Malignancy and "Violated Neck" Rates in Consecutive Cohort of 79 Adult Patients With Solitary Cystic Neck Mass-Lessons Learned and Recommendations for Clinical Practice Guidelines.

OBJECTIVE: The neck region is a common site for solitary cystic neck mass (SCNM) of various etiologies, including congenital, inflammatory, and neoplastic. In adults, the primary focus is excluding malignancy. The objective of this study was to retrospectively analyze the accuracy of available diagnostic technologies for the differentiation of benign and malignant SCNM in adult patients. The study aimed to develop new clinical practice guidelines for evaluating and managing SCNM. METHODS: The primary predictive variables were the diagnostic utilities of fine-needle aspiration cytology (FNAC), ultrasound (U/S), multislice computed tomography, and magnetic resonance imaging. The study's endpoint was the overall diagnostic accuracy in differentiating between benign and malignant SCNM. The final diagnosis was based on histopathology. RESULTS: The study included 79 adult patients: 55 (69.62%) male and 24 (30.38%) female ( P <0.05). The mean age at presentation was 42.1 years (range: 18-84 years). Solitary cystic neck mass was distributed in the anterior neck region in 30 (37.97%) patients and the posterolateral neck regions in 49 (62.03%) patients ( P <0.05). The posterolateral neck regions had a significantly higher rate of malignant SCNM than the anterior neck region [19/49 (38.78%) versus 1/30 (3.33%)] ( P <0.05). There was no statistically significant difference between the U/S+FNAC and U/S+FNAC+multislice computed tomography and/or magnetic resonance imaging groups in differentiating benign and malignant SCNM (40/42 versus 36/37, P >0.05). "Violated neck" was recorded in 2 cases. CONCLUSION: A systematic investigation protocol should be applied to evaluate adult patients with SCNM.

An overview of the burden of oral cancer in Sri Lanka and its inequalities in the face of contemporary economic and social malaise.

OBJECTIVES: Over the past several decades, oral cancer has been the most common malignancy among Sri Lankan males and the top 10 cancer among females, disproportionately affecting low socio-economic groups. Sri Lanka is a lower-middle-income developing country (LMIC), currently striking through an economic crisis, and social and political unrest. Occurring at an accessible body site and predominantly attributed to potentially modifiable health-related behaviours, oral cancer should be preventable and controllable. Unfortunately, broader contextual factors that are socio-cultural, environmental, economic, and political and mediated through social determinants of people's lives consistently hinder progress. Many LMICs with a high burden of oral cancer are now gripped by economic crises, consequent social and political unrest, all compounded by reduced public health investments. The aim of this review is to provide a critical commentary on key aspects of oral cancer epidemiology including inequalities, using Sri Lanka as a case study. METHODS: The review synthesizes evidence from multiple data sources, such as published studies, web-based national cancer incidence data, national surveys on smokeless tobacco (ST) and areca nut use, smoking and alcohol consumption, poverty headcount ratios, economic growth, and Gross Domestic Product (GDP) health expenditure. National trends in the oral cancer, ST use, smoking and alcohol consumption in Sri Lanka are identified alongside inequalities. RESULTS: Using these evidence sources, we discuss 'where are we now?', together with the availability, accessibility and affordability of oral cancer treatment services, oral cancer prevention and control programmes, tobacco and alcohol control policies, and finally, outline macroeconomic perspectives of Sri Lanka. CONCLUSIONS: Finally, we speculate, 'where to next?' Our overarching goal of this review is to initiate a critical discourse on bridging the gaps and crossing the divides to tackle oral cancer inequalities in LMIC such as Sri Lanka.

Self-Retaining Photography Cheek Retractor as an Excellent Aid for Upper Jaw Surgeries: A Technical Note.

Background: Proper retraction of soft and hard tissues is essential to a successful surgery. The Technique: The authors wish to report the use of a self-retaining photography cheek retractor during a Le Fort 1 surgery and an alveolar bone graft surgery which proved beneficial by achieving very good retraction. Conclusion: This is an eye opener to modify the traditional photography retractor to maximise its benefits as a retractor in Oral and Maxillofacial surgery.

