Clinicopathological features of myofibromas and myofibromatosis affecting the oral and maxillofacial region: A systematic review.

BACKGROUND: Myofibromas are rare benign neoplasms composed of myoid cells and myofibroblasts. This study aimed to systematically review case reports and a series of myofibromas (MF) and myofibromatosis (MFT) occurring in the oral and maxillofacial regions in order to describe their main clinicopathological features. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic searches were conducted in 2023 in four databases: MEDLINE/PubMed, Web of Science, Scopus, and EMBASE. A manual search and a search in the grey literature were also conducted. The lesions were classified as MF or MFT according to their original report. RESULTS: A total of 169 cases were included in this systematic review. Men were slightly more affected, with a painless nodule. When occurring in soft tissue, MF usually developed in the gingiva (mean age:29.23 ± 21.93 years) and when it was intra-osseous, it occurred more frequently in the posterior mandible (mean age:14.33 ± 15.62 years). MFT occurred mainly in the mandible and was predominantly described as well-circumscribed masses of spindle cells organized in fascicles with a prominent vascular activity in a hemangiopericytoma-like pattern. The lesions were mainly positive for smooth muscle actin and vimentin immunomarkers. Surgical excision was the treatment of choice in the majority of cases and recurrence was observed in only three cases. CONCLUSION: MF and MFT affect more men, with an indolent clinical course. Intra-osseous tumors and MFT seem to occur more frequently in younger individuals. These lesions seem to have a good prognosis and low recurrence.

Artificial intelligence for classification and detection of oral mucosa lesions on photographs: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to review and synthesize studies using artificial intelligence (AI) for classifying, detecting, or segmenting oral mucosal lesions on photographs. MATERIALS AND METHOD: Inclusion criteria were (1) studies employing AI to (2) classify, detect, or segment oral mucosa lesions, (3) on oral photographs of human subjects. Included studies were assessed for risk of bias using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). A PubMed, Scopus, Embase, Web of Science, IEEE, arXiv, medRxiv, and grey literature (Google Scholar) search was conducted until June 2023, without language limitation. RESULTS: After initial searching, 36 eligible studies (from 8734 identified records) were included. Based on QUADAS-2, only 7% of studies were at low risk of bias for all domains. Studies employed different AI models and reported a wide range of outcomes and metrics. The accuracy of AI for detecting oral mucosal lesions ranged from 74 to 100%, while that for clinicians un-aided by AI ranged from 61 to 98%. Pooled diagnostic odds ratio for studies which evaluated AI for diagnosing or discriminating potentially malignant lesions was 155 (95% confidence interval 23-1019), while that for cancerous lesions was 114 (59-221). CONCLUSIONS: AI may assist in oral mucosa lesion screening while the expected accuracy gains or further health benefits remain unclear so far. CLINICAL RELEVANCE: Artificial intelligence assists oral mucosa lesion screening and may foster more targeted testing and referral in the hands of non-specialist providers, for example. So far, it remains unclear if accuracy gains compared with specialized can be realized.

Application of neural networks for the detection of oral cancer: A systematic review.

One potential application of neural networks (NNs) is the early-stage detection of oral cancer. This systematic review aimed to determine the level of evidence on the sensitivity and specificity of NNs for the detection of oral cancer, following the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) and Cochrane guidelines. Literature sources included PubMed, ClinicalTrials, Scopus, Google Scholar, and Web of Science. In addition, the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess the risk of bias and the quality of the studies. Only 9 studies fully met the eligibility criteria. In most studies, NNs showed accuracy greater than 85%, though 100% of the studies presented a high risk of bias, and 33% showed high applicability concerns. Nonetheless, the included studies demonstrated that NNs were useful in the detection of oral cancer. However, studies of higher quality, with an adequate methodology, a low risk of bias and no applicability concerns are required so that more robust conclusions could be reached.

Deep learning for diagnosis of head and neck cancers through radiographic data: a systematic review and meta-analysis.

PURPOSE: This study aims to review deep learning applications for detecting head and neck cancer (HNC) using magnetic resonance imaging (MRI) and radiographic data. METHODS: Through January 2023, a PubMed, Scopus, Embase, Google Scholar, IEEE, and arXiv search were carried out. The inclusion criteria were implementing head and neck medical images (computed tomography (CT), positron emission tomography (PET), MRI, Planar scans, and panoramic X-ray) of human subjects with segmentation, object detection, and classification deep learning models for head and neck cancers. The risk of bias was rated with the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. For the meta-analysis diagnostic odds ratio (DOR) was calculated. Deeks' funnel plot was used to assess publication bias. MIDAS and Metandi packages were used to analyze diagnostic test accuracy in STATA. RESULTS: From 1967 studies, 32 were found eligible after the search and screening procedures. According to the QUADAS-2 tool, 7 included studies had a low risk of bias for all domains. According to the results of all included studies, the accuracy varied from 82.6 to 100%. Additionally, specificity ranged from 66.6 to 90.1%, sensitivity from 74 to 99.68%. Fourteen studies that provided sufficient data were included for meta-analysis. The pooled sensitivity was 90% (95% CI 0.820.94), and the pooled specificity was 92% (CI 95% 0.87-0.96). The DORs were 103 (27-251). Publication bias was not detected based on the p-value of 0.75 in the meta-analysis. CONCLUSION: With a head and neck screening deep learning model, detectable screening processes can be enhanced with high specificity and sensitivity.

Unlocking the potential of beta sitosterol: Augmenting the suppression of oral cancer cells through extrinsic and intrinsic signalling mechanisms.

