1,720,987 research outputs found
Clinicopathological Features Associated with Fluorescence Alteration: Analysis of 108 Oral Malignant and Potentially Malignant Lesions
No full textBackground: Several noninvasive diagnostic tools have been developed to aid the early detection of oral cancer and for evaluation before definitive biopsy. Among these, devices evaluating a tissues autofluorescence (AF) are emerging. In particular, the most well known of these is the VELscope® system (LED Medical Diagnostics, Inc., Barnaby, Canada), which emits a light of 400-460 nm. This study has been developed to describe the most relevant clinicopathological features associated with AF alterations in a set of patients with oral squamous cell carcinoma and potentially malignant disorders (PMDs). Materials and methods: Overall, 108 lesions from 60 patients with clinical diagnoses of potentially malignant oral disorders and carcinomas were included in the study. For each case, the following variables were recorded and compared with the AF pattern: (1) clinical appearance (white, red, and white/red); (2) histological diagnosis (no dysplasia, mild/moderate dysplasia, severe dysplasia/in situ carcinoma, invasive carcinoma, and verrucous carcinoma); and (3) clinicopathological diagnosis. Binomial logistic regression was performed to investigate whether clinical appearance and/or histological diagnosis were significant in determining the degree of AF. Results: Among the white lesions, 66% resulted in hyper-fluorescence, whereas the red lesions appeared hypo-fluorescent in 95.2% of cases. The AF was altered (both hypo-fluorescent and hyper-fluorescent) in 36% of lesions without dysplasia; in 75.9% of lesions with mild or moderate dysplasia and in the totality of the in situ, invasive, and verrucous carcinomas (p < 0.0001). With regard to the binomial logistic regression, variables were separately considered and both were extremely significant in determining the degree of AF. Conclusions: Promising evidence for the use of AF as an adjunctive tool to conventional oral examinations (COEs) has been demonstrated. However, although the sensitivity of AF examination associated with COE is very high, both the literature and this study agree to indicate a low specificity
Laser Applications and Autofluorescence
No full textThe diagnostic pathway for oral suspicious lesions usually starts with the clinical examination based on inspection and palpation of the oral mucosa. Such a phase is strongly related to the experience of the operator. Moreover, oral epithelial dysplasia and early oral carcinomas may already be present within areas of macroscopically intact oral mucosa. A great interest for techniques potentially improving the diagnostic accuracy has developed in several fields of surgical oncology in order to increase the specificity and sensitivity of the conventional diagnostic pathway. The development of noninvasive methods for real-time screening of neoplastic changes in oral cavity may be associated with the improvement of patients' quality of life and survival rate. The analysis of tissue autofluorescence (AF) for improving sensitivity and specificity in cancer diagnosis has been proposed for different organs, including colon, lung, cervix, and esophagus. Particularly, there are several evidences supporting the effectiveness of this technique in head and neck cancer diagnosis. Autofluorescence shows high specificity and sensitivity for oral cancer and precancerous lesions: 72.4% and 63.79%, respectively. It can also provide valuable information for diagnosis, for planning of margin resection in surgical excision, and for monitoring the therapeutic response during follow-up. Direct visual fluorescence examination (DVFE) is based on the action of irradiation of specific wavelengths, between 375 and 440 nm, which excites some natural fluorochromes which show fluorescence in the range of the green color. The analysis of the lesions with AF tools must be performed in a dark environment to avoid the interference of white light wavelengths and to improve the quality of recorded images. Healthy oral mucosa emits fluorescence, detectable as green light. Cell and tissues within dysplastic and malignant lesions display modifications of the amount, distribution, and chemical-physical properties of the endogenous fluorophores. This results in an autofluorescence pattern variation that can be potentially used at diagnostic level. Loss of autofluorescence (LAF) seems to increase in correspondence to the progression of dysplasia, and altered tissue appears dark (brown to black). LAF in dysplasia and carcinoma seems to be connected to different mechanisms, such as altered metabolic activity of dysplastic keratinocytes, altered structure of subepithelial collagen, and absorbance of light by increased blood circulation due to inflammatory phenomena in dysplastic tissue and cancer. AF can be used for guiding incisional biopsy and in the excision to identify the resection margins