Perceived Satisfaction of Patients and Related Factors for Oral Surgery Student Dental Clinic: Evidence From Sri Lanka.

We assessed perceived satisfaction of patients and related factors for treatment provided by the oral surgery student dental clinic of the only Sri Lankan dental school. A descriptive cross-sectional study was conducted among 288 consenting patients who received oral surgery treatment at the student dental clinic of Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka. A self-administered, validated questionnaire and a 19-item multidimensional patient satisfaction scale were used for data collection. Patients of all ages were represented, but were dominated by females, aged 30 to 44 years, possessing educational attainment up to General Certificate of Education ordinary or advanced level of which 54.9% were unemployed. They had travelled distances of less than 10 and 10 to 20 km (28.1% and 27.5%, respectively) predominantly to receive tooth extractions exacerbated by symptoms. Overall, 90% of responding patients were highly satisfied with the items of many dimensions of dental treatment. Despite high levels of perceived satisfaction expressed, further improvements were warranted for waiting time, optimal pain control with more kind, and courteous staff.

Re: Maxillofacial Surgery and COVID-19, the Pandemic!

COVID-19 pandemic revolutionised the practice of oral & maxillofacial surgery in addition to almost all specialties in health care across the globe. Stringent infection control is the cornerstone in this regard. However, there are some hidden benefits of COVID-19 lockdown and social distancing in reducing the incidence of maxillofacial trauma.

Oral epithelial dysplasia: Causes, quantification, prognosis, and management challenges.

Oral epithelial dysplasia is a spectrum of architectural and cytological epithelial changes caused by accumulation of genetic changes, and is associated with an increased risk of progression to squamous cell carcinoma. It is a microscopic diagnosis of immense clinical importance. The initial reports of oral potentially malignant disorders with oral epithelial dysplasia transforming to oral cancer helped in understanding the nature of oral malignancies. Since then, clinical studies on oral potentially malignant disorders have combined microscopic findings of oral epithelial dysplasia to assess the malignant transformation potential of different grades of epithelial dysplasia. A significant amount of scientific literature has amassed on oral epithelial dysplasia relating to aspects of its diagnosis and management. However, the evidence base is weak as a result of the significant variability of published research. Poorly described study methods, variability in different oral epithelial dysplasia grading systems, inter- and intra-examiner variability causing issues of reliability, inadequate sample size, and inconsistent durations of follow-up are some of the methodological issues contributing to the failure to provide dependable information. Randomized clinical trials on the malignant transformation potential of oral epithelial dysplasia and its treatment outcomes are limited. This comprehensive literature review on oral epithelial dysplasia summarizes the scientific knowledge published in the scientific literature in English since its first description. The historical development, etiological factors, grading systems, diagnostic criteria, assessment of risk factors and prevention of malignant transformation, management principles of different grades of oral epithelial dysplasia (surgical and nonsurgical), recommendations on follow-up, and prognostic indicators are discussed in detail.

Salivary hamartoma with a bifid tongue in an adult patient.

Congenital anomalies of tongue are rare disorders usually associated with syndromes. In present article we describe a case of a non-syndromic adult patient with bifid tongue with salivary hamartoma on the dorsum of the tongue. We described the clinical features, problems faced by the patient and management. As etiology is uncertain we should have proper understanding of embryology.

Squamous cell carcinoma arising from a keratocystic odontogenic tumor: a case report.

