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The aim of this study was to evaluate the long-term outcomes of the use of the free fibula flap for reconstruction with mandibular disarticulation resections.A retrospective chart cohort review was performed in patients reconstructed with a fibula free flap for a mandibular disarticulation resection at an academic tertiary care institution over a 5-year period.Twenty-four patients were included in the study. Fourteen patients were treated for benign pathology, and 10 cases were malignant. Average follow-up was 20 months. Virtual surgical planning/3-dimensional models were used in all cases. Maxillomandibular fixation (MMF) with surgical wires was used in 65% (n = 13/20) of the dentate patients. Average maximum interincisal opening was 28.2 mm in patients receiving radiation and 38.7 mm in the nonradiated group (P = .01). No patient developed joint ankylosis. Neocondyle position was an average of 11.7 mm from condylar fossa, radiographically. Seventeen of the dentate patients (85%) had reproducible class I occlusion. Occlusion was superior in patients placed into MMF compared with those with elastics or no MMF (P = .06) and independent of the position of the neocondyle (P = .19).The vascularized fibula flap can be used to provide functional reconstruction of the mandibular condyle defect. The use of at least 2 weeks of MMF maintains an adequate occlusion irrespective of the fibula-glenoid fossa position. The neocondyle does not need to directly abut the articular disc or fossa for adequate functional outcomes.

Background and purpose Treatment of oral squamous cell carcinoma (OSCC) is based on clinical exam, biopsy, and a precise imaging-based TNM-evaluation. A high sensitivity and specificity for magnetic resonance imaging (MRI) and F-18 FDG PET/CT are reported for N-staging. Nevertheless, staging of oral squamous cell carcinoma is most often based on computed tomography (CT) scans. This study aims to evaluate cost-effectiveness of MRI and PET/CT compared to standard of care imaging in initial staging of OSCC within the US Healthcare System. Methods A decision model was constructed using quality-adjusted life years (QALYs) and overall costs of different imaging strategies including a CT of the head, neck, and the thorax, MRI of the neck with CT of the thorax, and whole body F-18 FDG PET/CT using Markov transition simulations for different disease states. Input parameters were derived from literature and willingness to pay (WTP) was set to US $100,000/QALY. Deterministic sensitivity analysis of diagnostic parameters and costs was performed. Monte Carlo modeling was used for probabilistic sensitivity analysis. Results In the base-case scenario, total costs were at US $239,628 for CT, US $240,001 for MRI, and US $239,131 for F-18 FDG PET/CT whereas the model yielded an effectiveness of 5.29 QALYs for CT, 5.30 QALYs for MRI, and 5.32 QALYs for F-18 FDG PET/CT respectively. F-18 FDG PET/CT was the most cost-effective strategy over MRI as well as CT, and MRI was the cost-effective strategy over CT. Deterministic and probabilistic sensitivity analysis showed high robustness of the model with incremental cost effectiveness ratio remaining below US $100,000/QALY for a wide range of variability of input parameters. Conclusion F-18 FDG PET/CT is the most cost-effective strategy in the initial N-staging of OSCC when compared to MRI and CT. Despite less routine use, both whole body PET/CT and MRI are cost-effective modalities in the N-staging of OSCC. Based on these findings, the implementation of PET/CT for initial staging could be suggested to help reduce costs while increasing effectiveness in OSCC.

Purpose The SARS-CoV-2 global pandemic has resulted in widespread changes to healthcare practices across the United States. The purpose of this study is to examine the incidence of COVID-19 patients in the oral-maxillofacial surgery setting in order to help guide perioperative protocols during the pandemic. Methods In this retrospective cohort study, predictor variables (presence of preoperative symptoms on presentation, patient age, patient gender, patient race, hospital location, and presence of statewide stay-at-home orders) were examined with outcome variables (SARS-CoV-2 test results) over 10 months between March 2020 and December 2020 for patients undergoing surgical procedures in the operating room by the following Oral-Maxillofacial Surgery Departments: - Louisiana State University Health Sciences Center (Baton Rouge, LA) - University of Illinois at Chicago (Chicago, IL) - University of Texas Health Science Center at Houston (Houston, TX) Data analysis included Fisher exact tests to compare categorical variables across COVID test groups and Wilcoxon rank sum tests to compare continuous covariates. Two-sample tests of proportions were used to compare observed COVID-19 positivity rates to other study results. Results Out of 684 patients in 3 institutions, 17 patients (2.5%, 95% CI = 1.5 to 4.0%) tested positive for COVID-19 over a 10 month interval (March 1, 2020- December 31, 2020). The majority of patients that tested positive were asymptomatic in the preoperative setting (P-value = .09). They were significantly more likely to be African-American (P-value = .015) and less likely to have a stay-at-home order present at the time of surgery (P-value = .033). Age, gender, and hospital location did not play a statistically significant role. Conclusion Our results demonstrate a 2.5% incidence of COVID-19 infection in the total population of patients undergoing scheduled oral-maxillofacial surgeries in 3 major healthcare systems across the United States. This data may help inform perioperative protocols and infection control measures during the COVID-19 pandemic.

