The Role of an MRI-Based Radiomic Signature in Predicting Malignancy of Parotid Gland Tumors.

The aim of this study was to assess the ability of MRI radiomic features to differentiate between benign parotid gland tumors (BPGT) and malignant parotid gland tumors (MPGT). This retrospective study included 93 patients who underwent MRI examinations of the head and neck region (78 patients presenting unique PGT, while 15 patients presented double PGT). A total of 108 PGT with histological confirmation were eligible for the radiomic analysis and were assigned to a training group (n = 83; 58 BPGT; 25 MPGT) and a testing group (n = 25; 16 BPGT; 9 MPGT). The radiomic features were extracted from 3D segmentations of the PGT on the T2-weighted and fat-saturated, contrast-enhanced T1-weighted images. Following feature reduction techniques, including LASSO regression analysis, a radiomic signature (RS) was built with five radiomic features. The RS presented a good diagnostic performance in differentiating between PGT, achieving an area under the curve (AUC) of 0.852 (p < 0.001) in the training set and 0.786 (p = 0.017) in the testing set. In both datasets, the RS proved to have lower values in the BPGT group as compared to MPGT group (p < 0.001 and p = 0.023, respectively). The multivariate analysis revealed that RS was independently associated with PGT malignancy, together with the ill-defined margin pattern (p = 0.031, p = 0.001, respectively). The complex model, using clinical data, MRI features and the RS, presented a higher diagnostic performance (AUC of 0.976) in comparison to the RS alone. MRI-based radiomic features could be considered potential additional imaging biomarkers able to discriminate between benign and malignant parotid gland tumors.

High-Frequency Ultrasound in Diagnosis and Treatment of Non-Melanoma Skin Cancer in the Head and Neck Region.

Non-melanoma skin cancer is one of the most frequently diagnosed cancers in the human body and unfortunately the incidence continues to increase. NMSC is represented by the basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), which are the most prevalent forms, and basosquamous cell carcinomas (BSC) together with Merkel cell carcinoma (MCC), which are rare types but with a very aggressive pattern and poor prognosis. The pathological diagnosis is hard to assess without a biopsy, even by the dermoscopy. Moreover, the staging can be problematic because there is no access clinically to the thickness of the tumor and the depth of the invasion. The aim of this study was to evaluate the role of ultrasonography (US), which is a very efficient imaging method, non-irradiating and cheap, in diagnosis and treatment of non-melanoma skin cancer in the head and neck region. Thirty-one patients with highly suspicious malignant lesions of the head and neck skin were evaluated in the Oral and Maxillo-facial Surgery Department and Imaging Department in Cluj Napoca, Romania. All tumors were measured with three transducers: 13 MHz, 20 MHz and 40 MHz. Doppler examination and elastography were also used. The length, width, diameter, thickness, the presence of necrosis, status of regional lymph nodes, the presence of hyperechoic spots, strain ratio and vascularization were all recorded. After that, all patients were treated by surgical resection of the tumor and reconstruction of the defect. Immediately after surgical resection, all tumors were measured again after the same protocol. The resection margins were evaluated by all three types of transducers in order to detect malignant involvement and the results were compared with the histopathological report. We found that the 13 MHz transducers offered a big picture of the tumor but the level of details, in the form of the presence of the hyperechoic spots, is reduced. We recommend this transducer for evaluation of surgical margins or for the large skin tumors. The 20 and 40 MHz transducers are better for viewing the particularities of malignant lesions and for an accurate measurement; however, in the case of large size lesions, assessing all three dimensions of the tumor can be difficult. The intralesional hyperechoic spots are present in case of BCC and they can be used for differential diagnosis of BCC.

The Value of Multiparametric Magnetic Resonance Imaging in the Preoperative Differential Diagnosis of Parotid Gland Tumors.