The global increase in the prevalence of oral neoplasms and related deaths can be attributed to social development and lifestyle factors, leading to poor prognosis and a lack of early clinical detection. Oral cancer ranks ranked sixth mostly diagnosed cancer and is a leading cause of cancer-related deaths. In light of these circumstances, our objective was to assess the potential of ß-sitosterol, a naturally occurring herbal compound, as an anticancer agent against KB cells, a representative cell line for oral cancer. Our study primarily focused on evaluating the cytotoxic effect and mRNA expression of apoptotic proteins by ß-sitosterol on KB cells. The results demonstrated a remarkable cytotoxic effect, leading to cell death. Further investigation using flow cytometric analysis revealed that this cell death was mediated through the initiation of the apoptotic signalling by ß-sitosterol. The use of the bioinformatic tool, STITCH, supported our study by predicting drug-protein interactions and suggesting that ß-sitosterol may play a significant role in targeting apoptotic pathways. Additionally, docking results were employed to validate the findings demonstrating high binding affinity of ß-sitosterol with apoptotic-mediated signalling targets. To gain deeper insights into the molecular insights, we measured mRNA levels for BAX, BCL-2, MCL-1, P53, P21, MDM2, caspase3, and caspase9. Based on our comprehensive findings, our study concludes that ß-sitosterol holds significant therapeutic potential against oral cancer cells. These results strongly suggest that this herbal compound should be further explored as a potential treatment option for oral cancer for clinical trial.

Novel V-shaped kiss flap harvest technique for the forearm free flap in soft tissue reconstruction.

INTRODUCTION: Radial forearm flap (RFF) is widely used in oral reconstruction. However, the donor-site defect remains the main limit. In this paper, V-shaped kiss RFF (VRFF) is described as a novel technique to improve aesthetics and function of it. A retrospective study was conducted to introduce VRFF and evaluate its effect and safety. METHODS: A total of 21 patients who underwent VRFF for oral reconstruction, and 23 patients who underwent conventional RFF from February 2016 to April 2018 were included in this study. Direct comparisons were made on patient's subjective evaluation of postoperative hand function and degree of scarring and objective donor-site function assessment including range of wrist movements and grip strength before and after surgery between the two groups. RESULTS: No skin grafts were used in the VRFF group, and 20 of 21 patients achieved primary healing at donor site, while all patients from the RFF group had skin grafts. And 18 of 23 patients achieved primary healing. The postoperative scar score of donor site in the VRFF group was significantly higher than that in the RFF group (3.4 vs 2.8, P = 0.035). There were no significant differences in other subjective evaluation and donor-site morbidity and hand function assessment. CONCLUSION: VRFF is able to provide a new and simple method to close donor-site defect and realize a better healing in donor site.

Teratoma nasofaríngeo inmaduro con diagnóstico prenatal: reporte de un caso y revisión de la literatura / Immature nasopharyngeal teratoma with prenatal diagnosis: Case report and review of the literature

Objetivos: Reportar el caso de una gestante con diagnóstico de feto con teratoma nasofaríngeo inmaduro y realizar una revisión describiendo el pronóstico de esta patología. Materiales y métodos: Se reporta el caso de una gestante de 27 años, atendida en la Unidad de Ginecología y Obstétrica de un centro de referencia en Bogotá (Colombia), por hallazgo durante el control prenatal de un feto con evidencia de polihidramnios secundario a teratoma nasofaríngeo. Se realizó una búsqueda bibliográfica en las bases de datos Medline vía PubMed, Scopus, SciELO y ScienceDirect, restringiendo tipo de idioma (inglés y español) y por fecha de publicación (enero de 2001 a enero de 2021). Se incluyeron reportes de caso y series de casos que abarcaran el pronóstico de esta patología. Resultados: La búsqueda recuperó 168 títulos, de los cuales 55 cumplieron con los criterios de inclusión. En total se reportó el resultado perinatal de 58 fetos con diagnóstico de teratoma nasofaríngeo inmaduro detectado en etapa prenatal. En los casos identificados, la mortalidad perinatal fue del 25,4 % y el porcentaje de óbito fue cercano al 3,6 %. Conclusiones: El teratoma nasofaríngeo inmaduro es una patología poco frecuente. La literatura disponible sugiere que el pronóstico fetal depende del grado de compromiso de las estructuras intracraneales y de la posibilidad de resección de la lesión. Se requieren más estudios que evalúen el pronóstico de los fetos con teratoma nasofaríngeo inmaduro.

Objectives: To report the case of a pregnant woman with prenatal diagnosis of fetal immature nasopharyngeal teratoma, and to conduct a review of the literature describing the prognosis of this condition. Material and methods: We report the case of a 27-year-old pregnant woman who received care at the Obstetrics and Gynecology Unit of a reference hospital in Bogotá (Colombia) because of a finding during a prenatal visit of evidence of polyhydramnios, secondary to a nasopharyngeal teratoma. A literature search was conducted in the Medline via PubMed, Scopus, SciELO and ScienceDirect databases, restricted by language (English and Spanish) and date of publication (January 2001 to January 2021). Case reports and case series covering the prognosis of this condition were included. Results: Overall, 168 titles were retrieved, 55 of which met the inclusion criteria. Perinatal outcomes for a total of 58 fetuses with a diagnosis of immature nasopharyngeal teratoma detected during the prenatal stage were reported. In the identified cases, perinatal mortality was 25.4 % and the percentage of fetal demise was close to 3.6 %. Conclusions: Immature nasopharyngeal teratoma is an infrequent condition. The available literature suggests that fetal prognosis depends on the degree of compromise of intracranial structures and the possibility of resecting the lesion. Further studies are needed to assess the prognosis of fetuses with immature nasopharyngeal teratoma.

