Oral Surgery, Oral Medicine, Oral Pathology ,Oral Radiology

Congenital nonvascular neck masses: A retrospective analysis Publication date: Available online 12 June 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): Matteo Brucoli, Paolo Boffano, Arnaldo Benech, Silvia Rosa, Massimiliano Garzaro, Paolo Aluffi Valletti ABSTRACT Introduction Congenital nonvascular neck masses are a challenge in head and neck diagnosis and management. The aim of this study was to analyze the clinical and epidemiological findings in patients who were diagnosed for congenital nonvascular neck masses. Methods All patients with congenital nonvascular neck masses who were treated between 1996 and 2018 were reviewed. The following data were recorded: age, gender, final pathological diagnosis (thyroglossal duct cysts, branchial cleft cysts, dermoid cysts), side of the lesion, subtype according to branchial arch (for branchial cleft cysts), and need for second surgery. Results 226 patients were included, with 100 thyroglossal duct cysts, 97 branchial cysts, and 29 dermoid cysts. Excision surgery was performed in all cases. Recurrence and subsequent second surgery was necessary in 5 cases out of 226. Conclusions An appropriate knowledge of clinical and epidemiological data regarding congenital nonvascular neck masses is crucial. Surgical resection is the optimal choice of therapy. Early referral of these patients to a head and neck surgeon is crucial for a timely treatment.

Endoscopic-assisted Enucleation of Large Mandibular Odontogenic Cysts Publication date: Available online 6 June 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): Yan Wang, Shao-hai Chang, Zhao-yu Lin, Rui Chen, Zhiquan Huang Abstract Purpose Traditional enucleation of large mandibular odontogenic cysts is an invasive method that might be associated with several complications. The purpose of this study was to evaluate the clinical outcome of endoscope-assisted enucleation of large mandibular cysts. Materials and Methods Fifty-seven patients with large mandibular odontogenic cysts were enrolled in this study. Patients were divided into 2 groups as follows: 25 patients were treated by traditional enucleation and 32 underwent endoscope-assisted enucleation. Allogeneic bone grafting was applied in all patients. Results All patients successfully underwent the operation. The follow-up period ranged from 16 to 28 months. Recurrence was found in 2 patients (8%) in the traditional enucleation group. In addition, no recurrence was observed in patients in the endoscope-assisted enucleation group. Permanent mandibular nerve palsy was found in 2 patients in the traditional enucleation group. In addition, only 2 cases of temporary mandibular nerve palsy were observed in the endoscope-assisted enucleation group. Conclusion Endoscopically assisted enucleation of large mandibular odontogenic cysts proved to be an effective treatment method, which provides complete enucleation of the cystic lesion while preserving surrounding tissue.

Automatic detection and classification of radiolucent lesions in the mandible on panoramic radiographs using a deep learning object detection technique Publication date: Available online 6 June 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): Yoshiko Ariji, Yudai Yanashita, Syota Kutsuna, Chisako Muramatsu, Motoki Fukuda, Yoshitaka Kise, Michihito Nozawa, Chiaki Kuwada, Hiroshi Fujita, Akitoshi Katsumata, Eiichiro Ariji Abstract Objective To investigate whether a deep learning object detection technique can automatically detect and classify radiolucent lesions in the mandible on panoramic radiographs. Study Design Panoramic radiographs of patients with mandibular radiolucent lesions of 10 mm or more, including ameloblastomas, odontogenic keratocysts, dentigerous cysts, radicular cysts, and simple bone cysts, were included. Lesion labels including region of interest coordinates were created in text format. In total, 210 training images and labels were imported into the 'DIGITS' deep learning training system. A learning model was created using the deep neural network 'DetectNet'. Two testing datasets (testing 1 and 2) were applied to the learning model. Similarities and differences between the prediction and ground-truth images were evaluated using Intersection over Union (IoU). Sensitivity and false positive rate per image were calculated using an IoU threshold of 0.6. The detection performance for each disease was assessed using multi-class learning. Results Sensitivity was 0.88 for both testing 1 and 2. False positive rate per image was 0.00 for testing 1 and 0.04 for testing 2. The best combination of detection and classification sensitivity occurred with dentigerous cysts. Conclusion Radiolucent lesions of the mandible can be detected with high sensitivity using deep learning.