Background Many factors can contribute to the exact makeup of the salivary microbiome. Differences in the oral microbiome occur with old age, which may be due to oral conditions and diseases associated with old age, such as edentulism, as well as other unknown causes. Methods The salivary microbiome was sampled in patients from a large urban clinic. For all subjects age, gender, periodontal status, caries status, presence of edentulism, medications, and tobacco usage were recorded. Multifactor analysis was used to study variation in salivary microbiome profiles linked to these factors. Results In the population sampled, there were significantly higher numbers of edentulous subjects, and increased levels of polypharmacy found with aging. Large differences in alpha diversity and beta diversity of the salivary microbiome in the old age group were largely linked to edentulism. However, multivariable analysis revealed, even after adjusting for differences in edentulism, polypharmacy, tobacco usage, periodontal disease, caries level, and gender, that old age itself was associated with lower levels of taxa Porphyromonas endodontalis, Alloprevotella tannerae, Filifactor alocis, Treponema, Lautropia Mirabilis and Pseudopropionibacterium sp._HMT_194. Surprisingly, of these taxa, most were ones known to reside on or near tooth surfaces. Conclusions Another factor or factors beyond edentulism, polypharmacy and periodontal disease play a role in the differences seen in oral microbiome with old age. The nature of this factor(s) is not known.

Orbital abscess is a rare entity due to an odontogenic infection. The progression from a toothache to serious complications such as blindness or death can be sudden and severe. The authors present the case of a 13-year-old male patient with a 2-day history of dental pain, which progressed to involve the periorbital tissues. He was experiencing visual symptoms. Computed tomographic imaging revealed a canine space abscess associated with a carious right maxillary molar in continuity with a subperiosteal abscess of the right lateral orbit. Surgical drainage was performed under general anesthesia via intraoral and extraoral approaches. The postoperative course was uncomplicated and vision improved. Multidisciplinary and timely management is crucial for successful outcomes in managing orbital abscesses of odontogenic origin. Therefore, it is crucial for emergency and primary care physicians to recognize when specialist consultation is indicated and expedite this process.

In the area of craniomaxillofacial trauma, neurosensory disturbances are encountered commonly, especially with regard to the trigeminal and facial nerve systems. This article reviews the specific microanatomy of both cranial nerves V and VII, and evaluates contemporary neurosensory testing, current imaging modalities, and available nerve injury classification systems. In addition, the article proposes treatment paradigms for management of trigeminal and facial nerve injuries, specifically with regard to the craniomaxillofacial trauma setting.

Repair of soft tissue trauma to the lips requires careful attention to both function and esthetics. This article outlines basic lip anatomy, goals in managing lip injury, and appropriate workup and ultimate treatment of various types of trauma to the lips.