Management of Stage III Oral Cavity Squamous Cell Carcinoma in Light of the New Staging System: a Critical Review.

PURPOSE OF REVIEW: Oral squamous cell carcinoma (OSCC) patients have a poor prognosis, especially in advanced stages. AJCC/UICC staging system 8th edition (TNM8) included depth of invasion (DOI) as part of T staging and stage III has become a heterogeneous group of lesions, composed of patients with larger DOI and/or width. Additionally, stage III includes N1, regardless of the primary tumor width or DOI. The real prognostic value of each of these characteristics and the need for adjuvant treatment for stage III patients is not well established. RECENT FINDINGS: TNM8 stratified OSCC into prognostic groups based on overall survival. Extranodal extension, positive or close margins, pT3 or pT4 tumors, pN2 or pN3 nodal disease, nodal disease in levels IV or V, perineural invasion, vascular invasion, and lymphatic invasion are the main adverse features for OSCC, and adjuvant treatment is largely recommended for these patients. Stage III patients should be addressed with caution. So far, there is no significant evidence for recommending or excluding adjuvant treatment for stage III OSCC without adverse features. The authors largely recommend adjuvant radiotherapy for these cases, especially because pT3 without adverse features is rare. Further studies on this topic are necessary.

Outcomes of mandibular reconstruction using three-dimensional custom-made porous titanium prostheses.

BACKGROUND: Our aim was to report the long-term outcomes of mandibular reconstruction using CAD-CAM-designed 3D-printed porous titanium implants in patients not amenable to a free vascularized fibula flap reconstruction. METHODS: The implants were designed with ProPlan CMF® 2.2 software and manufactured with a Selective Laser Melting (SLM) "layer-by-layer" 3D-printing of pure porous titanium powder beds. Primary endpoints were implant exposure and implant removal calculated using Gray's tests. Secondary endpoints were predictive factors of implant exposure and implant removal, and rates of dental rehabilitation. RESULTS: Thirty-six patients were operated between 2015 and 2017 and were included in this study. Reconstruction using a porous titanium 3D-printed implant was proposed due to medical contraindication for a fibula free flap (n = 13), due to the failure of a previous fibula free flap reconstruction (n = 7), or due to refusal of a fibula free flap reconstruction by the patient (n = 16). The medical indications for mandibular reconstruction were a primary tumor requiring mandibulectomy in nine patients, mandibular osteoradionecrosis requiring mandibulectomy in nineteen patients, and secondary reconstruction in eight patients. The 2-year rates of implant exposure and implant removal were 69.4% and 52.8%. Reconstruction of the symphysis was a high-risk exposure variable (OR 30; p = 0.0003). Only one patient underwent a successful dental rehabilitation. CONCLUSION: The use of a porous titanium 3D- implant for mandibular reconstruction in head and neck cancer patients resulted in high rates of implant exposure and of implant removal, notably when symphysis involvement.

Análise das condutas estratégicas de gestores e profissionais para a prevenção e o controle do câncer bucal / Analysis of the strategic conduct of managers and professionals involved in oral cancer prevention and control

Resumo Gestores e profissionais de saúde são os agentes responsáveis pela implementação das políticas públicas nos serviços de saúde, sendo de fundamental importância compreender as formas como agem no cotidiano. O objetivo desta pesquisa é analisar as condutas estratégicas de gestores e profissionais que intervêm na prevenção e no controle do câncer bucal. Trata-se de pesquisa qualitativa, realizada por meio de 23 entrevistas com gestores e profissionais de cinco municípios da região de saúde Metropolitana I do Rio de Janeiro e três entrevistas com o corpo técnico estadual. Realizou-se a análise da conduta estratégica prevista na Teoria da Estruturação de Giddens. Verificou-se que esses agentes, sensibilizados pelas representações do câncer na sociedade, se mobilizam como potenciais agentes facilitadores do acesso e criam alternativas informais aos protocolos mais restritores. No entanto, essa mobilização não costuma ocorrer no período anterior à suspeita do câncer, constituindo uma contradição importante. Destacou-se a importância da ampliação da atenção primária e do aperfeiçoamento das ações de promoção da saúde, prevenção do câncer e educação permanente para garantia do direito ao acesso ao diagnóstico e tratamento precoce do câncer bucal.

Abstract Health managers and professionals are the agents responsible for implementing public policies in health services. It is therefore essential to understand how they act in everyday practice. The aim of this study was to analyze the strategic conduct of managers and professionals involved in oral cancer prevention and control. We conducted a qualitative study based on 23 interviews with oral health managers and professionals in five municipalities in the Metropolitana I health region in the state of Rio de Janeiro and three interviews with members of the oral health technical team of the state health department. We performed a strategic conduct analysis drawing on Anthony Giddens' theory of structuration. The findings show that, sensitized by the representation of cancer in society, these agents act as potential facilitators of access to services, creating informal alternatives to more restrictive protocols. However, this mobilization only tends to occur in cases of suspected cancer, constituting an important contradiction. It is concluded that it is essential to improve access to primary care, enhance health promotion and cancer prevention actions, and promote continuing training to guarantee the right to early diagnosis and timely treatment of oral cancer.

Characteristics and in-hospital morbidity trends associated with oral and oropharyngeal cancers in Brazil.

