Search

Objective: To perform a systematic review and meta‐analysis on the efficacy and safety of sialendoscopy in the treatment of obstructive diseases of the major salivary glands. Materials and Methods: We searched four databases for literature. The primary outcome assessed was the success rate. Secondary outcomes included the use of supportive devices, number of sialadenectomies and complications. Risk of bias was assessed. Meta‐analyses with subgroup analysis were performed. Results: In total, 91 studies were included, comprising 8218 patients undergoing 9043 sialendoscopic procedures. The majority of studies had a medium or high risk of bias. The incidence of sialadenectomy varied from 0% to 14%. No major complications were reported. Meta‐analysis revealed a weighted pooled success rate of 80.9%. Subgroup analyses showed the weighted pooled success rate in patients with sialoliths (89.6%), stenoses (56.3%), submandibular glands (88.3%), parotid glands (81.2%), patients treated by an endoscopic‐assisted transoral removal of a sialolith (86.3%), patients treated by a combined approach of the parotid gland (78.2%), patients with JRP (67.0%) and with RAIS (45.8%). Conclusion: The success rate of sialendoscopy did not considerably change in the last 9 years. Sialendoscopy is an efficient and safe procedure for the treatment of major salivary gland obstructive disease. [ABSTRACT FROM AUTHOR]

This report describes a rare case of recurrent head and neck desmoplastic neurotropic melanoma with perineural spread along the nervus mandibularis. An 87-year-old male presented with a rapidly growing mass on the right side of the chin, 4 years after surgical excision of a desmoplastic non-melanotic melanoma of the tip of the chin, with lymphadenectomy of the right side submental and submandibular areas. A panoramic X-ray showed extensive widening of the mandibular canal compatible with perineural tumour growth. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) images revealed intense pathological uptake in the recurrent tumour mass located in the right lower buccal fold, and linear pathological uptake in the mandibular canal. Although magnetic resonance imaging is considered the standard of reference, recognition of perineural spread on 18F-FDG PET/CT is important, as it usually leads to a change in patient management from cure to palliation and may avert further diagnostic procedures. [ABSTRACT FROM AUTHOR]

Abstract Riga Fede disease is a reactive mucosal disease as a result of repetitive trauma of the tongue by the anterior primary teeth during forward and backward movement. Although the aspect of the lesion might be impressive, its nature is relatively benign. The history and clinical features are most often so typical that there is seldom a need for addititonal histopathological examination. Riga Fede disease can most often be treated with conservative measures only. Beside the presentation of a six-month-old boy with Riga Fede disease, the literature has been reviewed as well. From this review it can be concluded that Riga Fede disease is almost exclusively restricted to the tongue, occurs soon after birth when associated with (neo)natal teeth, has a male predilection, and is in one quarter of the cases associated with neurologic disorders. In the later case, Riga Fede disease develops after the age of 6 months.

Background: Despite the adoption of minimally invasive techniques, recovery after abdominal surgery takes a long time. Electronic health (eHealth) modalities can provide guidance to patients, facilitating early return to normal activities. We aimed to assess the impact of a personalised eHealth programme on patients' return to normal activities after major abdominal surgery., Methods: This single-blind, randomised, placebo-controlled trial was done at 11 teaching hospitals in the Netherlands. Eligible participants were aged 18-75 years who underwent a laparoscopic or open colectomy or hysterectomy. An independent researcher randomly allocated participants (in a 1:1 ratio) to either the intervention or control group by use of computer-based randomisation lists, with stratification by sex, type of surgery, and hospital. Participants in the intervention group had access to a perioperative, personalised eHealth programme consisting of both standard face-to-face care and eHealth, that comprised interactive tools offering goal attainment and a personalised outcome measurement, which managed recovery expectations and provided postoperative guidance tailored to each patient. Patients were provided with an activity tracker and had access to a website and mobile app with an electronic consultation (eConsult) functionality. The control group received standard care and access to a placebo website containing recovery advice provided by the hospital. The primary outcome was the number of days between surgery and personalised return to normal activities, assessed with Kaplan-Meier curves. Intention-to-treat and per-protocol analyses were done with a Cox regression model. This trial is registered with the Netherlands National Trial Register (NTR5686)., Findings: Between Feb 11, 2016, and Aug 9, 2017, 355 participants were randomly assigned to the intervention (n=178) or control (n=177) groups. 342 participants were included in the intention-to-treat analysis. The median time until return to normal activities was 52 days (IQR 33-111) in the intervention group, and 65 days (39-152) in the control group (adjusted hazard ratio 1·30 [95% CI 1·03-1·64]; p=0·027). The frequency of postoperative complications did not differ between groups., Interpretation: This eHealth programme, delivering personalised care based on goal attainment scaling, enabled patients to return to their normal activities 13 days earlier than those who received standard care., Funding: ZonMw., Competing Interests: Declaration of interests CMdB, FGS, EvdM, HJB, JAFH, and JRA are the developers of the eHealth care programme under study. JAFH and JRA are consultants and certificate-holders of a spin-out company for implementation of the mobile application concerning the IkHerstel intervention in the Netherlands (ie, the intervention under study). JAFH received grants from Nederlandse Organisatie voor Wetenschappelijk Onderzoek, ZonMw, and Samsung, during the conduct of the study; and received a fee from Olympus, outside the submitted work. JRA holds a chair in insurance medicine paid by the Dutch Social Security Agency; and has received grants from ZonMw, Nederlandse Organisatie voor Wetenschappelijk Onderzoek, Instituut Gak, Uitvoeringsinstituut Werknemersverzekeringen, Sociale Zaken en Werkgelegenheid, VWS (volksgezondheid, welzijn en sport), Pfizer, Achmea, CVZ (college voor zorgverzekeringen), and Zorginstituut; all outside the submitted work. CMdB, FGS, ECJC, SESK, EvdM, PMvdV, and HJB declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