Background Oral squamous cell carcinoma (OSCC) is a capricious cancer with poor survival rates, even for early-stage patients. There is a pressing need to develop more precise risk assessment methods to appropriately tailor clinical treatment. Genome-wide association studies have not produced a viable biomarker. However, these studies are limited by using heterogeneous cohorts, not focusing on methylation although OSCC is a heavily epigenetically-regulated cancer, and not combining molecular data with clinicopathologic data for risk prediction. In this study we focused on early-stage (I/II) OSCC and created a risk score called the REASON score, which combines clinicopathologic characteristics with a 12-gene methylation signature, to predict the risk of 5-year mortality. Methods We combined data from an internal cohort (n = 515) and The Cancer Genome Atlas (TCGA) cohort (n = 58). We collected clinicopathologic data from both cohorts to derive the non-molecular portion of the REASON score. We then analyzed the TCGA cohort DNA methylation data to derive the molecular portion of the risk score. Results 5-year disease specific survival was 63% for the internal cohort and 86% for the TCGA cohort. The clinicopathologic features with the highest predictive ability among the two the cohorts were age, race, sex, tobacco use, alcohol use, histologic grade, stage, perineural invasion (PNI), lymphovascular invasion (LVI), and margin status. This panel of 10 non-molecular features predicted 5-year mortality risk with a concordance (c)-index = 0.67. Our molecular panel consisted of a 12-gene methylation signature (i.e., HORMAD2, MYLK, GPR133, SOX8, TRPA1, ABCA2, HGFAC, MCPH1, WDR86, CACNA1H, RNF216, CCNJL), which had the most significant differential methylation between patients who survived vs. died by 5 years. All 12 genes have already been linked to survival in other cancers. Of the genes, only SOX8 was previously associated with OSCC; our study was the first to link the remaining 11 genes to OSCC survival. The combined molecular and non-molecular panel formed the REASON score, which predicted risk of death with a c-index = 0.915. Conclusions The REASON score is a promising biomarker to predict risk of mortality in early-stage OSCC patients. Validation of the REASON score in a larger independent cohort is warranted.

Background Although rates of COVID-19 have remained low among US dentists, the authors aimed to determine the risk of there being COVID-19 in patients seeking oral health care. Methods The authors performed a retrospective chart review of all emergency department consultations from June 1, 2020, through December 31, 2020. They used Pearson correlation coefficients to compare rates with citywide prevalence (P Results The authors located 203 encounters with 149 tests and 10 cases of COVID-19. Cases were strongly correlated with the citywide positivity rate (r = 0.9147; P = .0039). All patients who tested positive were asymptomatic and afebrile, and one-half (50%) visited a dentist within a week of consultation. Conclusions The rate of COVID-19 in a population seeking oral health care reflects the community positivity rate. Asymptomatic or presymptomatic patients pose risks to providers, staff members, and other patients. Practical Implications Dentists should remain vigilant during the ongoing COVID-19 pandemic, even with vaccination rollout. The Centers for Disease Control and Prevention maintains an accessible website with easy access to each state's positivity rate and caseload.

Purpose Ablative procedures of the midface may require sacrifice of the infraorbital nerve (ION) resulting in permanent paresthesia of its dermatome. Because the ION is not commonly reconstructed, the goal of this study was to determine the feasibility of nerve allograft reconstruction. Patients and Methods A retrospective cohort of patients underwent immediate ION allograft reconstruction, during August 2018 to August 2019 at a single academic medical center by a single surgeon (M.M.). Demographic and clinical variables were collected. The outcome of interest was clinical neurosensory testing using the Medical Research Council Scale and subjective recovery, which was recorded using a visual analog scale at 3, 6, and 12 months after surgery. Results This cohort series consisted of 3 consecutive patients who underwent immediate ION allograft reconstruction. At 6 months, all patients achieved functional sensory recovery (S3, S3+, and S4) and acceptable subjective improvement. Conclusions Immediate nerve allograft reconstruction of the ION is a viable option to achieve functional sensory recovery.

Background Oral squamous cell carcinoma (OSCC) has poor survival rates. There is a pressing need to develop more precise risk assessment methods to tailor clinical treatment. Epigenome-wide association studies in OSCC have not produced a viable biomarker. These studies have relied on methylation array platforms, which are limited in their ability to profile the methylome. In this study, we use MethylCap-Seq (MC-Seq), a comprehensive methylation quantification technique, and brush swab samples, to develop a noninvasive, readily translatable approach to profile the methylome in OSCC patients. Methods Three OSCC patients underwent collection of cancer and contralateral normal tissue and brush swab biopsies, totaling 4 samples for each patient. Epigenome-wide DNA methylation quantification was performed using the SureSelectXT Methyl-Seq platform. DNA quality and methylation site resolution were compared between brush swab and tissue samples. Correlation and methylation value difference were determined for brush swabs vs. tissues for each respective patient and site (i.e., cancer or normal). Correlations were calculated between cancer and normal tissues and brush swab samples for each patient to determine the robustness of DNA methylation marks using brush swabs in clinical biomarker studies. Results There were no significant differences in DNA yield between tissue and brush swab samples. Mapping efficiency exceeded 90% across all samples, with no differences between tissue and brush swabs. The average number of CpG sites with at least 10x depth of coverage was 2,716,674 for brush swabs and 2,903,261 for tissues. Matched tissue and brush swabs had excellent correlation (r = 0.913 for cancer samples and r = 0.951 for normal samples). The methylation profile of the top 1,000 CpGs was significantly different between cancer and normal samples (mean p-value = 0.00021) but not different between tissues and brush swabs (mean p-value = 0.11). Conclusions Our results demonstrate that MC-Seq is an efficient platform for epigenome profiling in cancer biomarker studies, with broader methylome coverage than array-based platforms. Brush swab biopsy provides adequate DNA yield for MC-Seq, and taken together, our findings set the stage for development of a non-invasive methylome quantification technique for oral cancer with high translational potential.