BACKGROUND: Brazil experienced an expansion of the population's access to oral health policies after the creation of the Unified Health System (SUS, Sistema Único de Saúde). Through public policies, the consolidation of Primary Health Care (PHC) and the incorporation of dental care into primary and hospital care took place. The objective of this study was to identify epidemiological aspects, including the temporal trend, of hospital morbidity from oral and oropharyngeal cancer in Brazil, considering hospitalizations for this neoplasm in a hospital network linked to the public care system. METHODS: Observational study based on information on hospital admissions for oral cancer throughout Brazil. The research used data from the Brazilian Cancer Registry Information System. For the temporal series analysis, generalized linear regression model was used with the Prais-Winsten method. RESULTS: Of the 121,971 patients hospitalized with oral and oropharyngeal cancers, 76.40% were male and 23.60% were female, resulting in a M:F ratio of 3.24:1. Regarding the anatomical region of involvement among hospitalized patients with oral cavity neoplastic lesions, there was a predominance in non-specific places in the mouth, such as the floor of the mouth, soft and hard palate, among others (32.68%), followed by lesions in the region of tongue (28.89%). In this population, the predominant age group was between the fifth decade (31.09%) and sixth decade of life (24.99%); men presented neoplastic lesions of oral and oropharyngeal cancers at an earlier age than women. In all regions of the country, the staging of cases diagnosed in the tertiary health network accredited to the José Alencar Gomes da Silva National Cancer Institute (INCA) was late, with higher tendency for metastasis. The temporal trend of the adjusted in-hospital morbidity rates showed to be increasing in the Northeast, South and Midwest regions for the male gender. For females, they were increasing in the Northeast and South regions. CONCLUSIONS: It is concluded that the distribution of in-hospital morbidity rates of oral and oropharyngeal cancers in the country is irregular. There is a greater number of cases identified by the study in male patients and in the Southeast and South regions; with an increasing tendency of this coefficient in both genders.

Linfoma de Burkitt como diagnóstico diferencial de infecção odontogênica / Burkitt's Lymphoma as a differential diagnosis of dental infection / El Linfoma de Burkitt como diagnóstico diferencial de infección dental

Introdução: O linfoma de Burkitt é um linfoma altamente agressivo do tipo não-hodgkin originado a partir de mutação nos linfócitos B. Clinicamente demonstra características de malignidade como evolução rápida, destruição das corticais ósseas e mobilidade dentária, além de aumento de volume facial adjacente aos ossos maxilares. Esse tumor é de difícil diagnóstico devido às características clínicas inespecíficas, o que pode muitas vezes levar a um diagnóstico e tratamento tardio, piorando o prognóstico e a taxa de sobrevida do paciente. Relato de Caso: O caso clínico se trata de uma paciente, sexo feminino, 21 anos de idade, com história de aumento de volume em hemiface esquerda de evolução repentina, associada a dor, febre e relato de exodontia recente. A história clínica e os achados clínicos inespecíficos simularam uma infecção odontogênica, a qual atrasou o diagnóstico e o tratamento correto. Após exames imaginológicos específicos, exploração cirúrgica e exame histopatológico foi possível chegar a um diagnóstico definitivo de linfoma de Burkitt e manejo adequado dessa patologia. Conclusão: É de extrema importância o papel do cirurgião-dentista na detecção precoce dessa patologia com envolvimento dos maxilares, uma vez que a remissão e/ou a cura depende da extensão da doença, do seu comportamento biológico e do momento do diagnóstico... (AU)

Introduction: Burkitt's lymphoma is a highly aggressive non-Hodgkin type lymphoma originated from a mutation in B lymphocytes. It clinically demonstrates malignant characteristics such as rapid evolution, destruction of bone corticals and tooth mobility, in addition to increased facial volume adjacent to the maxillary bones. This tumor is difficult to diagnose due to its nonspecific clinical characteristics, which can often lead to a late diagnosis and treatment, worsening the patient's prognosis and survival rate. Case Report: The clinical case is a female patient, 21 years old, with a history of swelling in the left hemiface of sudden evolution, associated with pain, fever and a report of recent extraction. Clinical history and nonspecific clinical findings simulated an odontogenic infection, which delayed diagnosis and correct treatment. After specific imaging exams, surgical exploration and histopathological examination, it was possible to reach a definitive diagnosis of Burkitt's lymphoma and adequate management of this pathology. Conclusion: The role of dentists in the early detection of this pathology with involvement of the jaws is extremely important, since remission and/or cure depends on the extent of the disease, its biological behavior and the time of diagnosis... (AU)

Introducción: El linfoma de Burkitt es un linfoma de tipo no Hodgkin altamente agresivo originado por una mutación en los linfocitos B. Clínicamente demuestra características malignas como rápida evolución, destrucción de corticales óseas y movilidad dentaria, además de aumento de volumen facial adyacente a los huesos maxilares. Este tumor es de difícil diagnóstico debido a sus características clínicas inespecíficas, lo que muchas veces puede llevar a un diagnóstico y tratamiento tardíos, empeorando el pronóstico y la supervivencia del paciente. Caso Clínico: El caso clínico es una paciente femenina, de 21 años de edad, con antecedente de tumefacción en hemifacial izquierdo de evolución súbita, asociada a dolor, fiebre y reporte de extracción reciente. La historia clínica y los hallazgos clínicos inespecíficos simularon una infección odontogénica, lo que retrasó el diagnóstico y el tratamiento correcto. Luego de exámenes imagenológicos específicos, exploración quirúrgica y examen histopatológico, se logró llegar a un diagnóstico definitivo de linfoma de Burkitt y manejo adecuado de esta patología. Conclusión: El papel de los odontólogos en la detección temprana de esta patología con compromiso de los maxilares es de suma importancia, ya que la remisión y/o curación depende de la extensión de la enfermedad, su comportamiento biológico y el momento del diagnóstico... (AU)

Prognostic factors and overall survival in a 15-year followup of patients with malignant salivary gland tumors: a retrospective analysis of 193 patients / Fatores prognósticos e sobrevida global em um seguimento de 15 anos de pacientes com tumores malignos da glândula salivar: uma análise retrospectiva de 193 pacientes

