Oral Region Research Articles

Review of cysticercosis of maxillofacial region and report of two cases

Cysticercosis is a parasitic infection caused by the larval stage of Taenia solium, which very rarely manifests in the maxillofacial region. It usually presents as a painless swelling. The most common site for maxillofacial cysticercosis are the tongue and lips. When humans accidently ingest the eggs of Taenia solium, they become the intermediate host, a role which is typically played by pig. This paper describes two cases of cysticercosis cellulosae, presenting as non-tender swelling of left buccal mucosa and left temporalis region respectively. Case reports available on PubMed were searched and a review was performed. Excision of cystic lesion was the treatment modality in majority of published reports. It is emphasised that cysticercosis should be considered in differential diagnosis of solitary painless swellings of oral and maxillofacial region, especially in patients from an endemic region.

Clinical radiological evaluation of teeth-part2 : Caries, inflammatory dental changes and important differential diagnoses

Inflammatory diseases of the teeth and periodontium are widespread and are frequent secondary diagnoses in head and neck examinations. Periapical inflammation can be the cause of sinusitis or abscess formation in the oral and maxillofacial region. Early detection is important for the patient's course of treatment. For further diagnostics, adental presentation should be carried out. Dental radiological examinations, such as panoramic radiographs and dental films are used for specific diagnostics. This article is intended to provide an overview of the different stages of caries, the most important inflammatory dental changes and their most frequent differential diagnoses.

Challenges in the management of head and neck sarcomas in a resource scarce setting: A review of 54 cases

BackgroundSarcomas in the head and neck region are rare, the management can be challenging due to difficulty in making diagnosis, late presentation among others. MethodsA combined cohort study of all head and neck sarcomas seen in the Oral and Maxillofacial Surgery Department, University of Nigeria Teaching Hospital Enugu from 2010 to 2020. ResultFifty-four cases of sarcomas of the oral and maxillofacial region were reviewed based on histopathologic subtypes, clinical presentation, treatment options, while factors considered as challenges were noted. Thirty (55.6%) occurred in males while 24 (44.4%) in females in a ratio of 1.3:1. The mean age of the patients was 35.1 ± 18.2 years (range 6 months–72 years). The duration of the tumours on first presentation was between 1 and 60 months (mean 9.8 ± 10.2 months). Seventeen histopathologic subtypes were found with osteosarcoma 14 (26%) as the most predominant. Surgical intervention alone or in combination with other modalities was used in 41 (76%). Recurrence of the lesion was recorded in 27 (66%) patients, (23 (85.2%) local and 4 (14.8%) regional). Only 4 (9.8%) patients continued follow-up visit after the first year.Conclusion: head and neck sarcomas are rare, management of this condition in resource scarce centers is fraught with lots of challenges.

Pediatric Traumatic Neuroma of the Upper Lip - A Case Report

Traumatic neuroma (TN), represents a reactive proliferation of neural tissue following damage to an adjacent nerve. Clinically, patients usually present with inimitable pain, oral lesions appearing as nodule of size less than 2 cm with normal or greyish white smooth surface mostly involving the mental foramen, tongue or the lower lip. We report a rare case of an upper lip traumatic neuroma, in an uncommon age group and uncommon location, which was clinically thought to be hemangioma. Histopathologically, excision biopsy specimen showed haphazard proliferation of fascicles of nerve fibres. Immunohistochemical analysis revealed strong cytoplasmic positivity for S100 and was negative for SMA and CD34, affirming the neural origin of the lesion. TN could be considered as a differential in cases of soft tissue swelling from uncommon location in the oral region especially in the pediatric age group, where a clear trauma history cannot always be illustrated.

A concise review of the orofacial mesenchymal stromal cells as a novel therapy for neurological diseases and injuries.