Morphological changes in idiopathic condylar resorption with different degrees of bone loss Publication date: Available online 6 June 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): Yifan He, Han Lin, Qiuping Lin, Lin Lu, Mingyu Li, Qianli Li, Jingyi Xue, Yue Xu Abstract Objective The aim of this case control study was to investigate sizes, shapes, and angles of condyles exhibiting idiopathic condylar resorption (ICR) with different degrees of condylar bone loss, and to provide additional information for the diagnosis of ICR. Study Design In total, 154 condyles from ICR patients and 42 healthy condyles were included. The ICR group was further divided into three subgroups (ICR I, ICR II, and ICR III) based on the morphology of the condyle. 3D models of the condyles were measured and analyzed using the Mimics software based on cone beam computed tomography (CBCT) data. Results The condylar anteroposterior diameter, transverse diameter, height, superficial area, volume, articular surface angles, condylar neck angle, maximal sectional area, and condylar neck sectional area were all significantly different in the ICR group compared with the control group (P < 0.05). There were also significant differences among the three subgroups in many of these parameters (P < 0.05). Conclusions Morphologic changes in ICR become worse as the disease progresses, with significant differences between diseased and normal condyles. Many changes were significant between the subgroups. Posteriorly inclined condylar neck and slender condylar neck may be associated with ICR.

Multiphase Contrast-Enhanced CT Imaging Features of Salivary Duct Carcinoma: Differentiation from Other Salivary Gland Malignancies Publication date: Available online 6 June 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Author(s): Wen-li Wu, Cheng-long Wang, Dan Li, Jin Luo, Jun-yong Ye, Sheng-sheng Xu Abstract Objective To investigate the CT imaging features of salivary duct carcinoma (SDC) with multiphase contrast-enhanced CT (CECT) scanning and to compare them to mucoepidermoid carcinoma (MEC), adenoid cystic carcinoma (ACC), and acinic cell carcinoma (AcCC). Study design A total of 63 patients with histologically diagnosed salivary gland malignancies underwent preoperative multiphase CECT. Clinical information, location, size, mass pattern, enhancement pattern, borders, invasion of adjacent tissues, and lymph node metastasis were evaluated. CT number attenuation patterns were calculated. Results SDCs were significantly more common in males and in the parotid gland (p≤0.018). They were more likely to invade into adjacent tissues and metastasize to lymph nodes (p≤0.032). Six SDCs (66.7%) had comedonecrosis as detected on histopathological examination, and 3 lesions presented cribriform necrosis on CECT. CT numbers during delayed-phase scanning were significantly higher in SDC than ACC (p=0.031). Significant differences were discovered between MEC and ACC for CT numbers during arterial-phase scanning (p=0.047) and in the ratio of CT numbers (p=0.018). Conclusion SDC exhibits some specific CT features, and multiphase CECT imaging is useful in the differential diagnosis of salivary gland malignancies.

Subjective analysis of the application of enhancement filters on magnetic resonance imaging of the temporomandibular joint Publication date: June 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 6 Author(s): Gonzalo André Montesinos, Sérgio Lucio Pereira de Castro Lopes, Tarcila Trivino, José Andrés Sánchez, Fernando Akio Maeda, Claudio Fróes de Freitas, Andre Luiz Ferreira Costa Objective The aim of this study was to investigate the effect of enhancement filters on magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ). Study Design In total, 66 MRI scans of the TMJ were analyzed without filtration and with the application of 2 filters: Sharpen 1 and Sharpen 2 (OnDemand software). Two dentomaxillofacial radiologists examined the original and filtered images individually. Intra- and interobserver concordance was measured by using generalized estimating equations. The observers evaluated the subjective image quality and the visibility of 3 components of the TMJ: disk, condyle, and articular eminence. The images were ranked on a 4-point scale, from poor to excellent. The image quality of all filtered images was compared by using the χ2 test and Bonferroni correction for multiple comparisons. Results Intra- and interobserver concordance was good. The images filtered with Sharpen 1 and Sharpen 2 provided better definition of the structures compared with nonfiltered images, providing the highest scores for subjective image quality for all structures (P < .0001). Conclusions The use of enhancement filters led to improved subjective quality and may improve the diagnostic efficacy of MRI in TMJ evaluation.

Acinetobacter baumannii orofacial cellulitis: report of 2 cases Publication date: June 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 6 Author(s): Thaís dos Santos Fontes Pereira, Denise Vieira Travassos, Raissa Cristina Costa Silva, Laiz Fernandes Mendes Nunes, Maria Edileusa Santos, Célia Regina Lanza, Gabriela Assunção Goebel, Fabiana Maria Kakehasi, Tarcília Aparecida Silva Acinetobacter baumannii infection of skin and soft tissues is uncommon and usually associated with trauma. The present report describes 2 pediatric cases of cellulitis in the orofacial region, caused by A. baumanniiinfection with a fatal outcome. A 12-year-old male patient, diagnosed with acute promyelocytic leukemia, presented with an ulcerated lesion on the lip suggestive of local trauma. The condition progressed to cellulitis, epithelial necrosis, and nonspecific vesicles and blisters. The second case occurred in a 10-year-old male patient with a diagnosis of Burkitt lymphoma. The patient's condition progressed to World Health Organization Grade IV mucositis and cellulitis. In both cases, hemoculture was positive for multidrug-resistant A. baumannii. In conclusion, A. baumannii should be considered a potentially multidrug-resistant pathogen in the presence of skin and soft tissue cellulitis. Ulcerated oral lesions may place hospitalized pediatric patients at risk for A. baumannii infection.