Abstract Introduction Malignant tumors of the salivary glands are uncommon pathological entities, representing less than 5% of head and neck neoplasms. The prognosis of patients with malignant tumors of the salivary glands is highly variable and certain clinical factors can significantly influence overall survival. Objective To analyze the clinicopathologic and sociodemographic characteristics that influence survival in patients with malignant tumors of the salivary glands Methods This retrospective study analyzed sex, age, race, education level, tumor location, tumor size, lymph node involvement, distant metastasis, margin status, treatment type, marital status, method of health care access and 15-year overall survival in 193 patients with malignant tumors of the salivary glands. The X², log-rank Mantel-Cox, multinomial regression and Cox logistic regression tests were used (SPSS 20.0,p < 0.05). Results The most common histological types were adenocarcinoma (32.1%), adenoid cystic carcinoma (31.1%) and mucoepidermoid carcinoma (18.7%). The 15-year overall survival rate was 67.4%, with a mean of 116 ± 6 months. The univariate analysis revealed that male sex (p = 0.026), age > 50 years (p = 0.001), referral origin from the public health system (p = 0.011), T stage (p = 0.007), M stage (p < 0.001), clinical stage (p < 0.001), compromised surgical margins (p = 0.013), and chemotherapy (p < 0.001) were associated with a poor prognosis. Multivariate analyses also showed that age > 50 years was independently associated with a poor prognosis (p = 0.016). The level of education was the only factor more prevalent in older patients (p = 0.011). Conclusion Patients with malignant tumors of the salivary glands older than 50 years have a worse prognosis and an independent association with a low education level.

Resumo Introdução Os tumores malignos das glândulas salivares são entidades patológicas incomuns, representam menos de 5% das neoplasias de cabeça e pescoço. O prognóstico dos pacientes com tumores malignos das glândulas salivares é altamente variável e alguns fatores clínicos podem influenciar significativamente a sobrevida global. Objetivo Analisar as características clinicopatológicas e sociodemográficas que influenciam a sobrevida em pacientes com tumores malignos das glândulas salivares. Método Este estudo retrospectivo analisou sexo, idade, etnia, nível de escolaridade, localização do tumor, tamanho do tumor, envolvimento linfonodal, metástase distante, margens, tipo de tratamento, estado civil, método de acesso à assistência médica e sobrevida global em 15 anos de 193 pacientes com tumores malignos das glândulas salivares. Foram usados os testes X2, log-rank Mantel-Cox, regressão multinomial e regressão logística de Cox (SPSS 20.0, p < 0,05). Resultados Os tipos histológicos mais comuns foram adenocarcinoma (32,1%), carcinoma adenoide cístico (31,1%) e carcinoma mucoepidermoide (18,7%). A taxa de sobrevida global em 15 anos foi de 67,4%, com média de 116 ± 6 meses. A análise univariada revelou que sexo masculino (p = 0,026), idade > 50 anos (p = 0,001), origem de referência do sistema público de saúde (p = 0,011), estádio T (p = 0,007), estádio M (p < 0,001)), estágio clínico (p < 0,001), margens cirúrgicas comprometidas (p = 0,013) e quimioterapia (p < 0,001) foram associados a um prognóstico ruim. As análises multivariadas também mostraram que a idade > 50 anos foi associada independentemente a um prognóstico ruim (p = 0,016). O nível de escolaridade foi o único fator mais prevalente em pacientes idosos (p = 0,011). Conclusão Pacientes com tumores malignos das glândulas salivares acima de 50 anos apresentam pior prognóstico e associação independente com baixo nível de escolaridade.

Propranolol inhibits cell viability and expression of the pro-tumorigenic proteins Akt, NF-ĸB, and VEGF in oral squamous cell carcinoma.

BACKGROUND: Propranolol (PPL) has been suggested as an option for the treatment of various types of cancer. However, data regarding its effectiveness against oral cancer are scarce. Thus, we aimed to evaluate the antitumor potential of PPL in oral squamous cell carcinoma (OSCC) in vitro. METHODS: OSCC cell lines, SCC-9, SCC-25, and Cal27, were treated with PPL at different times and concentrations. OSCC cells were treated with PPL alone or in combination with cisplatin (CDDP) or 5-fluorouracil (5-FU). Cell viability was determined using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The expression of phosphorylated (p)-Akt, p-S6, p-PTEN, p-P65, and VEGF was verified by immunofluorescence. The migratory activity of OSCC cells was evaluated using a wound-healing assay. RESULTS: PPL reduced OSCC cell viability in a dose- and time-dependent manner. Concentrations above 300 µM, 110 µM, and 100 µM for SCC-9, Cal27, and SCC-25, respectively, significantly eliminated tumor cells. The combination of PPL with CDDP and 5-FU enhanced their antitumor effects. There was a modest difference between the use of the IC30 and IC50 of PPL in the combinatory options. PPL downregulated p-P65 NF-ĸB and VEGF expression in SCC-9 and Cal27 cells but not in SCC-25 cells. PPL inhibited the phosphorylation of Akt and s6 and increased the phosphorylation of PTEN in all OSCC cell lines studied. PPL inhibited OSCC cell migration after 24 h of treatment. CONCLUSION: PPL was effective against oral cancer cells and enhanced standard-of-care. PPL inhibited cell viability and the expression of pAkt, NF-ĸB, and VEGF.

Oral Malignant Non-Hodgkin Lymphoma: A Retrospective Single-Center Study.