A 12-year-old boy was referred with a painless swelling of the labial gingiva. The swelling was caused by the antihypertensive amlodipine, which he used because of arterial hypertension due to a chronic kidney disease. The treatment consisted of discontinuation of the causative drug after which the swelling of the gingiva slowly subsided.

Ulceration is a common presenting sign of a wide spectrum of diseases of the oral cavity involving many etiologic factors, such as trauma, infection, neoplasms, medication, and immune related disorders, ranging from self-limited lesions to life-threatening diseases. In most cases, a proper diagnosis can be established based on medical history and clinical features only. Early diagnosis is important as oral ulcerations might be a manifestation of a systemic disease or sometimes even due to a malignant process.

Lichen planus is an inflammatory disorder of the skin and/or mucosa. Immune dysregulation, infections, environmental and genetic factors play a role in its pathogenesis. Clinically, there are 6 important distinctive manifestations. The mucosal subtypes manifest inside the mouth, oesophagus, genitalia and - although less often - the nose, ear canal, tear duct and conjuctiva. The non-mucosal subtypes occur on the skin, scalp (hair follicles) and nails. Patients may suffer from several subtypes of lichen planus. Unfamiliarity with the different manifestations may lead to a delay in diagnosis and thus to insecurity and distress in patients. The advice to all healthcare providers is to ask patients with lichen planus about symptoms of all subtypes and clinically inspect the skin and mucosa, or to refer the patient to a dermatologist.

White lesions of the oral mucosa may be caused by various disorders. In most instances of white lesions, diagnoses can be made solely on clinical grounds. When the clinical diagnosis is not compatible with a known disease, the term leukoplakia is used. This is of importance since the yearly malignant transformation rate of oral leukoplakia into a squamous cell carcinoma is 2-4%. The presence and degree of epithelial dysplasia is the most important predictor for malignant transformation.

A 41-year-old patient presented with a sore tip of the tongue. The anterior side of the tongue had a red appearance showing a number of pronounced fungiform papillae and there were tooth impressions on the lateral sides of the tongue. This clinical picture is consistent with transient lingual papillitis. It has an unknown etiology. Local irritation might be a contributing factor. Transient lingual papillitis regresses spontaneously within a few weeks. Chronic lingual papulosis is a variant and shows enlarged filiform papillae; it can persist for years and is rarely painful. The cause of chronic lingual papulosis is similarly often unclear. Both conditions are very common, but often not recognized.

A periapical radiolucency, radiopacity or mixed lesion identified on a radiograph is usually caused by an inflammation of endodontic origin. However, a periapical lesion is sometimes caused by primary bone pathology, predominantly manifesting at the apices of the teeth. Various intraosseous lesions can also be projected across the apices, creating the impression of a causal relation with these teeth. An incorrect diagnosis can lead to 1 or more endodontic treatments being carried out unjustifiably. A thorough and detailed anamnesis, a complete extra- and intraoral clinical examination and the careful study of the radiographic imaging leads to a correct diagnosis in most cases. In this regard, knowledge of the differential diagnosis of periapical lesions is essential. In this article, the focus is on apparent periapical radiopacities and how they can be differentiated from each other.

