lesion of size 2.5 × 2 × 1.6 cm with relatively well-corticated walls. The lesion appeared to arise from the right maxillary alveolus with erosion of the floor of the maxillary sinus. A 7 × 5 mm tooth was visualized within the lesion. There was minimal enhancement in the postcontrast study. With the following provisional diagnoses—odontogenic keratocyst, dentigerous cyst, and unicystic ameloblastoma—the child underwent excision of the lesion. Intraoperatively, Hopkin's rigid endoscope 4 mm was used to ensure complete tumor removal in the maxillary sinus. Histopathological and immunohistochemistry examination resulted in the diagnosis of MNTI. On 1-year follow-up, the child did not show any signs of recurrence. A high index of suspicion, early diagnosis, and timely treatment are needed to diagnose such a rare tumor, to avoid morbidity, and to plan effective management when an infant presents with facial swelling. It should be complemented with close follow-up to identify recurrence early. Use of endoscope whenever feasible is encouraged by the authors to ensure adequate tumor removal.

Influence of pathogens on host genome and epigenome in development of head and neck cancer.

Head and neck cancer (HNSCC) is a heterogeneous group of cancers, affecting multiple regions such as oral cavity, pharynx, larynx, and nasal region, each showing a distinct molecular profile. HNSCC accounts for more than 6 million cases worldwide, soaring mainly in the developing countries. The aetiology of HNSCC is complex and multifactorial, involving both genetic and environmental factors. The critical role of microbiome, which includes bacteria, viruses, and fungi, is under spotlight due to the recent reports on their contribution in the development and progression of HNSCC. This review focuses on the effect of opportunistic pathogens on the host genome and epigenome, which contributes to the disease progression. Drawing parallels from the host-pathogen interactions observed in other tumour types arising from the epithelial tissue such as colorectal cancer, the review also calls attention to the potential explorations of the role of pathogens in HNSCC biology and discusses the clinical implications of microbiome research in detection and treatment of HNSCC. Our understanding of the genomic effects of the microbes on the disease progression and the mechanistic insights of the host-pathogen interaction will pave way to novel treatment and preventive approaches in HNSCC.

An Uncommon Cause of Chronic Nonhealing Perianal Ulcer

Chronic or persistent, nonhealing perianal ulcers could be due to an infection, inflammation, or a neoplasm. Perianal ulcer as the initial presentation of tuberculosis is rare. Tuberculosis cutis orificialis is a rare ulcerative form of cutaneous tuberculosis that affects the oral cavity, anal canal, or perianal region. A high index of suspicion for tuberculosis as the cause of persistent perianal ulcer is required for early diagnosis and treatment.

Ceramic Materials for Biomedical Applications: An Overview on Properties and Fabrication Processes.

A growing interest in creating advanced biomaterials with specific physical and chemical properties is currently being observed. These high-standard materials must be capable to integrate into biological environments such as the oral cavity or other anatomical regions in the human body. Given these requirements, ceramic biomaterials offer a feasible solution in terms of mechanical strength, biological functionality, and biocompatibility. In this review, the fundamental physical, chemical, and mechanical properties of the main ceramic biomaterials and ceramic nanocomposites are drawn, along with some primary related applications in biomedical fields, such as orthopedics, dentistry, and regenerative medicine. Furthermore, an in-depth focus on bone-tissue engineering and biomimetic ceramic scaffold design and fabrication is presented.

Peutz–Jeghers Syndrome: A Rare Genetic Cause of Intestinal Obstruction

Peutz–Jeghers syndrome (PJS) is a rare autosomal dominant disorder. The mutation is found in the serine threonine kinase (STK11)/ liver kinase B1 (LKB1) gene on chromosome 19. It impacts 1 out of 50000–200000 individuals. Clinical menifestations include hyperpigmented lesion in oral cavity, lips, fingertips and perianal region. Abdominal pain, Anaemia, Gastrointestinal (GI) bleeding, GI polyp, Intestinal obstruction (mostly due to intussusception) and malignancy are closely interlinked with the disease. We present a 21 years old lady with characteristic hyperpigmented lesions in lips and fingertips with multiple polyps in the GI tract. The patient was presented in general emergency department with abdominal pain and vomiting. Detail workout revealed the diagnosis as PJS. We have plotted the diagnosis according to the WHO criteria due to the lacking of genetic analysis facility. Patients with PJS are at high risk of intestinal and extraintestinal malignancy. Early diagnosis and polypectomy along with surveillance for recurrence may prolong cancer free lifetime.
 CBMJ 2023 January: Vol. 12 No. 01 P: 115- 120

Oral fibrolipoma: A rare clinicopathological entity.

Fibrolipoma, a subtype of lipoma, is a painless, well-circumscribed, slow-growing, submucosal benign adipocyte tumour. It is uncommon in the oral cavity and oropharyngeal region. It accounts for 1.6% of all facial lipomas. Fibrolipomas mostly affect the buccal mucosa and buccal vestibule and cause functional and cosmetic disabilities. The diagnosis and differentiation of fibrolipoma with clinically similar lesions such as fibroma and pleomorphic adenoma are very essential for a correct treatment plan and complete follow-up. Here, we present fibrolipoma, a very rare subtype of lipoma involving the buccal mucosa of the left premolar region in a 44-year-old male patient.