This study aimed to retrospectively evaluate the incidence of oral non-Hodgkin lymphoma (NHL) in patients referred to the Academic Hospital of the Magna Graecia University of Catanzaro from 2002 to 2020. A retrospective single-center study was performed. Patients with a histologically confirmed diagnosis of oral NHL were included. Demographic data and clinical parameters were digitally recorded, focusing on the NHL-specific localization and symptomatology. The study sample was evaluated by analyzing descriptive statistics with absolute and relative frequencies. A total of 26 patients with intraoral NHL were identified with a progressive increase in NHL occurrence during the observation period. Clinical manifestations included swelling/mass (80.7%), eventually associated with pain and ulcerations. The most common localizations were in soft tissues: buccal mucosa (38.4%), tongue (19.2%), gingiva (11.5%), cheek (11.5%). Oral NHL is rare. Clinical manifestations were unspecific, so a misdiagnosis could occur. The extranodal B-cell form of oral NHL, particularly diffuse large B-cell lymphoma, was the most common frequent oral NHL in this southern Italian population, with a progressively increased occurrence in almost 20 years.

Prognostic factors and overall survival in a 15-year followup of patients with malignant salivary gland tumors: a retrospective analysis of 193 patients.

INTRODUCTION: Malignant tumors of the salivary glands are uncommon pathological entities, representing less than 5% of head and neck neoplasms. The prognosis of patients with malignant tumors of the salivary glands is highly variable and certain clinical factors can significantly influence overall survival. OBJECTIVE: To analyze the clinicopathologic and sociodemographic characteristics that influence survival in patients with malignant tumors of the salivary glands METHODS: This retrospective study analyzed sex, age, race, education level, tumor location, tumor size, lymph node involvement, distant metastasis, margin status, treatment type, marital status, method of health care access and 15-year overall survival in 193 patients with malignant tumors of the salivary glands. The X², log-rank Mantel-Cox, multinomial regression and Cox logistic regression tests were used (SPSS 20.0,p < 0.05). RESULTS: The most common histological types were adenocarcinoma (32.1%), adenoid cystic carcinoma (31.1%) and mucoepidermoid carcinoma (18.7%). The 15-year overall survival rate was 67.4%, with a mean of 116±6 months. The univariate analysis revealed that male sex (p = 0.026), age > 50 years (p=0.001), referral origin from the public health system (p=0.011), T stage (p= 0.007), M stage (p< 0.001), clinical stage (p< 0.001), compromised surgical margins (p= 0.013), and chemotherapy (p< 0.001) were associated with a poor prognosis. Multivariate analyses also showed that age > 50 years was independently associated with a poor prognosis (p= 0.016). The level of education was the only factor more prevalent in older patients (p= 0.011). CONCLUSION: Patients with malignant tumors of the salivary glands older than 50 years have a worse prognosis and an independent association with a low education level.

Performance of deep convolutional neural network for classification and detection of oral potentially malignant disorders in photographic images.

Oral potentially malignant disorders (OPMDs) are a group of conditions that can transform into oral cancer. The purpose of this study was to evaluate convolutional neural network (CNN) algorithms to classify and detect OPMDs in oral photographs. In this study, 600 oral photograph images were collected retrospectively and grouped into 300 images of OPMDs and 300 images of normal oral mucosa. CNN-based classification models were created using DenseNet-121 and ResNet-50. The detection models were created using Faster R-CNN and YOLOv4. The image data were randomly selected and assigned as training, validating, and testing data. The testing data were evaluated to compare the performance of the CNN models with the diagnosis results produced by oral and maxillofacial surgeons. DenseNet-121 and ResNet-50 were found to produce high efficiency in diagnosis of OPMDs, with an area under the receiver operating characteristic curve (AUC) of 95%. Faster R-CNN yielded the highest detection performance, with an AUC of 74.34%. For the CNN-based classification model, the sensitivity and specificity were 100% and 90%, respectively. For the oral and maxillofacial surgeons, these values were 91.73% and 92.27%, respectively. In conclusion, the DenseNet-121, ResNet-50 and Faster R-CNN models have potential for the classification and detection of OPMDs in oral photographs.

Análise da cobertura de saúde bucal e práticas das equipes de saúde bucal na atenção primária em municípios sul-mato-grossenses / Analysis of oral health coverage and practices of oral health teams in primary care in Sul-Mato-Grossenses municipalities

Resumo Introdução Considerando a estimativa para o Brasil de 15.190 novos casos de câncer de boca e orofaringe para o triênio de 2020 a 2022, justifica-se a importância de o odontólogo na atenção primária estar capacitado para o diagnóstico precoce de câncer de boca e orofaringe, à biópsia e à regulação ao Centro de Especialidades Odontológicas. Objetivo Analisar a cobertura de saúde bucal e práticas das equipes de saúde bucal da atenção primária à saúde quanto ao cuidado ao câncer de boca e orofaringe em municípios de Mato Grosso do Sul. Material e método Estudo descritivo, transversal, quantitativo, em bases de dados secundários oficiais e públicos, referentes aos municípios do estado de Mato Grosso do Sul em que foram determinadas prevalência de câncer de boca e orofaringe, CID-10 C00 - C10, cobertura de saúde bucal e análise de dados de cuidado em saúde bucal do PMAQ-AB, 3º Ciclo. Resultado Houve divergência nas respostas entre as equipes de saúde bucal de alguns municípios no direcionamento do fluxo de referenciamento para biópsia e tratamento do câncer de boca e orofaringe, evidenciando desconhecimento das ofertas de serviços especializados. Conclusão Há fragilidades no processo de trabalho que podem influenciar no estadiamento do diagnóstico, tratamento, qualidade de vida e sobrevida do paciente com neoplasia maligna de boca e orofaringe. São importantes a capacitação e valorização das equipes de saúde bucal por meio de uma educação continuada e permanente, voltada ao diagnóstico precoce e à orientação dos fluxos assistenciais aos serviços especializados de referência, fortalecendo a coordenação do cuidado e ordenação na rede de atenção à saúde.