BACKGROUND: The aim of the present study was to determine the value of multiparametric MRI in the preoperative differential diagnosis of parotid tumors, which is essential for therapeutic strategy selection. METHODS: A three-year prospective study was conducted with 65 patients. Each patient was investigated preoperatively with multiparametric MRI and surgical excision of the tumor was performed. The preoperative imaging diagnosis was compared with the histopathological report. Several MRI parameters were analyzed, including T1 and T2 weighted image (WI), apparent diffusion coefficient (ADC), time to peak (TTP), and the time intensity curve (TIC). RESULTS: In the differential diagnosis of benign from malignant tumors, T2WI and ADC showed statistically significant differences. Multiparametric MRI had a sensitivity, specificity, and accuracy of 81.8%, 88.6% and 92.3%, respectively. All of the studied parameters (T1, T2, TIC, TTP, ADC) were significantly different in the comparison between pleomorphic adenomas and Warthin tumors. With reference to the scope of this study, the conjunction of multiparametric and conventional MRI demonstrated a sensitivity, specificity, and accuracy of 94.1%, 100%, and 97.8%, respectively. CONCLUSIONS: Morphological analysis using conventional MRI combined with diffusion-weighted imaging (DW) and dynamic contrast-enhanced (DCE) multiparametric MRI improved the preoperative differential diagnosis of parotid gland tumors.

The Role of miRNA-221 and miRNA-34a in Non-Melanoma Skin Cancer of the Head and Neck Region.

Non-melanoma skin cancer (NMSC) is one of the most frequent types of malignancy in the human body with an increasing incidence. Short, non-coding RNA molecules called microRNAs (miRNAs) can control post-transcriptional gene expression and they have a significant role in several physiological cellular processes and pathologies, including cancer. Depending on the functions of the genes, miRNAs may function as oncogenes or tumor suppressors. The aim of this paper was to describe the role of miRNA-34a and miRNA-221 in head and neck NMSC. Thirty-eight NMSC match paired (tumor and adjacent) tissue samples were evaluated by qRT-PCR. Total RNA was extracted and isolated from tissue samples using the phenol-chloroform (Trireagent) method according to the manufacturer's protocol. The concentration of RNA was measured by a NanoDrop-1000 spectrophotometer. The expression level of each miRNA was calculated by threshold cycle. For all statistical tests, the 0.05 significance level was used and two-tailed p values. All analyses were conducted in an R environment for statistical computing and graphics. We found the miRNA-221 being overexpressed in squamous cell carcinoma (SCC) (p < 0.05), basal cell carcinoma (BCC) and basosquamous cell carcinoma (BSC) compared with adjacent normal tissue. Additionally, the levels of miRNA-221 were two times higher (p < 0.05) in cases where the excision of the tumor was done with positive margins (R1), which means that we are the first to highlight the potential role of miRNA-221 in the microscopical local invasion. Mi-RNA-34a expression was altered in the malignant tissue compared with the adjacent normal one both in BCC and SCC but not statistically significantly. In conclusion, NMSC are challenging because of their increasing incidence and rapidly evolving development and discovering their molecular mechanisms of action lead us to understand tumorigenesis and evolution, while also contributing to the implementation of novel therapeutic keys.

Characterization of eggshell as a bio-regeneration material.

Objective: The objective of this study was to identify and summarize the characteristic features of eggshell for regeneration purpose in oral surgery procedures. Methods: A review of literature was undertaken based on the PubMed database. A search to reveal the current state of knowledge and the current uses of the eggshell as a biomaterial was performed. The characteristics of the materials, the specific use, the procedure and the outcome were extracted from the articles. Results: The materials have been found to be used in humans, animals, and in vitro studies. There is a wide use regarding oral surgery especially in experimental models. There have also been attempts to enhance certain properties and improve the capabilities of eggshell as a biomaterial. There is yet a commercial product to be developed and approved for human use. Conclusions: Eggshell can be an important biowaste which can be of use in guided bone regeneration procedures, but it has not yet entered the commercial phase and approval through official regulation channels.

Recovery following Orthognathic Surgery Procedures-A Pilot Study.

This study aims at evaluating and categorizing patients' objective and subjective postoperative recovery symptoms after bimaxillary orthognathic surgery assigning the healing process. The patients were monitored throughout the recovery process, and their symptoms were managed. A prospective, observational study was performed. Patients with Class II and III malocclusion (aged 18 to 35) were evaluated and monitored preoperatively, and postoperatively at 48 h, 2 weeks, 1 month, and 3 months postsurgery. A questionnaire was used to assess pain and anesthesia/hypoesthesia. The most common objective and subjective signs that were correlated with the healing process were edema, hematoma, trismus, pain, and anesthesia/hypoesthesia. Edema peaked at 48−72 h postoperatively (distance between eye's external canthus and gonion, mean difference = 4.53, between tragus and cheilion, mean difference = 7, between tragus and gnathion, mean difference = 4.65, p < 0.001); mouth opening amplitude was significantly decreased during the first two weeks postsurgery (class II, mean difference = 32.42, p = 0.006, class III, mean difference = 44.57, p < 0.001), but it steadily and considerably improved over three months. The nose tended to widen postsurgery. The most severe pain experienced by patients was of medium intensity in the mandibular body, described as pressure, and usually did not spread. Patients were most severely and persistently impacted by anesthesia/hypoesthesia.