A radiolucency, radiopacity or mixed lesion identified on a radiograph is usually the result of an inflammation of endodontic origin. However, a periapical lesion is sometimes caused by primary bone pathology, predominantly manifesting at the apices of the teeth. Various intraosseous lesions can be projected across the apices, creating the impression of a causal relation with these teeth. An incorrect diagnosis can lead to 1 or more endodontic treatments being carried out unjustifiably. A thorough and detailed anamnesis, a complete extra- and intraoral examination, and a careful examination of the radiological imaging will result in a correct diagnosis in most cases. Knowledge of the differential diagnosis of periapical lesions is essential. This article focuses on periapical radiolucencies due to overprojection of neoplastic pathology.

A radiolucency, radiopacity or mixed lesion, identified on a radiograph is usually the result of an inflammation of endodontic origin. However, a periapical lesion is sometimes caused by primary bone pathology, predominantly manifesting at the apices of the teeth. Various intraosseous lesions can be projected across the apices, creating the impression of a causal relation with these teeth. An incorrect diagnosis can lead to 1 or more endodontic treatments being carried out unjustifiably. A thorough and detailed anamnesis, a complete extra- and intraoral examination, and a careful examination of the radiological imaging will result in a correct diagnosis in most cases. Knowledge of the differential diagnosis of periapical lesions is essential. This article focuses on apparent periapical radiolucencies caused by overprojection of non-neoplastic pathology.

Background: Data regarding the inter- and intraobserver variability in the radiological assessment of sialolithiasis using cone beam computed tomography are missing in the current literature. This study assessed the inter- and intraobserver variability in the radiological assessment of sialolithiasis using cone beam computed tomography (CBCT)., Material and Methods: In 107 patients, 130 salivary glands (65 parotid and 65 submandibular) with clinical signs of obstruction were assessed by four independent observers; 2 residents OMFS and 2 experienced OMFS. The observers analyzed the CBCT images and determined the absence or presence of one or more salivary stones in the affected gland. This procedure was repeated after three months., Results: Interobserver agreements showed kappa values of 0.84 for the parotid gland, and 0.93 for the submandibular gland. Intraobserver agreements for the whole group reported kappa values between 0.83 - 0.95. There was no significant difference between residents and experienced OMFS., Conclusions: Due to the good inter- and intraobserver agreement, CBCT appears to be a reproducible imaging modality for detecting salivary stones in patients with signs and symptoms of obstructed parotid and submandibular glands.

Objective: To study the reproductive outcomes after surgical management of women with Asherman syndrome (AS)., Design: Cohort study., Setting: International referral hospital for women with AS., Patient(s): A total of 500 women who were diagnosed with and treated for AS between January 2003 and December 2016 and followed for a minimum of 2 years., Intervention(s): Hysteroscopic adhesiolysis using conventional instruments with concomitant fluoroscopy as a guidance method., Main Outcome Measure(s): Live birth rate., Result(s): Of the 500 women included in the cohort, 569 pregnancies were achieved within 3 years after surgery. The miscarriage rate was 33.0%, and the live birth rate was 67.4%. Age, the causal procedure, and at least one miscarriage after adhesiolysis strongly predicted the outcome of a live birth., Conclusion(s): The overall take-home newborn rate was 67.4% after adhesiolysis in women with AS. Women with AS who are relatively young, with a first-trimester procedure preceding AS, and with low grades of adhesions and no miscarriage after adhesiolysis have the best chance of a newborn delivery., (Copyright © 2021 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