Association between biomarkers and medication-related osteonecrosis of the jaws: a systematic review Publication date: June 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 6 Author(s): Vittorio Moraschini, Daniel Costa Ferreira de Almeida, Carlos Marcelo Figueredo, Monica Diuana Calasans-Maia Objectives Our aim was to conduct a systematic review (SR) of the literature assessing the role of human biomarkers in the diagnosis or prognostication of medication-related osteonecrosis of the jaws (MRONJ). Study Design An electronic search without date or language restriction was carried out in PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials, Web of Science, and LILACS for publications until March 2018. In addition, a manual search in the gray literature was conducted. The search process was performed by 2 independent reviewing authors. Eligibility criteria included randomized and nonrandomized clinical trials, prospective or retrospective cohorts, case controls, and case series evaluating the association between biomarkers and MRONJ. The protocol of this SR was registered in PROSPERO under number CRD42018095886. Results The search and selection process yielded 19 studies (2 case series, 6 case-control studies, 9 prospective cohort studies, and 2 retrospective studies) published between 2008 and 2018. Twenty-four biomarkers collected from serum, saliva, and urine were investigated by these studies. Eleven biomarkers were possibly related to MRONJ; however, no consensus is observed in the literature with regard to the sensitivity and clinical effectiveness of these biomarkers. Conclusions Although many biomarkers have been associated with MRONJ, the present SR found scarce clinical evidence supporting the use of these biomarkers for the diagnosis and prognosis of MRONJ.

Diagnostic delay and suboptimal management in persistent idiopathic facial pain and persistent dentoalveolar pain; a cross-sectional study Publication date: June 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 6 Author(s): Yazan Hassona, Ahmad El- Ma'aita, Jacqueline Amarin, Anas Al Taee Objectives The aim of this study was to explore the diagnostic and therapeutic challenges encountered by patients with persistent idiopathic facial pain (PIFP) and to investigate factors influencing its delayed diagnosis. Study Design In this cross-sectional study, 34 patients with newly diagnosed PIFP were interviewed. Data about diagnostic delay, number and nature of previous consultations, and previous medical and surgical interventions were recorded. Pearson's correlation and Student t test were used to examine the differences among the variables in relation to diagnostic delay. Results The average time between the onset of symptoms to correct diagnosis was 19.3 ± 11.1 months. Diagnostic delay was significantly longer in patient with pain localized to intraoral sites (22.6 ± 7.4) compared with patients with extraoral pain (16.1 ± 9.3). The average number of health care professionals consulted before correct diagnosis was 3.7 ± 2.3. General dental practitioners were the most commonly consulted health care professionals (n = 27; 79.4%). On average, patients were given 2.3 ± 0.24 misdiagnoses before the correct diagnosis was determined and were prescribed 3.5 ± 2.4 classes of drugs. Twenty-five patients (73.5%) underwent unnecessary surgical/dental interventions. Conclusions Patients with PIFP are frequently misdiagnosed, leading to prescription of ineffective medications and unnecessary investigations and surgical interventions. Educational efforts should emphasize on improving knowledge and awareness of this condition.

Association of geographic tongue and fissured tongue with ABO blood group among adult psoriasis patients: a novel study from a tertiary care hospital in Saudi Arabia Publication date: June 2019 Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 6 Author(s): Nabeeh A. Al Qahtani, Angeline Deepthi, Nada Mohammed Alhussain, Bashayer Ayesh Mohammed Al Shahrani, Hamza Alshehri, Amal Alhefzi, Betsy Joseph Objective We aimed to determine if there was any association between geographic tongue (GT) and fissured tongue with ABO blood group among adult psoriasis patients in Saudi Arabia. Study Design This hospital-based cross-sectional study included 100 consecutive new adult patients diagnosed with psoriasis and 100 case-matched participants in the control group (nonpsoriatic). Sociodemographic and dermatologic parameters, intraoral lesions (GT and fissured tongue), and ABO blood grouping and immunoglobulins were recorded and evaluated using χ2 or Fisher's exact test. Results A total of 74% of patients had an early age of onset, and 48% of them reported this disease in their parents. A total of 76% of those with generalized psoriasis had plaque type, whereas 78% with the localized type had pustular lesions. A total of 70% of psoriatic patients had O Rh-positive blood; 63% of tongue lesions seen in these patients were GT, and it was most prominent in O Rh-positive (64.28%) and O Rh-negative (62.50%) blood types. GT was prevalent among women (75.6%). Conclusions This study found a positive association of both GT and fissured tongue in this population of adult patients with psoriasis compared with a case-matched control population without psoriasis.

Alexandros Sfakianakis
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