One of the central challenges in the development of single-molecule protein sequencing technologies is achieving high-fidelity sequential recognition and detection of specific amino acids that comprise the peptide sequence. An approach towards achieving this goal is to leverage naturally occurring proteins that function through recognition of amino (N)-terminal amino acids (NAAs). One such protein, the N-end rule pathway adaptor protein ClpS, natively recognizes NAAs on a peptide chain. The native ClpS protein has a high specificity albeit modest affinity for the amino acid Phe at the N-terminus but also recognizes the residues Trp, Tyr, and Leu at the N-terminal position. Here, we employed directed evolution methods to select for ClpS variants with enhanced affinity and selectivity for two NAAs (Phe and Trp). Using this approach, we identified two promising variants of the Agrobacterium tumefaciens ClpS protein with native residues 34-36 ProArgGlu mutated to ProMetSer and CysProSer. In vitro surface binding assays indicate that the ProMetSer variant has enhanced affinity for Phe at the N-terminus with sevenfold tighter binding relative to wild-type ClpS, and that the CysProSer variant binds selectively to Trp over Phe at the N-terminus while having a greater affinity for both Trp and Phe. Taken together, this work demonstrates the utility of engineering ClpS to make it more effective for potential use in peptide sequencing applications.

Repair of soft tissue trauma to the lips requires careful attention to both function and esthetics. This article outlines basic lip anatomy, goals in managing lip injury, and appropriate workup and ultimate treatment of various types of trauma to the lips.

Traditional surgical approaches to the inferior alveolar nerve (IAN) pose a technical challenge and risk iatrogenic damage to healthy, uninvolved nerve tissue. The use of computer-assisted virtual surgical planning and fabrication of surgical guides has shown efficacy in various craniomaxillofacial surgical procedures, and may provide greater precision in accessing the inferior alveolar canal and allow for a more conservative approach. The addition of a depth control feature to a tooth-borne and bone-borne surgical guide, with the use of a standard contra-angle handpiece, provides safe and efficient access for IAN repair. This report describes this novel technique involving a guided transoral approach to the IAN for excision of a neurofibroma of the inferior alveolar nerve, with immediate peripheral nerve allograft IAN reconstruction.

The effect of oral microbial composition on periodontal health and on systemic health has been, and is being established. The oral microbiome, in turn, can be altered by local and systemic diseases and conditions. Gastroesophageal reflux disease (GERD), has been associated with increased acidity in the oral cavity resulting in dental erosion, and controversially a reduced risk of periodontal disease. We hypothesized that presence of GERD was linked to a modified microbial profile in untreated GERD patients and that the use of proton pump inhibitor (PPI) drugs: potent disruptors of gut microbiome, in GERD patients might result in a salivary microbiome that is further distinct. Untreated GERD patients showed multiple differences in salivary microbiome as compared to healthy controls. Taxa found at lower levels related to the presence of GERD not treated by PPI included: Prevotella melaninogenica, Prevotella pallens, Leptotrichia, and Solobacterium moorei and thirteen others. In contrast, GERD patients chronically using PPI showed minimal differences in salivary taxa compared to healthy controls not using PPI.

OBJECTIVES Our understanding of odontogenic cancers is limited primarily to case studies given the rarity of these head and neck neoplasms. Using the National Cancer Database, we report the treatment patterns and survival outcomes for one of the largest cohorts of patients with odontogenic cancers. METHODS Patients with odontogenic tumors who did not have metastatic disease and received at least part of their care at the reporting facility were included. Patient and treatment variables were assessed using logistic regression. Survival was assessed using Cox proportional hazard models. RESULTS We identified 437 patients with odontogenic cancers, the majority of which had malignant ameloblastoma (n = 203) or odontogenic carcinoma (n = 217). Median follow-up was 44.8 months. On multivariate analysis, improved survival was associated with age