The aim of this study was to investigate the role of lower dentures in the development of distally located stenoses of Wharton's duct and to further identify contributing factors to this mechanism. In a database of 352 patients with submandibular gland obstruction, three patients with four obstructed glands with stenosis of the ostium of Wharton's duct suspected to be caused by a lower denture were identified and further retrospectively analysed by studying medical records, operation reports, and clinical photographs. In all three cases, the causative lower dental prosthesis was implant-retained. All affected sublingual caruncles were in close relationship with the implants or the implant bar. Initially, all patients were advised to leave out the lower denture for a period of several weeks. One patient was free of symptoms after this period and did not develop any complaints after adjustment and replacement of the prosthesis. Surgical treatment with posterior rerouting of the orificium of Wharton's duct was performed in the remaining two patients because of persistent signs of obstruction. All patients were free of symptoms after long-term follow-up. Although not frequently occurring, implant-retained dental prostheses seem to play a role in the development of some distally located stenoses of Wharton's duct., (Copyright © 2021 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Successful removal of salivary stones depends on exact pretreatment information of the location, the size and shape of the stones. This study aimed to compare the volume of submandibular sialoliths determined by preoperative Cone-Beam Computer Tomography (CBCT) scans with the volume of the removed stones on micro-Computer Tomography (micro-CT) scans., Material and Methods: In this study, using twenty-one submandibular sialoliths, the pretreatment volumes in-vivo measured on CBCT were compared to the volumes of removed stones determined by micro-CT scans. The volume measured on micro-CT scans served as the gold standard. Pre-operative CBCT's and in-vitro micro-CT's were converted into standard tessellation language models (STL-models) using an image segmentation software package. The CBCT and micro-CT images of the stones were subsequently metrologically assessed and compared to each other using reverse engineering software., Results: Volumes of submandibular sialoliths determined by CBCT's correlated significantly with volumes measured on micro-CT's (Spearman's coefficient r = 0.916). The interquartile range (IQR) for the volume measured with micro-CT was 117.23. The median is 26.41. For the volume measured with CBCT the IQR was 141.3 and the median 36.61. The average volume on micro-CT is smaller than on CBCT., Conclusions: When using CBCT-scans for the detection of submandibular sialoliths one should realize that in-vivo those stones are actually a fraction smaller than assessed on the preoperative scan. This is important when cut-off values of sizes of stones are used in the pretreatment planning of stone removal.

Objective: To perform a retrospective external validation of miniPIERS in Zanzibar's referral hospital., Methods: From February to December 2017, data were collected retrospectively on all cases of hypertensive disorders of pregnancy (HDP) admitted to Mnazi Mmoja Hospital, Zanzibar, Tanzania. The primary outcome was the predictive performance of miniPIERS by examining measures of discrimination, calibration, and stratification accuracy. The secondary outcome was the applicability of miniPIERS within the referral hospital setting., Results: During this period, 2218 of 13 395 (21%) patients were identified with HDP, of whom 594 met the inclusion criteria. Sixty per cent of patients with adverse outcomes were excluded because they had experienced one of the adverse outcomes before admission. The discriminative ability of miniPIERS was inaccurate. It was not likely to aid risk stratification because of low sensitivity and low positive predictive value. The model showed fair discrimination in HDP before 34 weeks of gestation (area under the receiver operating characteristics curve 0.72, 95% confidence interval 0.63-0.82)., Conclusions: The benefit of miniPIERS appeared to be limited, although clinical conditions make any validation challenging. Its application for risk stratification in preterm pregnancies should be further investigated., (© 2020 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

A periapical radiopacity is frequently encountered by chance on a conventional periapical or panoramic x-ray. However, local pain and/or swelling in the area of a radiopacity is seldom seen. Here, we report on 2 cases of patients referred to the oral and maxillofacial surgeon with a painful periapical radiopacity in the lower jaw. The clinically and radiologically assumed diagnosis was a cementoblastoma, which was confirmed by histopathological examination following its surgical removal. A cementoblastoma is a rare, benign odontogenic tumor, mostly found in patients younger than 30. Treatment consists of surgical removal of the tumor, almost always together with the attached tooth. The recurrence rate after complete removal is approximately 12%. A cementoblastoma is clinically distinguished from other periapical radiopacities by local pain and sometimes swelling and radiologically by a relationship with the roots of a (pre)molar, a radiolucent rim surrounding the opacity, bone and/or root resorption and expansive growth.