Orofacial mesenchymal stromal cells (OFMSCs) are mesenchymal stromal cells isolated from the oral and facial regions, which possess typical mesenchymal stromal cell features such as self-renewing, multilineage differentiation, and immunoregulatory properties. Recently, increasing studies have been carried out on the neurotrophic and neuroregenerative properties of OFMSCs as well as their potential to treat neurological diseases. In this review, we summarize the current evidence and discuss the prospects regarding the therapeutic potential of OFMSCs as a new approach to treat different neurological diseases and injuries.

Identification of HOX signatures contributing to oral cancer phenotype

The role of evolutionarily conserved homeobox-containing HOX genes as transcriptional regulators in the developmental specification of organisms is well known. The contribution of HOX genes involvement in oral cancer phenotype has yet to be fully ascertained. TCGA-HNSC HTSeq-counts and clinical data were retrieved from the GDC portal for oral cavity neoplasms. GEO datasets (GSE72627, GSE30784, GSE37991) were accessed and analyzed using GEO2R. Differential HOX gene expression was profiled using the DESeq2 R package with a log2 fold change cut-off (− 1 and + 1) and Benjamini–Hochberg p-adjusted value at ≤ 0.01. Gene set over-representation analysis and semantic analysis associated with the disease ontology was performed using the ClusterProfiler R package, and pathway over-representation analysis was performed using IMPaLa. HOX protein interaction network was constructed using the Pathfind R package. HOX phenotype associations were performed using Mammalian Phenotype Ontology, Human Phenotype Ontology, PhenGenI associations, Jensen tissues, and OMIM entries. Drug connectivity mapping was carried out with Dr. Insight R package. HOXA2 was upregulated in oral dysplasia but silenced during tumor progression. Loss of HOXB2 expression was consistent in the potentially malignant oral lesions as well as in the primary tumor. HOXA7, HOXA10, HOXB7, HOXC6, HOXC10, HOXD10, and HOXD11 were consistently upregulated from premalignancy to malignancy and were notably associated with risk factors. Overrepresentation analysis suggested HOXA10 was involved in the transcriptional misregulation contributing to the oral cancer phenotype. HOX genes subnetwork analysis showed crucial interactions with cell cycle regulators, growth responsive elements, and proto-oncogenes. Phenotype associations specific to the oral region involving HOX genes provide intrinsic cues to tumor development. The 5′ HOX genes were aberrantly upregulated during oral carcinogenesis reflecting their posterior prevalence.

Epidermolysis bullosa acquisita

Epidermolysis bullosa acquisita is a rare autoimmune disease, characterized by the synthesis of anti-collagen VII autoantibodies, the main component of hemidesmosome anchoring fibrils. The antigen-antibody binding elicits a complex inflammatory response, which culminates in the loss of dermo-epidermal adhesion of the skin and/or mucous membranes. Skin fragility with bullae, erosions, and milia in areas of trauma characterizes the mechanobullous form of the disease. In the inflammatory form of epidermolysis bullosa acquisita, urticarial inflammatory plaques with tense bullae, similar to bullous pemphigoid, or mucosal lesions can determine permanent scars and loss of functionality in the ocular, oral, esophageal, and urogenital regions. Due to the similarity of the clinical findings of epidermolysis bullosa acquisita with other diseases of the pemphigoid group and with porphyria cutanea tarda, the diagnosis is currently confirmed mainly based on the clinical correlation with histopathological findings (pauci-inflammatory subepidermal cleavage or with a neutrophilic infiltrate) and the demonstration of the presence of anti-collagen VII IgG in situ by direct immunofluorescence, or circulating anti-collagen VII IgG through indirect immunofluorescence and/or ELISA. There is no specific therapy for epidermolysis bullosa acquisita and the response to treatment is variable, usually with complete remission in children and a worse prognosis in adults with mucosal involvement. Systemic corticosteroids and immunomodulators (colchicine and dapsone) are alternatives for the treatment of mild forms of the disease, while severe forms require the use of corticosteroid therapy associated with immunosuppressants, intravenous immunoglobulin, and rituximab.