Purpose The pathophysiology and treatment of medication-related osteonecrosis of the jaws (MRONJ) remain unclear after nearly two decades of recorded observation and discussion. The purpose of this study was to assess outcomes of surgical resection of MRONJ in patients exposed to denosumab. Materials and Methods A literature review was performed in conjunction with experts at the University of Illinois at Chicago Library. The primary outcome of interest was surgical success defined by maintenance of complete mucosal closure without bone exposure and infection after surgical resection. Secondary interests included demographics, MRONJ stage, location of the focus of osteonecrosis, and the primary underlying disease necessitating antiresorptive treatment. Statistical analysis was performed by χ2, analysis of variance, or t test (P Results A total of 70 articles were identified and 14 met inclusion criteria. Twenty patients were included (13 women; 7 men); age 61.8 years ± 12.9 (range 19 to 77); and MRONJ stage I (40.0%), II (35.0%), and III (25.0%). Most cases occurred in the mandible (65.0%), followed by the maxilla (30.0%). The success rate of surgical intervention for MRONJ secondary to denosumab was in 16 of 20 (80.0%) patients. Stage I MRONJ lesions achieved mucosal closure in 100% of patients, stage II in 71.4%, and stage III in 60.0%. The surgical success rate was 83.3% in the maxilla and 76.9% in the mandible. Conclusions The surgical success rate for MRONJ secondary to denosumab was 80.0%, similar to that reported in bisphosphonates of 85 to 95%; however, more evidence must be reported and analyzed.

Myositis ossificans traumatica (MOT) is a focal reactive ossification of muscle that typically occurs secondary to a single acute high-impact trauma or multiple chronic low-grade traumas. The disease is often limited to a single muscle and can occur throughout the body. Ossification of the muscles in the head and neck region is extremely rare but can occur after falls, motor vehicle accidents, blunt force trauma, or surgical procedures such as extractions and local infiltration. The purpose of this paper is to present the case of a seven-year-old girl with trismus and calcification within her medial pterygoid muscle. To our knowledge, this is the youngest known reported case of MOT of the head and neck region.

Purpose Computer-assisted surgery (CAS) was implemented rapidly, and recent concerns have been raised regarding its safety and its effect on surgical outcomes. We wanted to understand the impact CAS has on the surgical margin status when used for the resection of ameloblastoma. Materials and Methods We performed a 10-year retrospective cohort study at a single institution. Subjects were identified by surgical logs and chart query. Histopathologic reports were examined for margin status. We compared surgical technique (CAS and non-CAS) with the surgical margin (≤5 mm vs >5 mm). Other variable outcomes included previous treatment, histologic type, time from imaging to surgery, and recurrence. Bivariate analysis was performed to determine significance. Results A total of 31 subjects were identified (12 females; 19 males) with a mean age of 34.5 (standard deviation [SD] ± 19.1) years. Fifteen subjects were included in the CAS group and 16 subjects in the non-CAS group. No statistically significant difference was identified between the CAS and non-CAS group when surgical margins were defined as less than or equal to 5 mm and greater than 5 mm (P = .5368). The average distance from surgical margin to lesion was 9.6 mm (SD ± 5.1) in the CAS group and 8.5 mm (SD ± 5.6) in the non-CAS group (P = .2590). However, the non-CAS group had 1 positive margin and a total of 6 margins of less than or equal to 2 mm compared with zero margins of less than or equal to 2 mm in the CAS group (closest margin 3 mm). Conclusions The use of CAS and cutting guides based on predetermined surgical margins did not compromise the margin status in surgical resections of ameloblastoma. The use of CAS could potentially decrease the occurrence of close or positive margins.