Which are the main fluorophores in skin and oral mucosa? A review with emphasis on clinical applications of tissue autofluorescence
Full text linkOBJECTIVES: The present review provides information about which molecules appear to be the main fluorophores in skin and oral mucosa, together with their clinical applications. DESIGN: The MEDLINE database was searched, using "oral mucosa AND fluorophores", "skin AND fluorophores", "epidermal AND fluorophores", "dermal AND fluorophores" and "cutaneous AND fluorophores" as entry terms. We searched the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The level of evidence in the studies was assessed using the Classification of the Oxford Centre for Evidence-based Medicine (CEBM) Levels for Diagnosis. RESULTS: Five papers and 17 were primarily focused on description of fluorophores in oral mucosa and skin Evidence exists that fluorophores of oral mucosa and skin are mainly proteins such as collagen, elastin, keratin and tryptophan. Other possible fluorophores identified are: porphyrins, advanced glycation end products, flavins, lipopigment, nicotinamide adenine dinucleotide, flavin adenine dinucleotide, pheomelanin, eumelanin and components of lipofuscin. Clinical applications of oral mucosal autofluorescence (AF) are related to management of malignant and potentially malignant lesions. In the skin, AF has been used for acne assessment, diagnosis of sweat-gland pathologies, glycemic control and management of malignant lesions and as a marker for skin aging. CONCLUSION: Fluorophores stimulated through AF devices are implied in different physiologic and pathologic processes. AF seems to be useful for several clinical applications, especially in skin department. Because most of the studies show a low level of evidence, further studies are necessary in such a promising and fascinating field
Advantages of new technologies in oral mucosal surgery: an intraoperative comparison among Nd:YAG laser, quantic molecular resonance scalpel, and cold blade
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Postoperative discomfort in oral soft tissue surgery: a comparative perspective evaluation of Nd:YAG Laser, quantic molecular resonance scalpel and cold blade
No full textAIM: The aim of this paper was to compare pain, health-related quality of life (HRQoL) and need for painkillers during the postoperative course of oral soft tissue surgery performed with neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, quantic molecular resonance (QMR) scalpel and cold blade.METHODS: One-hundred and sixty-three similar surgical interventions were subclassified as follows: group 1 (G1), 77 cases performed with Nd:YAG laser; group 2 (G2), 45 cases performed with QMR scalpel and group 3 (G3), 41 cases performed with cold blade. Pain was evaluated using a Visual Analogue Scale (VAS), a Numeric Rating Scale (NRS) and a Verbal Rating Scale-6 (VRS-6) on the same day of surgery (day 0), and at 1, 3 and 7 days after surgery. The HRQoL was evaluated on day 7 using a 0-45 score range questionnaire. On day 7, painkillers taken were recorded.RESULTS: No statistically significant differences could be highlighted in the VAS and NRS scores at day 1, 3 and 7. A trend toward significance at day 0 was evident, with a VAS and NRS average scores lower in G1 than G2 and G3. With regard to VRS-6, the scores resulted statistically lower in G1 than G2 and G3 at day 1 and 3. The HRQoL in G1 was statistically lower than G3.CONCLUSION: Our study demonstrates that the use of new technologies in oral soft tissue surgery is associated to a reduction of postoperative discomfort. The better HRQoL and the lower postoperative pain observed in laser-treated patients may be associated to the possible bio-modulating effect of the laser
Pain and Health-Related Quality of Life After Oral Soft Tissue Surgical Interventions: The Advantages of Nd:Yag Laser
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Mucocutaneous Leishmaniasis With Oral Involvement: A Case Report
No full textThe primary objective of the present study is the retrospective analysis of a clinical case of oral leishmaniasis treated at Parma Hospital and a review of the literature on mucosal leishmaniasis (ML) with oral cavity involvement. We report the case of a patient diagnosed in 2017 with mucocutaneous leishmaniasis who was referred to our clinic due to the emergence of oral manifestations. Through a detailed review of the clinical documentation, we aim to describe the clinical presentation, diagnosis, treatment choices made, and evolution of the disease. Literature describes various pharmacological approaches for leishmaniasis, with treatment selection dependent on clinical presentation. ML does not spontaneously resolve, and systemic therapy is necessary. Due to its rarity, oral leishmaniasis can be challenging to diagnose. This case report can help physicians recognize the clinical presentation of oral lesions, enabling prompt diagnosis and effective treatment
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