Background: Decision making regarding future fertility can be very difficult for female cancer patients. To support patients in decision making, fertility preservation decision aids (DAs) are being developed. However, to make a well-informed decision, patients need personalized information tailored to their cancer type and treatment. Tailored cancer-specific DAs are not available yet., Methods: Our DA was systematically developed by a multidisciplinary steering group (n = 21) in an iterative process of draft development, three rounds of alpha testing, and revisions. The drafts were based on current guidelines, literature, and patients' and professionals' needs., Results: In total, 24 cancer-specific DAs were developed. In alpha testing, cancer survivors and professionals considered the DA very helpful in decision making, and scored an 8.5 (scale 1-10). In particular, the cancer-specific information and the tool for recognizing personal values were of great value. Revisions were made to increase readability, personalization, usability, and be more careful in giving any false hope., Conclusions: A fertility preservation DA containing cancer-specific information is important in the daily care of female cancer patients and should be broadly available. Our final Dutch version is highly appraised, valid, and usable in decision making. After evaluating its effectiveness with newly diagnosed patients, the DA can be translated and adjusted according to (inter)national guidelines., (© 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Cat scratch disease is a usually harmless infectious disease caused by Bartonella henselae bacteria. These bacteria are transmitted to humans by a cat scratch or bite. Its typical presentation is a self-limiting lymphadenitis of regional lymph nodes, mostly in the neck. The disease is especially prevalent in children and young adults. Cat scratch disease can be associated with fever, headaches, and malaise, sometimes present itself atypically and in only a few cases expand as a disseminated disease. A swelling in the neck can be caused by many different disorders. In patients with lymphadenitis in the neck and a cat scratch or bite in their recent history, the probable diagnosis cat scratch disease can be made on the basis of clinical findings. Diagnostic testing should be performed when required. For patients with a typical manifestation of cat scratch disease, a wait-and-see policy can be considered. For patients with atypical manifestations, further diagnostic testing and treatment with antibiotics are recommended.

Important characteristics of Sjögren syndrome include a sensation of dry mouth, reduced saliva secretion and swelling of the large salivary glands, usually the parotids. Sjögren patients also run a significantly increased risk of developing a non-Hodgkin lymphoma, generally a so-called mucosa associated lymphoid tissue (MALT) lymphoma. Such a MALT lymphoma often develops in the parotid gland. In 2 cases patients presented with recurrent swellings of the parotid glands who developed both Sjögren syndrome and a MALT lymphoma in both of their parotid glands.

A 67-year-old man presented with a swelling on the right side of the mandible. Histopathological investigation of a biopsy revealed a peripheral dentogenic ghost cell tumour. Treatment consisted of thorough excochleation of the abnormality and 2 years after treatment, the patient was free of recurrence. In the literature, a distinction is made between peripheral and central dentogenic ghost cell tumours, which, like calcifying odontogenic cysts, are considered to be ghost cell odontogenic lesions. These are rarely occurring abnormalities, where the chances of recurrence after proper treatment are limited. The central dentogenic ghost cell tumour has a greater chance of recurring locally.

Sometimes it is difficult to diagnose temporal arteritis because the complaints may vary, change in intensity and are not always characteristic. The condition is a cranial form of giant-cell arteritis affecting large and medium-sized arteries. The first manifestation of temporal arteritis can be a sore tongue that does not manifest any abnormalities during a clinical investigation. In a later stage patients sometimes develop ulceration or necrosis of a part of one side of the tongue. Other symptoms can be a recently developed headache, jaw claudication and acute loss of vision. To diagnose temporal arteritis, histological investigation of a biopsy of the temporal artery is carried out. The treatment consists of long-term use of corticosteroids. A patient in your practice with inexplicable pain on one side of the tongue, without clinical abnormalities, or an ulceration of the tongue without an immediately apparent cause may have temporal arteritis.

Opacities in the orofacial soft tissue rather than the bone are frequently seen on panoramic radiographs. The differential diagnosis of these opacities is diverse and concerns frequently occurring disorders but also rare ones. Due to the diversity of diagnoses, the clinical interpretation of a soft tissue opacity is often difficult. A distinction is made among heterotopic calcifications, heterotopic ossifications, and foreign bodies. Heterotopic calcifications are subdivided into 3 groups, i.e. dystrophic, idiopathic and metastatic calcifications. In this article, stress is placed on the radiographic and clinical characteristics of heterotopic ossifications and foreign bodies, and how they can be recognised on a panoramic radiograph. Besides this, attention will be paid to the need for possible additional imaging techniques and indications regarding treatment option.

Opacities not in the bone but in the orofacial soft tissue, are frequently seen on panoramic radiographs. The differential diagnosis of these opacities is diverse and concerns frequently occurring disorders but also rare ones. Due to the diversity of diagnoses, the clinical interpretation of a soft tissue opacity is often difficult. A distinction is made among heterotopic calcifications, heterotopic ossifications, and foreign bodies. Heterotopic calcifications are subdivided into 3 groups, i.e. dystrophic calcifications, idiopathic calcifications, and metastatic calcifications. In this article, stress is placed on the radiographic and clinical characteristics ofidiopathic calcifications and how they can be recognised on a panoramic radiograph. Besides this, attention will be paid to the need for possible additional imaging techniques and indications regarding treatment options. Idiopathic calcification results from deposition of calcium salts in healthy tissue without an apparent cause. Calcium and phosphate levels in the serum are normal in these cases.