Evaluation of Dose Calculation Based on Cone-Beam CT Using Different Measuring Correction Methods for Head and Neck Cancer Patients.

Purpose: To investigate and compare 2 cone-beam computed tomography (CBCT) correction methods for CBCT-based dose calculation. Materials and Methods: Routine CBCT image sets of 12 head and neck cancer patients who received volumetric modulated arc therapy (VMAT) treatment were retrospectively analyzed. The CBCT images obtained using an on-board imager (OBI) at the first treatment fraction were firstly deformable registered and padded with the kVCT images to provide enough anatomical information about the tissues for dose calculation. Then, 2 CBCT correction methods were developed and applied to correct CBCT Hounsfield unit (HU) values. One method (HD method) is based on protocol-specific CBCT HU to physical density (HD) curve, and the other method (HM method) is based on histogram matching (HM) of HU value. The corrected CBCT images (CBCTHD and CBCTHM for HD and HM methods) were imported into the original planning system for dose calculation based on the HD curve of kVCT (the planning CT). The dose computation result was analyzed and discussed to compare these 2 CBCT-correction methods. Results: Dosimetric parameters, such as the Dmean, Dmax and D5% of the target volume in CBCT plan doses, were higher than those in the kVCT plan doses; however, the deviations were less than 2%. The D2%, in parallel organs such as the parotid glands, the deviations from the CBCTHM plan dose were less than those of the CBCTHD plan dose. The differences were statistically significant (P < .05). Meanwhile, the V30 value based on the HM method was better than that based on the HD method in the oral cavity region (P = .016). In addition, we also compared the γ passing rates of kVCT plan doses with the 2 CBCT plan doses, and negligible differences were found. Conclusion: The HM method was more suitable for head and neck cancer patients than the HD one. Furthermore, with the CBCTHM-based method, the dose calculation result better matches the kVCT-based dose calculation.

Edema of the larynx - an emergency caused by angina Ludovici

Introduction. Laryngeal edema is a rare complication of angina Ludovici. Infections of this region are mostly of dentogenic origin, less often caused by tonsillitis or other infections in the pharynx. We present a case of a patient with laryngeal edema and dyspnea caused by a lower jaw tooth infection and an ipsilateral submandibular abscess. Case outline. The clinical picture of our patient progressed rapidly ? from toothache, painful swelling of the floor of the oral cavity, submandibular and submental regions, bilaterally, all the way to lifethreatening dyspnea. A flexible nasopharyngolaryngoscopy was performed. Swelling of the base of the tongue on the left side was observed, along with pronounced edema of the aryepiglottic fold on the same side, which narrowed the breathing space. Since the breathing space was significantly reduced, the patient was urgently hospitalized. The surgical treatment was carried out in the form of an external incision and drainage of the abscess collection of the left submandibular region, with the use of oxygen support and parenteral therapy, in accordance with the recommendations from the available medical literature. Constant monitoring of saturation levels indicated a significant improvement after just a few hours of medicamentous therapy. Conclusion. The goal of our work is to point out a very rare but serious complication, laryngeal edema, which can lead to airway obstruction even in the first few days of the development of the infection, and endanger the life of the patient.

Antimicrobial resistance in odontogenic infections: A protocol for systematic review

It is estimated that up to 90% of head and neck infections have an odontogenic origin, which are considered among the most common in the oral cavity and maxillofacial region. Bacterial resistance has been 1 of the main problems related to the treatment of this type of infection in recent years. The frequency of this resistance is increasing, which is mainly due to patient self-medication and the mutations that bacteria present. Therefore, the objective of this study is to analyze the antimicrobial resistance of antibiotics commonly administered for the treatment of odontogenic infections. To carry out the study, PubMed, ScienceDirect, and Scopus databases were reviewed using the keywords "odontogenic infection", "pharmacological treatment", and "microbial resistance. Studies whose main objective was the pharmacological treatment of odontogenic infections were selected. Exclusions were review-type studies, systematic reviews, or in vitro or animal model studies. For the analysis of risk of bias, the Checklist for Analytical Cross-Sectional Studies of the Joanna Briggs Institute was used. The search and analysis of the studies was carried out by 2 researchers independently. A total of 13 studies were included in this review. The mean age was 39.6 years; the location of the infection in the study subjects was in the submandibular and vestibular spaces; there were periodontal, periapical, and dentoalveolar lesions; the main microorganisms identified were Streptococcus, Staphylococcus, Prevotella, Peptostreptococcus, Clostridium, and Klebsiella; and finally, the main microorganisms identified for bacterial resistance were penicillin, clindamycin and amoxicillin. The health professional is obliged to update their knowledge to avoid such antibiotic resistance and thus provide better patient care.