Treatment of Maxillary Inflammatory Odontogenic Cyst with Laser Therapy – Case Report

Purpose: Odontogenic cysts occur in the oral and maxillofacial region; most jaw cysts are lined by epithelium derived from odontogenic epithelium associated with tooth development. Odontogenic cysts can be classified as “developmental type” or “inflammatory type”. A correct diagnosis is essential for planning the treatment of conditions that compromise the maxilla-mandibular complex. Given that, a significative number of cystic lesions of the jaws share similar clinical and radiographic features, the diagnosis of odontogenic cysts, usually requires detailed analysis of the clinical, radiological and histopathological findings. All odontogenic cysts, with the exception of inflammatory periapical cyst and lateral radicular cyst, should be treated with surgical intervention. The periapical cystic lesions are usually treated by conservative endodontic treatment (periapical curettage) or surgical treatment (enucleation, marsupialization and decompression). In lateral radicular and inflammatory periapical cysts, surgery is indicated only if the lesions do not regress after removal of odontogenic infection intra-canal the affected tooth. In case of residual cyst, surgery is the only option. Case Report: A 55-year-old female patient, caucasian, attended the Oral-Maxillofacial Surgery consultation at Clitrofa - Centro Médico, Dentário e Cirúrgico, in Trofa - Portugal, to evaluate a dental cyst in the second quadrant diagnosed during the evaluation to place dental implants in the upper jaw. It was decided to carry out surgical treatment of the lesion using LightWalker® from Fotona with application of Er:YAG and Nd:YAG lasers. Conclusion: After a 12-month follow-up period, the patient is pain free and the lesion has no signs of recurrence. Laser therapy may be considered a successful treatment modality for inflammatory odontogenic cyst

Photothermal effect of indocyanine green modified scaffold inhibits oral squamous cell carcinoma and promotes wound healing.

As the most prevalent malignant tumor of the oral and maxillofacial regions, squamous cell carcinoma (SCC) has relatively high recurrence and low survival rates. Currently, the most common treatment strategies are surgery and chemoradiotherapy. However, incomplete removal of the tumor can allow residual tumor cells to regrow and metastasis, resulting in treatment failure. Although postoperative adjuvant radiotherapy or chemotherapy can reduce recurrence, serious adverse reactions significantly compromise patients' quality of life. Large soft tissue defects after surgery are also difficult to heal. Therefore, therapies that eliminate residual tumor cells and promote tissue regeneration post-surgery are urgently needed. Indocyanine green (ICG) can convert absorbed light into heat to ablate tumor cells. Three-dimensional (3D) scaffolds are efficient drug carriers and support cell migration and proliferation. Here, we fabricated collagen/silk fibroin encapsulated ICG (I-CS) scaffolds by combining 3D printing with freeze-drying methods. The I-CS scaffolds delayed ICG decomposition and clearance, allowing the scaffolds to be used repeatedly for photothermal therapy (PTT). With the laser positioned at 4cm from the 1.0 I-CS scaffold and irradiation for 10min (1.0W/cm2), temperatures above 50°C were achieved, which effectively killed SCC-25 cells in vitro and suppressed tumor growth in vivo. Moreover, the I-CS scaffolds supported attachment and proliferation of rat buccal mucosa fibroblasts (RBMFs) and promoted the repair of buccal mucosal wounds in rats. These results suggested that I-CS scaffolds may be useful in preventing local recurrence and support regeneration of large soft tissue defects after oral SCC surgery.

Cocktail Formula and Application Prospects for Oral and Maxillofacial Organoids.

Oral and maxillofacial organoids (OMOs), tiny tissues and organs derived from stem cells cultured through 3-d cell culture models, can fully summarize the cell tissue structure, physiological functions and biological characteristics of the source tissues in the body. OMOs are applied in areas such as disease modelling, developmental and regenerative medicine, drug screening, personalized treatment, etc. Although the construction of organoids in various parts of the oral and maxillofacial (OM) region has achieved considerable success, the existing cocktail formulae (construction strategies) are not widely applicable for tissues of various sources due to factors including the heterogeneity of the source tissues and the dependence on laboratory technology. Most of their formulae are based on growth factor niches containing expensive recombinant proteins with their efficiency remaining to be improved. In view of this, the cocktail formulae of various parts of the OM organs are reviewed with further discussion of the application and prospects for those OMOs to find some affordable cocktail formula with strong operability and high repeatability for various maxillofacial organs. The results may help improve the efficiency of organoid construction in the laboratory and accelerate the pace of the clinical use of organoid technology.