Abstract Introduction Considering the estimate in Brazil of 15,190 new cases of oral and oropharyngeal cancer for the triennium 2020 to 2022, the importance of the dentist in Primary Care is justified in the early diagnosis of oral and oropharyngeal cancer, biopsy and regulation to the Dental Specialties Center. Objective To analyze the Oral Health coverage and practices of the Oral Health Teams of Primary Health Care, in the care of mouth and oropharynx cancer in municipalities of Mato Grosso do Sul. Material and method Descriptive, cross-sectional, quantitative study of official and public secondary databases referring to municipalities in the state of Mato Grosso do Sul in which the prevalence of oral and oropharyngeal cancer was determined, ICD-10 C00 - C10, coverage of oral health and analysis of oral health care data from the PMAQ-AB, 3rd Cycle. Result There was a divergence in the answers between the oral health teams of some municipalities in the direction of the referral flow for biopsy and treatment of oral and oropharyngeal cancer, evidencing a lack of knowledge of the offers of specialized services. Conclusion There are weaknesses in the work process that can influence the staging of diagnosis, treatment, quality of life and survival of patients with malignant neoplasm of the mouth and oropharynx. It is important to train and value the Oral Health Teams through continuous and permanent education, aimed at early diagnosis and guidance of care flows to specialized reference services, strengthening the coordination of care and ordering in Health Care Network.

Câncer bucal: o que sabem os cirurgiões-dentistas da Baixada Litorânea-RJ? / Oral cancer: what do dentists from the Baixada Litorânea region - RJ know about?

Introdução: Apesar das estratégias para prevenção e diagnóstico precoce, o câncer bucal está entre os mais incidentes no Brasil. Objetivo: Avaliar o conhecimento de cirurgiões-dentistas da Atenção Primária à Saúde sobre o câncer bucal. Material e método: Pesquisa censitária, exploratória e quantitativa, realizada em 2021. Cirurgiões-dentistas vinculados à rede pública dos 9 municípios da Baixada Litorânea/RJ preencheram um questionário com 41 questões, divididas em 5 blocos: 1. Perfil sociodemográfico, 2. Conhecimento sobre câncer bucal, 3. Fatores de risco para câncer bucal, 4. Segurança para diagnóstico do câncer bucal e 5. Experiência na identificação de lesões suspeitas. Resultado: Dos 128 cirurgiões-dentistas habilitados, 89,1% (n=114) participaram e caracterizavam-se por terem menos de 40 anos (50%), serem do sexo feminino (64,9%) e formados há mais de 16 anos (57,9%). Quanto ao conhecimento sobre o câncer bucal e fatores de risco, 84,2% consideraram seu nível de conhecimento regular ou bom e 65,8% consideraram baixo o seu nível de segurança para realização de procedimentos de diagnóstico do câncer bucal. Quanto à identificação de lesões suspeitas de câncer bucal, 86,8% realizavam exame da cavidade bucal, 7,9% não realizam porque o tempo da consulta é insuficiente e 5,3% porque não sabem fazer. Além disso, 50,9% identificaram alguma lesão suspeita nos últimos 12 meses. Notou-se também que 65,8% dos CDs não tinham conhecimento do fluxograma do município para diagnóstico e tratamento do câncer bucal. Conclusão: Os achados evidenciaram lacunas com relação ao conhecimento e procedimentos para diagnóstico precoce do câncer bucal.

Introduction: Despite the strategies for prevention and diagnosis, oral cancer is among the most incidents in Brazil. Objective: To evaluate the knowledge about oral cancer of primary health care dentists. Material and method: This is a census, exploratory and quantitative study carried out in 2021. Dentists linked to the public network of the 9 municipalities of the "Baixada Litorânea" region/RJ filled out a questionnaire with 41 questions, divided into 5 blocks: 1. Sociodemographic profile, 2. Knowledge on oral cancer, 3. Risk factors for oral cancer, 4. Safety for diagnosing oral cancer and 5. Experience in identifying suspicious lesions. Result: Of the 128 dentists, 89.1% (n=114) participated and were characterized by being less than 40 years old (50%), female (64.9%) and for having the dentistry degree for more than 16 years (57.9%). As for knowledge about oral cancer and risk factors, 84.2% considered their level of knowledge regular or good and 65.8% considered their level of security low for carrying out diagnostic procedures for oral cancer. Regarding the identification of oral cancer suspicious lesions, 86.8% performed oral cavity examination, 7.9% did not perform it because the consultation time was insufficient and 5.3% because they did not know how to do it. In addition, 50.9% have identified a suspicious lesion in the last 12 months. It was also observed that 65.8% of dentists were not aware of the municipality's flowchart for the diagnosis and treatment of oral cancer. Conclusion: The findings showed that the knowledge about oral cancer was satisfactory; however, training regarding risk factors and diagnostic procedures related to oral cancer should be strengthened.

