Diameter of alveolar antral artery in the lateral sinus wall: study of related factors.

To identify the variables that influence the diameter of the artery in the lateral sinus wall, we studied 240 sinuses, focusing on sex, pattern of tooth loss, type of residual crest, thickness of the lateral wall, height and width of the ridge, and width of the sinus.

Distance of the alveolar antral artery from the alveolar crest. Related factors and surgical considerations in sinus floor elevation.

BACKGROUND: In a variable proportion of maxillary sinuses alveolar antral artery is located close to the residual ridge, increasing the chances for haemorrhagic complications during sinus floor elevation procedures. MATERIAL AND METHODS: Retrospective observational study of CBCT explorations performed for implant-treatment planning. The upper first molar area was selected for this study. The relative uncertainty (standard deviation of the measurement divided by its mean and expressed as a percentage from 0% to 100%) was chosen for determining the observational errors. For modeling the chances of AAA detection, the generalized additive models (GAM) approach was chosen. RESULTS: A total of 240 maxillary sinuses were studied (46.25% males) whose median median age was 58 years old (IQR: 52-66). Univariate models showed that the chances for an AAA-alvelar crest distance ≤15mm increase in wider sinuses with lower, subsinusally edentulous crests. When distance is considered as a continuous variable, the best mutivariate model showed an explained deviance of 67% and included AAA diameter, distance AAA-sinus floor, sinus width, and shape, height and width of the residual ridge. Thinner AAAs are found closer to the crest (within the ≤15mm safe distance). CONCLUSIONS: Bearing in mind the inclusion criteria and the limitations of this investigation, it is concluded that there is a high proportion of maxillary sinuses where AAA describes a course close to the alveolar crest (≤15mm), which was classically considered a safe distance for SFE. This position is related to the presence of atrophic crests (depressed ridge form) and wide maxillary sinuses where the distance of the vessel to the floor of the sinus is small. This information may permit a better surgical planning of SFE procedures.

Cáncer oral. Hacer biopsia o referir. Cómo hacerlo / Oral cancer. Performing a biopsy or referring. How to proceed

Se revisan los criterios de referencia de pacientes con lesiones sospechosas de malignidad a servicios especializados y los criterios para llevar a cabo las biopsias orales con la finalidad de acortar los intervalos de tiempo hasta alcanzar el diagnóstico definitivo. También se describe la técnica de biopsia incisional y se discuten los conceptos básicos para la comprensión de los informes anátomo-patológicos (AU)

Criteria for both biopsy and patient referral to specialised services are reviewed in an attempt to shorten the time intervals required to reach a final diagnosis of the disease. Technical aspects of oral incisional biopsy -including biopsy site selection and sample handling to avoid artefacts- are also discussed together with basic concepts to ease interpretation of the pathologist’s report (AU)

Er,Cr:YSGG laser therapy for oral leukoplakia minimizes thermal artifacts on surgical margins: a pilot study.

Laser use for biopsy of suspicious lesions may simulate cytological atypia at the margin of the incisions, challenging pathological diagnosis. Erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser has shown promising results in experimental models by inducing fewer artifacts. The aims of this study were to examine the thermal wounds induced by Er,Cr:YSGG laser in a short series of oral leukoplakias in terms of cytological and epithelial architectural changes and also to assess the width of the thermal damage lateral to the incision. Four oral leukoplakia patients entered the study and underwent complete surgical excision of their lesions by using Er,Cr:YSGG laser. Patients were weekly controlled until complete healing was accomplished. The patients were included on the existing follow-up program for these lesions thereafter. Study samples were routinely processed by the same technician and double-blindedly studied by two pathologists until a consensus was reached for each case. The pathological analysis of the samples revealed no autolysis and no fixation- or handling-related artifacts. However, cellular and nuclear polymorphism could be observed in two samples. Loss of intercellular adherence was the most frequent thermal artifact in this series; all pseudodysplastic artifacts recognized in the study were of low intensity and located at the basal and suprabasal layers of the leukoplakias' epithelium. The width of the thermal damage at the edge of the incision scored an average of 26.60 ± 25.3 µm. It is concluded that irradiation with Er,Cr:YSGG laser induces a minimal amount of thermal artifacts at the surgical margins of oral leukoplakias and avoids diagnostic interferences with real dysplastic borders.