Ossification of Pterygospinous and Pterygoalar Ligaments and Their Clinical Significance: An Anatomic Study.

Pterygospinous and pterygoalar ligaments, present in close proximity of foramen ovale at the base of skull, ossify creating pterygospinous and pterygoalar foramina, which causes problems in accessing retro and parapharyngeal spaces, trigeminal ganglion for treating trigeminal neuralgia by thermocoagulation and blocking it. Besides, these anatomical entities may compress nearby neurovascular structures causing discomfort to patients. Considering immense clinical significance associated with ossification of pterygospinous and pterygoalar ligaments, the study has been carried out. Aim of the study is to provide extended new classification related to pterygospinous and pterygoalar foramina and associated clinical significance. Seven hundred thirty skull bases were observed for variant ossification pterygospinous and pterygoalar ligaments and a new classification of occurrence of these anomalies has been proposed. Literature search revealed that incidence of formation of various forms of pterygospinous and pterygoalar foramina in world populations ranges between 1% and 31.2% and 1.3% and 62.4%, respectively. The highest incidence of complete pterygospinous foramen was observed in Brazilian population followed by Anatolian population and that of incomplete pterygospinous foramen also in Brazilian population. Various neurovascular structures are present in relation to pterygospinous and pterygoalar ligaments. Comprehension of foramina formed by ossification of these ligaments at the cranial base is imperative for proper planning and treating trigeminal neuralgia, clinical neuralgias involving oral and maxillofacial region and carrying out interventions like transfacial needle approaches to the foramen ovale and also for evaluating skull base radiographs. Therefore, thorough knowledge of these entities is of utmost use to anesthesiologists, dentists, and oral maxillofacial surgeons and neurosurgeons.

Intra osseous schwannoma of inferior alveolar nerve with multilocular radiolucency crossing the midline: A case report

Schwanomma is a soft tissue tumor derived from Schwann cells of the peripheral nerves system. Schwannoma of the oral and maxillofacial regions primarily appears in soft tissue with tongue being the common site. Schwannoma arising within the bone are rare and commonly involve the mandible compared to maxilla. In this article, we report a case of rare intra-osseous schwanomma crossing the midline, which presented as a multilocular lesion on radiograph, which is again very rarely seen. Chief complaint of the patient was swelling and pain. Panoramic Radiograph showed a solitary oval shaped radiolucency with corticated borders and scalloping. Biopsy report revealed connective tissue component comprising of hyalinized stroma and tumor cells with large number of siderophages and histiocytes suggesting intra osseous schwannoma. Surgical resection performed and histopathologically examined confirming intra osseous schwannoma of ancient type. The post-operative course of the patient was uneventful for 2 years.

Extensive lipoma in chin region- A rare case report

Lipomas are common soft tissue tumors, but occur infrequently in the oral and maxillofacial region. Incidence of oral lipomas are noted to be only 1 - 4.4% with common sites being buccal mucosa followed by lips, tongue and vestibule. In this paper we would like to report a rare case of an extensive lipoma in the chin region.

Gold Nanostars Combined with the Searched Antibody for Targeted Oral Squamous Cell Carcinoma Therapy.