BACKGROUND: The term "primary intraosseous squamous cell carcinoma" was introduced in 2005 by the World Health Organization with three subcategories. Squamous cell carcinoma arising from the lining of an odontogenic cyst is one important rare subcategory of such lesions with an incidence of 0.01 to 0.02%. Furthermore, the appearance of such malignancy in an odontogenic tumor such as keratocystic odontogenic tumor is considered extremely rare. CASE PRESENTATION: In this case report we report a case of a 50-year-old Sri Lankan woman who complained of pain and increase in the size of a swelling at the anterior mandible, which had been present for over 1 year. The increase was significant for 1 month with accompanying numbness of the left half of her lip. Cone beam computed tomography results revealed an irregular radiolucent lesion involving most of her mandible and, except in the anterior part, very little buccolingual expansion was seen that suggested a keratocystic odontogenic tumor. An excision biopsy of the cyst lining confirmed a squamous cell carcinoma arising from a preexisting keratocystic odontogenic tumor. CONCLUSIONS: Even though primary intraosseous squamous cell carcinoma arising from a keratocystic odontogenic tumor is considered to be very rare, the present case is comparable to most of the aspects cited in the literature. The current case emphasizes the importance of careful investigation of swellings present in the mandible. Clinicians as well as patients should be aware and detect these changes to avoid being clinically negligent.

The use of an iced cotton bud as an effective pre-cooling method for palatal anaesthesia: A technical note.

The palatal injection of anaesthesia is more painful for the patient when compared to other sites of the oral cavity. Pre-cooling (cyro anaesthesia) is a well-known method practiced to reduce pain, with the use of ice or refrigerant spray on the affected site. The already known methods of ice application to the palatal site have few practical drawbacks. Therefore, this technical note highlights the use of an iced cotton bud as a novel way of providing effective pre-cooling for palatal anaesthesia. Commercially available cotton buds were dipped in clean water and then placed in the freezer. Next the frozen cotton bud was placed on the proposed anaesthetic site for one minute and anaesthesia less than 0.5CC local anaesthetic solution was delivered at a slow pace while maintaining pressure using the iced-cotton cotton bud. All patients tested showed a 0 pain response to a visual analogue scale of 0-10. This technique can be valuable to dental practitioners who are aiming for a pain free anaesthetic experience for their patients. There is potential for further research and evaluation of this technique.

An unusual foreign object mimicking an odontoma in a patient with cleft alveolus: a case report.

BACKGROUND: The habit of inserting foreign objects into body cavities is seen in children and in adults with intellectual disability. Usually, the foreign objects cause chronic inflammation and local tissue destruction, which give rise to symptoms. Diagnosis at an asymptomatic stage is uncommon when the history is not suggestive. We describe a rare case where a foreign object was misdiagnosed as an odontoma in a patient with an alveolar cleft. CASE PRESENTATION: A radiopaque round mass was noted on the radiograph of a 12-year-old Sinhalese boy who was awaiting an alveolar bone graft. Apart from problems related to the alveolar cleft and mild halitosis, he was otherwise healthy. This was suspected to be an odontoma in the cleft region. During alveolar bone graft surgery, a button battery was recovered that was later confirmed as having been self-inserted by the child. Alveolar bone graft surgery was delayed because of local chronic inflammation due to the foreign object. Three months later, complete healing of the site was noted when reexplored for alveolar bone grafting. CONCLUSIONS: It is important to include foreign objects in the radiological differential diagnosis in asymptomatic children. Furthermore, cone beam computed tomography should be considered in suspected cases. Early removal with thorough debridement causes minimal tissue destruction.

Malignant transformation of a long-standing submental dermoid cyst to a carcinosarcoma: a case report.

BACKGROUND: Submental dermoid cysts are uncommon midline cysts which occur due to entrapment of ectoderm between the second and third branchial arches during embryogenesis. Most dermoid cysts of the head and neck are benign, but rarely malignant transformation may occur. To the best of our knowledge, this is the first report of a carcinosarcoma arising in a submental dermoid cyst. CASE PRESENTATION: A 42-year-old Sri Lankan Tamil man presented with a large cystic swelling in his submental region which was diagnosed as an extensive submental dermoid cyst. The cyst had been asymptomatic for 11 years but there was sudden enlargement and pain during the past 2 months. On surgical removal, a primary carcinosarcoma arising from part of the cyst wall was identified. After completion of radiotherapy, the disease was well controlled and he was disease free at 18 months. CONCLUSIONS: Although extremely rare, a dermoid cyst of the submental region can undergo malignant transformation. It can be successfully treated with surgical excision and radiotherapy.