Oral cancer awareness at chemist's and herbalist's shops: new targets for educational interventions to prevent diagnostic delay.

OBJECTIVES: To assess whether chemist's and herbalist's shops were offering appropriate advice for patients seeking guidance on a potentially malignant oral lesion. MATERIAL AND METHODS: A cross-sectional study was undertaken using the standardised patient approach on a representative sample of chemist's and herbalists' shops in Galicia (Spain). The introductory statement was "I have a painful ulceration on the tongue for about a month now. What would you advise?" The study sample was selected by stratified random sampling for a 5% precision, and contacted by telephone. To disclose a hypothetical bias in telephone answers, another study was designed for two provinces where pharmacies were visited in one province and herbal shops in the other one. RESULTS: A total of 460 establishments out of 1534 were contacted: 306 pharmacies (66.5%) and 154 herbalist's shops (33.5%). Patients were adequately referred from pharmacies significantly more frequently than were from herbalist's shops, which mostly prescribe over-the-counter (OTC) remedies (86.4%). Community pharmacy assistants resulted more likely to recommend OTC remedies (55.6% vs. 13%) and significantly less likely to refer patients to a dentist or physician than pharmacists. The most frequent OTC offered at chemists' were mouthwashes, while herbalist's shops prescribed propoleum (50%) and tea tree (Melaleuca alternifolia) preparations (23.8%). CONCLUSION: New off-clinical counsellors (herbalists and pharmacy assistants) have been identified as potential creators of patient diagnostic delay in oral cancer, as well as the need for increasing oral cancer awareness amongst community pharmacists. Educational strategies to improve advice and referral should be designed for these collectives.

Er,CR:YSGG lasers induce fewer dysplastic-like epithelial artefacts than CO2 lasers: an in vivo experimental study on oral mucosa.

Our aim was to assess wounds made by lasers (CO(2) and Er,Cr:YSGG) for their epithelial architectural changes and width of damage. We allocated 60 Sprague-Dawley(®) rats into groups: glossectomy by CO(2) laser at 3 different wattages (n=10 in each); glossectomy by Er,Cr:YSGG laser at two different emissions (n=10 in each), and a control group (n=10). Histological examination assessed both prevalence and site of thermal artefacts for each group. Both lasers (CO(2) and Er,Cr:YSGG) caused the same type of cytological artefacts. The 3W Er,Cr:YSGG laser produced the fewest cytological artefacts/specimen, and was significantly different from the other experimental groups: 3W CO(2) laser (95% CI=0.8 to 1.0); the 6W CO(2) laser (95% CI=0.1 to 2.0) and the 10W CO(2) laser (95% CI=1.1 to 3.0). CO(2) lasers (3-10W) generate epithelial damage that can simulate dysplastic changes with cytological atypia that affects mainly the basal and suprabasal layers. Irradiation with Er,CR:YSGG laser (2-4W) produces significantly fewer cellular artefacts and less epithelial damage, which may be potentially useful for biopsy of oral mucosa.

La biopsia oral en el contexto del precáncer y del cáncer oral / Oral biopsy in the context of oral cancer and precancer

Es este artículo se revisa el papel de la biopsia oral en el diagnóstico de lesiones precancerosas y en el diagnóstico precoz del cáncer oral. Se discuten diferentes técnicas, procedimientos, materiales, indicaciones y aspectos quirúrgicos. Se propone efectuar biopsias incisionales en lesiones malignas y sospechosas de malignidad, en tanto se preconizan biopsias escisionales, cuando el tamaño lo permita, en lesiones precancerosas (AU)

This article reviews the paper of oral biopsy on the precancerous lesions diagnosis and on the oral cancer early diagnosis. Different techniques, procedures, materials, indications and other surgical aspects are debated. It proposes to do incisional biopsies on malignant lesions and on malignant suspicious lesions, while doing excisional biopsies on precancerous lesions when the size allows it (AU)