Study Design Case report. Objective A sialocele is a subcutaneous cavity containing saliva, caused by trauma or infection in the parotid or submandibular gland parenchyma, by ductal stenosis or glandular duct laceration with subsequent asymptomatic dilation and swelling. Many cases of parotid sialoceles have been published, but few cases of submandibular sialoceles occurring as a result of surgical trauma have been reported. The purpose of this article is to inform clinicians and to raise awareness about an unusual post-operative condition of a sialocele of the submandibular gland after treatment of a sequele of a mandible fracture. Methods We report a case of a 33-year-old male with a submandibular sialocele in the submandibular gland, that presented on computed tomography as a 10 × 4 × 3 cm right submandibular fluid collection in the submandibular space, and developed after an open reduction and internal fixation of a mandibular fracture through a submandibular approach. Results In the clinical case, the patient presented with sequelae of untreated fractures of the right angle and parasymphysis of the mandible. Both fractures had unfavorable deviations for 2 months, with a diagnosis of pseudoarthrosis, or non-union. In the first surgical stage, extensive debridement at the stie of non-union and precise anatomical reduction and fixation of the bone segments were performed via a submandibular surgical approach. The treatment of the post-operative sialocele occurred in a second surgical procedure, which included surgical exploration and right submandibular gland excision. No complications related to the post-operative approach were observed in a follow-up of 1 month. Conclusions Given the paucity of publications and treatment strategies for submandibular gland sialoceles in the literature, we hope to build a foundation to guide clinicians who encounter these rare adverse events. Surgeons will have a better understanding of the risks involved when they encounter cases like this, where extensive surgical debridement was necessary due to skewed consolidation and extensive pseudoarthrosis after the absence of immediate treatment following the initial trauma.

Proteomic analysis can be a critical bottleneck in cellular characterization. The current paradigm relies primarily on mass spectrometry of peptides and affinity reagents (i.e., antibodies), both of which require a priori knowledge of the sample. An unbiased protein sequencing method, with a dynamic range that covers the full range of protein concentrations in proteomes, would revolutionize the field of proteomics, allowing a more facile characterization of novel gene products and subcellular complexes. To this end, several new platforms based on single-molecule protein-sequencing approaches have been proposed. This review summarizes four of these approaches, highlighting advantages, limitations, and challenges for each method towards advancing as a core technology for next-generation protein sequencing.

Mandibular reconstruction is often necessary after benign and malignant tumor expiration, traumatic defects, or congenital abnormalities. The goals of mandibular reconstruction are to reestablish mandibular continuity while also allowing for restoration of speech, esthetics, swallowing, and dental rehabilitation.

Purpose The purpose of this study is to evaluate the level of evidence in the craniomaxillofacial trauma literature. The secondary purpose is to determine if improvement in the quality of evidence has been made over the past 2 decades. Materials and Methods This retrospective cohort study analyzed clinical articles published in select craniomaxillofacial surgery journals. Patient-focused articles were selected. The year of publication (1999, 2009, 2019) was the primary predictor variable. Secondary predictor variables included study funding status, anatomical facial region (eg maxilla, mandible, and so on), specific journal, and journal impact factor. The level of evidence was determined using the Center of Evidence-Based Medicine criteria, which served as the outcome variable. The statistical analysis included descriptive, bivariate, and regression analysis. Results The sample consisted of 469 craniomaxillofacial trauma articles, with 13.2% being published in 1999, 44.1% in 2009, and 42.6% in 2019. The majority of the studies (77.5%) were published in 4 journals. The impact factor varied among the journals with a significant improvement in the mean impact factor from (0.89 ± 0.29) in 1999 to (1.4 ± 0.47) in 2009 and a slight decline in 2019 (1.26 ± 0.71). Mandibular fractures (31.6%) and orbital trauma (26%) were the most investigated topics. Level 4 studies accounted for 67.4% of the sample, with level 3 evidence of 4.7%, level 2 of 22.6%, and level 1 of 5.3% of the included studies. Significant progress in the level of evidence has been made from 1999 but not since that time (P = .002). It is unclear why this may be but sheds light on the need for further development of high quality studies. Finally, a higher quality of evidence is associated with journal impact factor (odds ratio = 1.9; P Conclusions While there has been some improvement in the level of evidence in the craniomaxillofacial trauma literature over the past 2 decades, the current quality remains low, and further progress is needed to support the practice of evidence-based medicine.

Immediate obturation of the patient undergoing maxillectomy who is not undergoing formal autologous reconstruction is important for immediate form and function of the patient. Exophytic tumors, that are large in dimension can make pre-operative obturator formation challenging. Traditional methods of obturator fabrication involve a physical or digital impression. Preoperative virtual surgical planning for tumor resection and reconstruction using free tissue transfer has become a mainstay in head and neck reconstruction. We describe a variation of this for a patient unable to undergo free tissue transfer where the authors used preoperative virtual surgical planning and CAD/CAM technologies to perform tumor resection, and fabricated an obturator based on the CT imaging alone.