The quality of life after cleft lip and palate surgery.

Background and aims: Labio-maxillo-palatal clefts represent one of the most common congenital malformations, which manifests through aesthetic, functional and psycho-social alterations. The long course of multidisciplinary treatments represent a psycho-emotional and financial burden for both the patient and his family, being an important factor in the complex management of these patients.The study aims to assess the quality of life of parents of children with clefts and the psychosocial impact on the family and society. Methods: The study included 40 subjects who met the inclusion criteria for this study. Following patient informed consent and the approval of the ethics committee, the data were collected by applying the quality-of-life evaluation questionnaire. The evaluation was performed using the Likert scale (1 - not at all to 5 - very satisfactory), and the data were statistically processed. Results: Most of the questionnaires were completed by the mother, who accompanied the child to the regular check-up; 58% of parents believe that their social life is not affected by having a child with a cleft, and 83% say that interfamilial relationships have not been affected. Most parents consider that the postoperative result was very good, which led to improved psycho-social integration of the child. Conclusions: The study confirmed an acceptable quality of life for the children's parents, which was not influenced by the family presence of a child with a cleft. At the same time, the excessive care of the parents for the child with the cleft was confirmed. The postoperative improvement of the aesthetic aspect led to a much better psycho-emotional integration of the child in the society.

Lateral Cephalometric Analytical Uses for Temporomandibular Joint Disorders: The Importance of Cervical Posture and Hyoid Position.

The temporomandibular joint disorder (TMD) is a syndrome that affects the masticatory muscles and temporomandibular joint (TMJ). Its pathophysiology is not yet fully known. Cephalometric analysis is used for routine evaluation regarding orthodontic treatment and other purposes. The aim of this study was to assess if using cephalometric analysis and TMJ conservative therapy to evaluate the hyoid bone position and the cervical posture reduced symptoms in adults with TMDs compared to no intervention. The authors conducted a systematic review of the literature (PubMed, Cochrane, Web of Science, Scopus, and Embase) for clinical studies of TMDs with conservative treatment and lateral cephalometric analysis of the hyoid and cervical posture. To assess the risk of bias for non-randomized clinical trials ROBINS-I tool was used. Out of 137 studies found, 6 remained to be included. Most of them found a link between TMD and lateral cephalometric analysis, but there was a high risk of bias. This review found a possible link between TMDs, the neck and cervical posture. There is a benefit reported regarding the use of the lateral cephalometry as a treatment, but more extensive prospective randomized clinical trials are necessary to be able to draw definitive conclusions.

Prospective Evaluation of Intraorbital Soft Tissue Atrophy after Posttraumatic Bone Reconstruction: A Risk Factor for Enophthalmos.

Orbital fractures are a common finding in facial trauma, and serious complications may arise when orbital reconstruction is not performed properly. The virtual planning can be used to print stereolithographic models or to manufacture patient-specific titanium orbital implants (PSIs) through the process of selective laser melting. This method is currently considered the most accurate technique for orbital reconstruction. Even with the most accurate techniques of bone reconstruction, there are still situations where enophthalmos is present postoperatively, and it may be produced by intraorbital soft tissue atrophy. The aim of this paper was to evaluate the orbital soft tissue after posttraumatic reconstruction of the orbital walls' fractures. Ten patients diagnosed and treated for unilateral orbital fractures were included in this prospective study. A postoperative CT scan of the head region with thin slices (0.6 mm) and soft and bone tissue windows was performed after at least 6 months. After data processing, the STL files were exported, and the bony volume, intraorbital fat tissue volume, and the muscular tissue volume were measured. The volumes of the reconstructed orbit tissues were compared with the volumes of the healthy orbit tissues for each patient. Our findings conclude that a higher or a lower grade of fat and muscular tissue loss is present in all cases of reconstructed orbital fractures. This can stand as a guide for primary or secondary soft tissue augmentation in orbital reconstruction.

Is miRNA Regulation the Key to Controlling Non-Melanoma Skin Cancer Evolution?