Oral squamous cell carcinoma (OSCC) is the most common cancer in the oral and maxillofacial region. Due to the special physiological and anatomical position of the oral cavity, the disease often has a significant impact on the chewing, swallowing, language, and breathing functions of patients. In recent years, with the development of medical molecular biology, molecular targeted therapy has received increasing clinical attention and has gradually become a new method for the treatment of malignant tumors. In this research, gold nanostars with a high photothermal effect combined with the searched targeted antibody were used for OSCC therapy. We use the data set in the public database and construct a gene co-expression module by weighted gene co-expression network analysis (WGCNA). It was found that the turquoise module and the midnight blue module had the greatest connection to tumorigenesis. Cytoscape software was used to analyze the important modules, and the top 10 genes of each module were selected; the survival analysis of the top 10 genes was carried out by gene expression profiling interactive analysis (GEPIA), which indicated that these genes (SERPINH1, MMP11, ADAM12, FADS3, SLC36A2, C1QTNF7, SCRG1, and APOBEC2) have statistical significance as key genes that are related to the tumorigenesis of OSCC. Then, the anti-SERPINH1 antibody targeted to SERPINH1 was chosen as the inhibitor and combined with gold nanostars for photothermal assisted targeted therapy. Thus, the searched key genes can be regarded as biomarkers and therapeutic targets for further precise diagnosis.

Development and future promise of salivary gland organoids and salivary gland tumor organoids

Salivary glands are important organs in the oral and maxillofacial region. Environment and genetic factors may cause salivary gland tumors or non-neoplastic diseases, but the mechanisms of those diseases are still unclear. One of the important reasons is the short of researching media and model. As a new technique and research model, organoids have been widely used in the research of various diseases. Organoid culture plays a bridging role between two-dimensional cell culture and living animal models, and it is also the most promising translational research model that could connect the clinical research to basic research. This review will discuss the recent development of organoid techniques in the culture of normal salivary glands and salivary gland tumors, also their applications and challenges in tissue engineering, etiological research, and tumor therapy.

Unique challenges in naval military dentistry

Divers are regularly exposed to a unique and changing environment that dentists must consider when treating such patients. This review focuses around two case studies encountered in naval dentistry: (i) diving barotrauma (pressure-induced injury related to an air space); and (ii) scuba diving mouthpiece-related oral conditions. Each condition is described by its effect on the oral cavity and in particular the teeth. Then we generally review the latest literature on the different effects of scuba diving on the diver’s head, face and oral regions and emphasize methods of dental disease prevention, diagnostic tools and treatment guidelines.

Somatosensory evoked magnetic fields caused by mechanical stimulation of the periodontal ligaments

The periodontal ligaments are very important sensory organ for our daily life such as perception of food size or hardness, determination of jaw position, and adjustment of masticatory strength. The sensory properties of the periodontal ligament, especially those of the maxillary and mandibular molars, have not yet been fully investigated. Somatosensory evoked magnetic fields (SEFs) can be measured and evaluated for latency and intensity to determine the sensory transmission characteristics of each body parts. However, previous reports on SEFs in the oral region have only reported differences in upper and lower gingival and lip sensations. In this study, the aim was to clarify these sensory characteristics by measuring SEFs during mechanical stimulation of the periodontal ligament in the maxillary and mandibular first molars. Somatosensory evoked magnetic fields were measured in the contralateral hemispheres of 33 healthy volunteers. Mechanical stimulation of the maxillary and mandibular right first molars, and the left wrist was performed with a specific handmade tool. The first peak latency for the mandibular first molars was 41.7 ± 5.70 ms (mean ± SD), significantly shorter than that for the maxillary first molars at 47.7 ± 7.36 ms. The peak intensity for the mandibular first molars was 13.9 ± 6.06 nAm, significantly larger than that for the maxillary first molars at 7.63 ± 3.55 nAm. The locations in the contralateral hemispheres showed no significant difference between the maxillary first molars and mandibular first molars. These locations were more anteroinferior and exterior than that of the wrist, as suggested by the brain homunculus. Neural signals from the mandibular periodontal ligaments pass faster and more intensely to the central nervous system than those from the maxillary periodontal ligaments, and may preferentially participate in adjustment of the occlusal force and the occlusal position.