Spindle cell squamous carcinoma (SpCC) is an exceedingly rare variant of squamous cell carcinoma with unique clinicopathological characteristics. SpCC is an aggressive and rapidly progressive neoplasm, and increased awareness for dentists, oral surgeons, and head and neck specialists should aid diagnosis and prompt treatment. We present a case of SpCC in the anterior maxilla of an 84-year-old female which displayed rapid growth.

Objective Variations in genes that are critical for tooth formation may contribute to the tooth agenesis. MMPs are potential candidate genes for dental alterations based on the roles they play during embryogenesis. The aim of this study was to investigate the possible association between MMP1, MMP3, and MMP20 and tooth agenesis. Methods One hundred sixty-seven nuclear families from two different populations were analysed, 116 from Brazil and 51 from Turkey. Probands had at least one congenitally missing tooth. DNA samples were obtained from blood or saliva samples and genotyping was performed using TaqMan chemistry. In addition, Mmp20 was selected for quantitative real-time polymerase chain reaction analysis with SYBR Green I Dye in mouse tooth development. Results Associations between tooth agenesis and MMP1 (p = 0.007), and MMP20 (p = 0.03) were found in Brazilian families. In the total dataset, MMP20 continued to be associated with tooth agenesis (p = 0.01). Mmp20 was not expressed during the initial stages of tooth development. Conclusion Our findings provide evidence that MMP1 and MMP20 play a role in human tooth agenesis.

Caries is a multifactorial disease, and studies aiming to unravel the factors modulating its etiology must consider all known predisposing factors. One major factor is bacterial colonization, and Streptococcus mutans is the main microorganism associated with the initiation of the disease. In our studies, we have access to DNA samples extracted from human saliva and blood. In this report, we tested a real-time PCR assay developed to detect copies of genomic DNA from Streptococcus mutans in 1,424 DNA samples from humans. Our results suggest that we can determine the presence of genomic DNA copies of Streptococcus mutans in both DNA samples from caries-free and caries-affected individuals. However, we were not able to detect the presence of genomic DNA copies of Streptococcus mutans in any DNA samples extracted from peripheral blood, which suggests the assay may not be sensitive enough for this goal. Values of the threshold cycle of the real-time PCR reaction correlate with higher levels of caries experience in children, but this correlation could not be detected for adults. Fil: Vieira, Alexandre R.. University of Pittsburgh; Estados Unidos Fil: Deeley, Kathleen B.. University of Pittsburgh; Estados Unidos Fil: Callahan, Nicholas F.. University of Pittsburgh; Estados Unidos Fil: Noel, Jacqueline B.. University of Pittsburgh; Estados Unidos Fil: Anjomshoaa, Ida. University of Pittsburgh; Estados Unidos Fil: Carricato, Wendy M.. University of Pittsburgh; Estados Unidos Fil: Schulhof, Louise P.. University of Pittsburgh; Estados Unidos Fil: DeSensi, Rebecca S.. University of Pittsburgh; Estados Unidos Fil: Gandhi, Pooja. University of Pittsburgh; Estados Unidos Fil: Resick, Judith M.. University of Pittsburgh; Estados Unidos Fil: Brandon, Carla A.. University of Pittsburgh; Estados Unidos Fil: Rozhon, Christopher. University of Pittsburgh; Estados Unidos Fil: Patir, Asli. Istanbul Medipol University; Turquía Fil: Yildirim, Mine. Istanbul University; Turquía Fil: Poletta, Fernando Adrián. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina Fil: Mereb, Juan C.. Hospital de Area El Bolsón; Argentina Fil: Letra, Ariadne. University of Pittsburgh; Estados Unidos Fil: Menezes, Renato. University of Pittsburgh; Estados Unidos Fil: Wendell, Steven. University of Pittsburgh; Estados Unidos Fil: López Camelo, Jorge Santiago. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina Fil: Castilla, Eduardo Enrique. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina Fil: Orioli, Ieda Maria. Hospital de Area El Bolsón; Argentina Fil: Seymen, Figen. Istanbul Universit; Turquía Fil: Weyant, Robert J.. University of Pittsburgh; Estados Unidos Fil: Crout, Richard. West Virginia University; Estados Unidos Fil: McNeil, Daniel W.. West Virginia University; Estados Unidos Fil: Modesto, Adriana. University of Pittsburgh; Estados Unidos Fil: Marazita, Mary L.. University of Pittsburgh; Estados Unidos