Perfil epidemiológico do carcinoma de células escamosas de cavidade oral e orofaringe diagnosticados na liga mossoroense de estudos e combate ao câncer / Epidemiologic Profile of squamous cell carcinoma of the oral cavity and oropharynx in the MossoróLeague for Studying and Combating Cancer / Perfil epidemiológico del carcinoma epidermoide de cavidad oral y orofaringe diagnosticado en la Liga Mossoroense de Estudios y Combate al Cáncer

Introdução:O carcinoma de células escamosas de cavidade oral e orofaringe é uma neoplasia epitelial maligna comum, respondendo pela maioria dos casos de tumores de cabeça e pescoço. Ele está relacionado a hábitos comportamentais, como tabagismo e etilismo de longa duração, e à infecção pelo Papilomavírus humano. Objetivos:Esse estudo objetivou descrever o perfil epidemiológico dos pacientes diagnosticados com essa neoplasia na Liga Mossoroense de Estudos e Combate ao Câncer. Metodologia: Foi realizado um estudo observacional com delineamento transversal a partir de dados presentes nos prontuários clínicos e laudos anatomopatológicos e no Sistema de Informações sobre Mortalidade no período entre 2006 a 2018. Os dados foram analisados a partir do Software R, utilizandoo teste de Wilcoxon-Mann-Whitney para as análises inferenciais e o método de Kaplan-Meier para análise da sobrevida. Resultados:225 prontuários foram analisados, sendo 70,22% de homens, 65,33% na faixa etária entre 46-70 anos e cor branca (51,57%). Destes, 25,78% eram tabagistas e 39,11% tabagistas e etilistas. O principal tratamento identificado foi a associação de cirurgia, quimioterapia e radioterapia. Observou-se que 49,10% dos óbitos foram em decorrência dessa neoplasia. O principal estádio patológico encontrado foi o quatro A (34,22%). Foi identificada maior sobrevida nos pacientes acima de 70 anos, cujo tratamento foi exclusivamente cirúrgico. Menor sobrevida foi identificada em indivíduos que tinham associação de hábitos (etilismo e tabagismo). Conclusões:Nossos resultados sugerem que a evolução à óbito foi o principal desfecho clínico e, isso pode estar relacionado aos hábitos comportamentais que influenciam diretamente o curso e prognóstico da doença. Ademais, destaca-se a importância do diagnóstico precoce a fim de reduzir óbitos e melhorar a qualidade de vida dos indivíduos, assim como a necessidade de implementar políticas educativas sobre os principais fatores de risco associados ao desenvolvimento dessa neoplasia (AU).

Introduction: Squamous cell carcinoma of the oral cavity and oropharynx is a common malignant epithelial neoplasm, accounting for most cases of head and neck tumors. It is related to behavioral habits, such as long-standing smoking and alcoholism, as well as to the human Papillomavirus infection. Objectives: This study aimed at describing the epidemiological profile of the patients diagnosed with this neoplasm in the Mossoró League for Studying and Combating Cancer. Methodology:An observational study with a cross-sectional design was carried out based on data present in the medical records and anatomopathological reports and in the Mortality Information System during the 2006-2018 period. The data were analyzed using the R Software, resorting to the Wilcoxon-Mann-Whitneytest for the inferential analyses and to the Kaplan-Meier method for survival analysis. Results: 225 medical records were analyzed: 70.22% belonging to men, 65.33% aged between 46 and 70 years old and white-skinned (51.57%). Of these, 25.78% were smokers and 39.11% were smokers and alcoholics. The main treatment identified was the association of surgery, chemotherapy and radiotherapy. It was observed that 49.10% of the deaths were due to this neoplasm. The main pathological stage found wasfour A(34.22%).Longer survival was identified in patients over 70 years of age, whose treatment was exclusively surgical. Shorter survival was identified in individuals who had associated habits (alcoholism and smoking). Conclusions:Our results suggest that evolution to death was the main clinical outcome; this can be related to the behavioral habits that exert a direct influence on the course and prognosis of the disease. Furthermore, the importance of early diagnosis is highlighted in order to reduce the number of deaths and improve the individuals' quality of life, as well as the need to implement educational policies on the main risk factors associated with the development of this neoplasm (AU).

Introducción: El carcinoma de células escamosas de la cavidad oral y la orofaringe es una neoplasia epitelial maligna común, que representa la mayoría de los casos de tumores de cabeza y cuello. Se relaciona con hábitos de comportamiento, como el tabaquismo y el alcoholismo, y la infección por el virus papiloma humano. Objetivos:Este estudio tuvo como objetivo describir el perfil epidemiológico de los pacientes diagnosticados con esta neoplasiaen la Liga Mossoroense de Estudios y Combate al Cáncer. Metodología: Se realizó un estudio observacional, transversal a partir de los datos presentes en las historias clínicas e informes patológicos y en el Sistema de Información de Mortalidad en el período 2006-2018. Los datos se analizaron mediante el Software R, con utilización de la Prueba de Wilcoxon-Mann-Whitney para análisis inferencial y el método de Kaplan-Meier para análisis de supervivencia. Resultados:Se analizaron 225 historias clínicas, 70,22% en hombres, 65,33% con edades entre 46-70 años y blancos (51,57%). De estos, 25,78% eran fumadores y 39,11% eran fumadores y alcohólicos. El principal tratamiento identificado fue la asociación de cirugía, quimioterapia y radioterapia. 49,10% de las muertes se debieron a esta neoplasia. El principal estadio patológico encontrado fue cuatro A (34,22%). Se identificó mayor sobrevida en pacientes mayores de 70 años, cuyo tratamiento fue exclusivamente quirúrgico. Se identificó una menor sobrevida en personas que tenían hábitos asociados. Conclusiones:Nuestros resultados sugieren que la evolución hacia la muerte fue el principal resultado clínico y esto puede estar relacionado con hábitos de comportamiento que influyen directamente en el curso y pronóstico de la enfermedad. Además, se destaca la importancia del diagnóstico precoz para reducir las muertes y mejorar la calidad de vida, así como la necesidad de implementar políticas educativas sobre los principales factores de riesgo asociados al desarrollo de esta neoplasia (AU).