Wet-adhesive materials of oral and maxillofacial region: From design to application

Oral and maxillofacial diseases are a group of high-incidence disorders that affect people's life quality to a great extent, while the wet and highly movable environment of the related regions brings challenges to traditional therapies. Faced with the obstacles of insufficient adhesive strength and ensuing short drug retention time, conventional oral therapeutic agents often have difficulty in achieving their desired efficacy. Oral and maxillofacial wet-adhesive materials have the advantages of excellent wet environment retention, internal stability, plasticity, and clinical potential, thus have become a significant research direction in the field of oral related disorders healing. In the past decade, the development of oral adhesive materials with good wet adhesion has accelerated based on the chemical molecular interaction, physical interlocking, and biological adhesion mechanisms, including biomimetic-inspired materials, naturally derived polymer–based materials and adhesive electrospun fiber films. These fancy wet-adhesive materials can be used for oral mucosal drug delivery, oral vaccination, wound healing, and bone defects treatments. Despite their numerous novel applications, wet-adhesive materials in stomatology still face unresolved challenges from material and biological aspects. Here, advances in designs of oral and maxillofacial wet-adhesive materials are reviewed in terms of design backgrounds, attachment mechanisms, and common classifications. Recent demonstrations of wet-adhesive materials for oral and maxillofacial region medical applications from drug delivery to multifunctional tissue treatments are presented. To conclude, current challenges and prospects on potential applications of oral and maxillofacial wet-adhesive materials are also briefly discussed.

Long noncoding RNA lnc-H2AFV-1 promotes cell growth by regulating aberrant m6A RNA modification in head and neck squamous cell carcinoma.

Head and neck squamous cell carcinoma (HNSCC) is the most common malignant tumor in the oral and maxillofacial regions, and long noncoding RNAs (lncRNAs) play crucial roles in the occurrence and progression of HNSCC. The lncRNA lnc‐H2AFV‐1 was found to be upregulated in HNSCC tissues; however, the function of lnc‐H2AFV‐1 in regulating HNSCC proliferation and the potential molecular mechanism is unclear. The present study evaluated the expression of lnc‐H2AFV‐1 in HNSCC tissues using quantitative real‐time PCR (qPCR) and associated abundant lnc‐H2AFV‐1 expression with tumor size. Functionally, lnc‐H2AFV‐1 significantly promoted the proliferation of HNSCC cells in vitro and in vivo. Quantified N6‐methyladenosine (m6A) RNA methylation and dot blot assays revealed that total m6A methylation in HNSCC cells was accompanied by lnc‐H2AFV‐1 expression. Western blotting showed that the expression of methyltransferase‐like (METTL) 3 and METTL14 was consistent with that of lnc‐H2AFV‐1, whereas the expression of demethylase fat mass and obesity‐associated (FTO) was contrary to that of lnc‐H2AFV‐1. Methylated RNA immunoprecipitation sequencing (MeRIP‐seq) and MeRIP‐qPCR revealed that lnc‐H2AFV‐1 overexpression led to the elevated expression and maximal m6A methylation of intraflagellar transport (IFT) 80 in HNSCC. In addition, METTL3/14 knockdown decreased IFT80 expression. Thus, our findings suggested that lnc‐H2AFV‐1 might be a biomarker that alters m6A modification by regulating the m6A methylases METTL3/14 and FTO and then mediating the downstream target IFT80 to promote HNSCC progression.

COVID-19 Oral Manifestations: A Mini-Review Focused on Early Evidence

Covid-19 has its etiology associated with infection by the New Coronavirus SARS-CoV-2, transmitted by inhalation of air carrying very small fine droplets and aerosol particles that contain the virus. Major signs and symptoms include fever, cough, and other symptoms associated with acute respiratory illness. However, there are reports of variation in clinical manifestations due to viral variants. Recent studies have documented various oral manifestations associated with COVID-19. In the medical literature, there can be evidence of numerous injuries such as: ulcer, papule, macule, plaque, hemorrhagic and necrotic lesions, with the tongue, labial mucosa and palate being the most affected oral regions. It is not yet clear whether oral lesions are directly caused by SARS-CoV-2, as coinfections or both. Understanding this problem may have relevant clinical implications and should be investigated in future studies. Keywords: COVID-19; SARS-CoV-2; oral manifestations.