Torus thickenings have been found previously in intervascular pit membranes of species of Daphne and Wikstroemia (Thymelaeaceae). A search for tori was undertaken in the closely related genera Diarthron, Stellera and Thymelaea. Tori were observed in five of the seven species of Diarthron that were investigated. Presence of tori was associated with commonly occurring imperforate conducting elements and with perennial growth habit. Tori of a different morphology from that of Diarthron were present in two of the three specimens of Stellera chamaejasme that were studied. This study suggests torus presence to have systematic value; specifically, tori are present in species of the subgenera Dendrostellera and Stelleropsis within Diarthron but absent in the subgenus Diarthron. Of 19 species of Thymelaea investigated, only two of four specimens of T. villosa contained torus-bearing pit membranes. It is suggested that the original classification of this species as Daphne villosa be reconsidered.

Tooth agenesis is a common congenital disorder that affects almost 20% of the world's population. A number of different genes have been shown to be associated with cases of tooth agenesis including AXIN2, IRF6, FGFR1, MSX1, PAX9, and TGFA. Of particular interest is AXIN2, which was linked to two families segregating oligodontia and colorectal cancer. We studied two collections of families affected with tooth agenesis and tested them for association with AXIN2. Significant association between tooth agenesis and AXIN2 was found (p = 0.02) in cases with at least one missing incisor. Our work further supports a role of AXIN2 in human tooth agenesis and for the first time suggests AXIN2 is involved in sporadic forms of common incisor agenesis. Future studies should identify which specific tooth agenesis sub-phenotypes are consequence of AXIN2 genetic variations. A sub-set of these cases could have an increased susceptibility for colon cancer or other types of tumours and this knowledge would have significant clinical implications.

Whereas arginine vasopressin binds to its receptor subtypes V 1 R and V 2 R with equal affinity of approximately 2 nM, nonpeptide antagonists interact differently with vasopressin receptor subtypes. The V 2 R antagonist binding site was mapped by site-directed mutagenesis at six selected amino acid positions, K100D, A110W, M120V, L175Y, R202S, and F307I, predicted to be involved in antagonist binding differences between V 2 R and V 1 R. These mutations did not alter the affinity for arginine vasopressin. However, the affinity for six nonpeptide receptor antagonists SR121463B [1-[4-( N - tert -butylcarbamoyl)-2-methoxybenzenesulfonyl]-5-ethoxy-3-spiro-[4[(2 morpholinoethoxy)cy-clohexane]indoline-2-one, phosphate monohydrate cis -isomer], SR49059 [(2 S )1-[(2 R 3 S )-(5-chloro-3-(2 chlorophenyl)-1-(3,4-dimethoxybenzene-sulfonyl)-3-hydroxy-2,3-dihydro-1 H -indole-2-carbonyl]-pyrrolidine-2-carboxamide], SSR149415 [(2 S ,4 R )-1-[5-chloro-1-[(2,4-dimethoxyphenyl)sulfonyl]-3-(2-methoxyphenyl)-2-oxo-2,3-dihydro-1 H -indol-3-yl]-4-hydroxy- N , N -dimethyl-2pyrrolidine carboxamide, isomer(-)], OPC21268 [1-[1-[4-(3-acetylaminopropoxy)benzoyl]-4-piperidyl]-3,4-dihydro-2(1 H )-quinolinone], OPC41061 [(±)-4′-[(7-chloro-2,3,4,5-tetrahydro-5-hydroxy-1 H -1-benzazepin-1-yl)carbonyl]- o -tolu- m -toluidide], and OPC31260, [(±)-5-dimethylamino-1-[4-(2-methylbenzoylamino)benzoyl]-1,2, 3,4,5-tetrahydro-1 H -benzazepine monohydrochloride], was altered to varying degrees, resulting in differences up to 6000-fold. Replacement of the small alanine for the bulky tryptophan in position 110 resulted in a reduced affinity for all six antagonists. In contrast, replacement of the large methionine for the smaller valine in position 120 caused a dramatic increase in affinity, up to a K i of 7 fM for OPC31260. Molecular modeling revealed that the binding sites for arginine vasopressin and the nonpeptide antagonists are partially overlapping. Whereas arginine vasopressin binds on the extracellular surface of V 2 R, the nonpeptide antagonists penetrate deeper into the transmembrane region of the receptor, in particular OPC21268. The mutagenesis data point to significant differences in the shape of the V 1 R and V 2 R antagonist binding pockets. The most important factor determining the specificity of nonpeptide antagonists seems to be the shape of the binding pocket on the receptor.