Case Report: A Giant Epignathus with a Well-Developed Skeleton of Head and Neck.

Epignathus is an extremely rare teratoma found in the oral cavity or oropharyngeal region of newborns, whose pathogenesis is poorly understood. We describe a giant epignathus arising from the oropharynx in a newborn. The giant tumor completely obstructed the airway of the newborn resulting in death. Histological and radiological examination of the tumor reveals the presence of a remarkably well-developed skeleton of the head and neck. A row of teeth, the axis and atlas, thyroid and salivary glands, trachea, and cerebral tissue are all detected within the tumor. These findings suggest that the epignathus is fetus-in-fetu which is considered a type 0 germ cell tumor in accordance with current literature.

Histologic Features of a Solitary Fibrous Tumor in the Region of Oral Cavity and Maxillofacial Complex with Recurrence and Distant Metastasis: a Rare Case Report

Abstract Introduction/Objective Solitary fibrous tumor (SFT) is an uncommon mesenchymal neoplasm, and may involve many anatomic locations. Approximately 0.6% of SFTs in the oral cavity and maxillofacial complex may recur and/or develop distant metastasis. Here we report a case of SFT in oral cavity with local recurrence and distant metastasis. Methods/Case Report The patient was a 66-year-old male with a past medical history of left buccal mass status post excision with an unclear diagnosis in a foreign country 6 years ago. He presented with a recurrence of the left buccal mass. Computerized tomography (CT) of the head and chest demonstrated a 9 cm expansile mass centered in the left pterygopalatine fossa and a 1.7 cm mass in left upper lobe of the lung, respectively. Biopsy of the lung mass was performed first and displayed a hypercellular mesenchymal tumor, composed of spindle cells arranged in vague short fascicles, and scant fibrous stroma with thin-walled and staghorn-like vasculature. The tumor cells had mild nuclear atypia with 5 mitoses/10 high power fields. No necrosis is identified. There were trapped benign pneumocytes and bronchial epithelial cells in the tumor. The tumor is positive for CD34, CD99, Bcl-2 and STAT6 immunostains. The large left buccal mass was biopsied later and showed similar morphology. The diagnoses of metastatic SFT in the lung and recurrent SFT were rendered, respectively. Results (if a Case Study enter NA) NA. Conclusion The histologic findings of the recurrent SFT and the pulmonary metastasis are similar in our case. Although marked cellular atypia and necrosis are not observed in either tumor, other features including the large size of recurrent tumor, hypercellularity, and increased mitotic activity are associated with malignant behavior in this report, and warrant the need for long-term follow-up.

Feasibility of using dental putty-based custom molds for high-dose-rate brachytherapy of oral mucosal melanoma

PurposeTo investigate the feasibility of using dental putty to fabricate custom molds for high-dose-rate (HDR) brachytherapy of oral mucosal melanoma. Practical guidelines of using dental putty for the custom mold fabrication are presented. MethodsDose measurements were performed using radiochromic films to understand the dosimetric characteristics of dental putty. The percentage depth dose (PDD) and profile curves were obtained using a single Co-60 source located on top of a cubic volume of the dental putty. Two custom molds were fabricated for a patient with mucosal melanoma lesions, which were spread throughout the right mandibular gingiva and soft palate regions. Furthermore, pretreatment dosimetry for both lesions was performed to evaluate the delivery quality of the resulting HDR brachytherapy plans and adjust the overall dose level. ResultsPrescribed doses for the two oral cavity regions were successfully delivered with a reasonable dose uniformity. Based on the measured single-source PDD curve, the maximum dose was observed at a depth of approximately 1 mm, which indicated steep dose gradients at depths ranging from 0 to 2 mm. Furthermore, a simulation with the measured single-source two-dimensional profile revealed that a source-to-source distance of 10 mm was appropriate to generate a uniform dose distribution at a source-to-surface distance of 5 mm. ConclusionsThe use of a custom mold was found to be feasible for HDR brachytherapy while carefully considering the source-to-surface and source-to-source distances. Pretreatment delivery verification would be necessary when a uniform dose distribution is required.

Myxolipoma of hand in a child: case report of a rare tumor

Lipomatous tumors account for less than 10% of tumors in the pediatric population. Myxolipomas (a subset of lipoma characterised by mature adipose tissue and abundant mucoid substance) are found to be even rarer. There are a few case reports in different body parts like heart, kidney, oral cavity, epiglottis, cervical and mediastinal regions. However, there are no case reports on the involvement of the hands in any age group. High resolution ultrasound is the imaging modality of choice for the initial evaluation of superficial soft tissue tumors, their site, nature and extent. In conjunction with clinical findings and age of presentation, it helps in narrowing down the differential diagnosis and planning the management. Hyperechoic fatty tumors in the pediatric hand are mostly benign and includes lipomas, lipoblastomas and fibrous hamartomas of infancy as the main differentials. A definitive diagnosis is based on a histo-pathological and molecular cytogenetic examination. This article presents a never before reported case of a rare, large, myxolipoma of the hand in a 22-month-old boy.