Non melanoma skin cancer (NMSC) is one of the most common types of skin cancer. It has a number of subtypes, which include basal cell carcinoma, cutaneous squamous cell carcinoma and Merkel cell carcinoma. MicroRNAs are short, non-coding RNA (ribonucleic acid) molecules, capable of regulating gene expression at a post transcriptional level. They play a pivotal role in a variety of physiologic cellular functions and pathologies, including malignant diseases. The development of miRNAs represents an important study field, which has been extensively exploited in melanoma for almost a decade with promising results, therefore we consider it a stepstone for further research projects also in non-melanoma skin cancers. The aim of our study was to explore the current literature in order to present the role of the different miRNAs in some of the most frequent types of NMSC pertaining to oncogenesis, evolution and therapy. The most relevant and accurate available data from the literature were evaluated. Our study concluded that there are almost 100 miRNAs which can be upregulated or downregulated and can play a role in oncogenesis. They can be easily identified in circulation, are stable and they can be important diagnosis/prognosis and therapy monitoring markers.

The role of ultrasonography in head and neck Non-Melanoma Skin Cancer approach: an update with a review of the literature.

Non-Melanoma Skin Cancer is one of the most common cancer types and the face is the most affected region. The diagnosis of the skin cancer relies on clinical inspection, palpation, dermoscopy followed by incisional or excisional biopsy. When skin cancers are removed from the face, many factors are involved, including aesthetics. In addition, surgical planning with preoperative acknowledgement of the tumour margins is often the key to avoid incomplete excision, the need for reintervention, or in the prevention of functional and aesthetical defects in the treatment of skin tumours. In recent years, the development of new technologies in sonography, including high frequencies transducers can provide a full range of data. It can offer valuable information regarding the size of the tumour including the depth of invasion, the extent of the tumour, histology and subtypes of the lesions which are helpful for the treatment plan. It also may be efficient in detection of positive margins after surgery and it could play a role in the treatment of skin cancer, prevention of local recurrences and overall control of the disease. K.

Ultrasonography techniques in the preoperative diagnosis of parotid gland tumors - an updated review of the literature.

Preoperative diagnosis of parotid tumors plays a crucial role in selecting and planning the surgical treatment. Ultrasound (US) with its modern techniques can contribute to the differential diagnosis of parotid tumors. This paper aims to achieve a comprehensive review of the ultrasound techniques used in the differential diagnosis of parotid tumors, based on the latest literature data. Considering that most parotid gland tumors are located in the superficial lobe, US is frequently the first imaging technique used for the diagnosis of parotid tumors. Sonoelastography can provide additional data on the elasticity of parotid tumors, but there is an overlap between malignant and benign parotid tumors parameters. Contrast-enhanced ultrasound adds value to conventional ultrasound and allows a more complete characterization of parotid tumors. Many authors have reported promising results using contrast-enhanced ultrasound in the differential diagnosis of parotid tumors. Multiparametric ultrasound with a careful and systematic approach usually allows an accurate differential diagnosis of parotid tumors.

Cross-sectional imaging and cytologic investigations in the preoperative diagnosis of parotid gland tumors - An updated literature review.

An accurate preoperative diagnosis of parotid tumors is essential for the selection and planning of surgical treatment. Various modern cross-sectional imaging and cytologic investigations can support the differential diagnosis of parotid tumors. The aim of this study was to achieve a comprehensive and updated review of modern imaging and cytologic investigations used in parotid tumor diagnosis, based on the latest literature data. This literature review could serve as a guide for clinicians in selecting different types of investigations for the preoperative differential diagnosis of parotid tumors. Magnetic resonance imaging (MRI) with its dynamic and advanced sequences is the first-line imaging investigation used in differentiating parotid tumors. Computed tomography (CT) and positron emission tomography (PET)-CT provide limited indications in differentiating parotid tumors. Fine needle aspiration biopsy and core needle biopsy can contribute with satisfactory results to the cytological diagnosis of parotid tumors. Dynamic MRI with its dynamic contrast-enhanced and diffusion-weighted sequences provides the best accuracy for the preoperative differential diagnosis of parotid tumors. CT allows the best evaluation of bone invasion, being useful when MRI cannot be performed, and PET-CT has value in the follow-up of cancer patients. The dual cytological and imaging approach is the safest method for an accurate differential diagnosis of parotid tumors.