Lugol's iodine identifies synchronous invasive carcinoma—time for a clinical trial

Lugol's iodine is currently under investigation as a technique to detect dysplasia, carcinoma in situ and invasive carcinoma at resection margins, plus further afield.Lugol's iodine is inexpensive and easy to use. We present two cases where the technique revealed abnormal mucosa (one carcinoma, one squamous cell carcinoma in situ) at distant sites from the tumour being treated within oral cavity and oropharynx.     

Use of Lugol's iodine in the resection of oral and oropharyngeal squamous cell carcinoma

We evaluated the use of Lugol's iodine in achieving surgical margins free from dysplasia, carcinoma in situ, and invasive carcinoma by an observational study of two series of 50 consecutive patients having resection of oral and oropharyngeal squamous cell carcinoma (SCC) between November 2004 and March 2007.     

Clinical evaluation of Lugol's iodine staining in the treatment of stage I-II squamous cell carcinoma of the tongue

Oral squamous cell carcinoma (OSCC) is often surrounded by epithelial dysplasia; leaving it unresected can result in local recurrence. Staining with Lugol's iodine solution detects epithelial dysplasia in oral mucosa, but whether it decreases local recurrence after OSCC surgery is unknown. This study investigated local recurrence rates in patients with early tongue cancer who underwent surgery using Lugol's staining. 93 patients with T1-2N0 tongue SCC underwent partial glossectomy using Lugol's staining during surgery. Resection was performed at least 5 mm from the margin of the unstained area. Patients were investigated retrospectively for local recurrence status. Postoperative histology revealed negative surgical margins for SCC or epithelial dysplasia in 81 patients, close margins for SCC in 5, positive margins for mild epithelial dysplasia in 6, and a positive margin for SCC in one. Those with a positive or a close margin for SCC underwent additional resection 2-4 weeks after surgery; one was proved histologically to have residual SCC. No patients developed local recurrence, but 2 died of neck metastasis and 2 of distant metastasis. The 5-year disease specific survival rate was 93.8%. Lugol's staining during surgery can reduce local recurrence and improve survival in patients with early tongue SCC.     

False-positive xerostomia following radioactive iodine treatment: case report

Radioactive iodine (131I), used in the treatment of differentiated thyroid carcinoma, is known to cause both short-term and long-term radiation damage to the salivary glands. The injury appears as glandular swellings and/or decreased salivation with 131I dosage and passage of time playing significant roles. A case report is presented to alert the profession to the existence of patients who have received 131I therapy and who complain shortly thereafter of xerostomia, but following a thorough examination are found to represent a group of false-positives. Emphasis is placed on the diagnostic techniques used in the differential diagnosis.     

Radioactive iodine: An unappreciated threat to salivary gland function

Thyroid cancer is an endocrine malignancy whose prevalence is increasing in the United States. Nearly 57,000 new cases of thyroid cancer are estimated to be diagnosed in 2017. The standard of care for differentiated thyroid cancer is thyroidectomy followed by ablation of thyroid remnants with high‐dose radioactive iodine (¹³¹I). Apart from thyroid glands, ¹³¹I accumulates in cells of salivary glands and compromises its function. Xerostomia is, therefore, a frequent and often persistent complaint of patients. Despite adoption of standard preventive measures, parenchymal damage and chronic salivary dysfunction are observed in a substantial number of patients. Saliva is important for oral homeostasis, and its reduction increases the risk of oral morbidity. As differentiated thyroid cancer patients have an excellent survival rate, preservation of salivary gland function carries added significance. A focus on treatments that preserve or restore long‐term salivary flow can significantly improve the quality of life of thyroid cancer survivors.     

Extracanal invasive root resorption: a perplexing oddity

Extracanal invasive resorption originates in the periodontal ligament, making it difficult to determine during treatment whether all resorption cells have been eliminated. Consequently, periodontal defects and recurrence of the process are quite common. This process can occur supraosseously or subosseously and treatment may or may not include endodontic therapy. The pathogenesis, diagnosis, and treatment modalities are presented along with a clinical case with an 18-month follow-up as an example of the challenges associated with treatment of this lesion.     

微创牙科学:文献回顾与最新进展

微创牙科学是指采用生物学方法而不是传统的牙体手术处理龋病,以最大限度地减少对牙体结构的破坏。这种新的龋病处理方法,将过去强调的视龋损为“洞”而反复充填的理念,转变为视龋损为口腔生态失衡而促使生物膜产生生物学变化。微创牙科学的目的在于阻止龋病进程,然后修复缺失的牙体结构和功能,最大限度地发挥牙体的愈合潜能。微创牙科学的处理方法可概括为3个步骤:(1)判定患者的患龋风险;(2)再矿化,即防止龋损形成并逆转未形成“洞”的浅龋;(3)修复,即控制龋活性,使愈合潜能最大化并修复龋损。龋病并非仅仅是牙体脱矿,而是一个因生物膜与牙界面生态和化学平衡失衡而致的反复的脱矿过程(生态菌斑学说)。饮食和生活方式(尤其是碳水化合物的摄入频次)、饮水、吸烟是导致生物膜生态和致病性的重要因素。椅旁评价菌斑和唾液的方法的问世,使得龋病危险评估和监测患者的顺从性成为可能。唾液的再矿化特性,可以通过使用能够释放Ca2 、P5 、F1-的再矿化剂(CPP-ACPandCPP-ACFP)而予强化。使用某些化学制剂(氟、氯已定和木糖醇),可改变菌斑的致病性。采用微创治疗方案,可修复早期龋损,增进患者的理解力和顺从性。本文从3个方面,详细论述了微创牙科学的概念、理论基础和操作方法。     

Minimally invasive orthognathic surgery: a systematic review

Minimally invasive techniques are currently applied in many oral and maxillofacial surgical procedures, including orthognathic surgery. A systematic review on the application of potentially minimally invasive procedures in orthognathic surgery was performed to provide a clear overview of the relevant published data. Articles in English on minimally invasive orthognathic procedures, published in the scientific literature, were obtained from the PubMed, Embase, and Cochrane Library databases, and an additional manual search (revised 31 December 2016). After screening the abstracts and applying the eligibility criteria, 403 articles were identified. All articles reporting the potential for minimally invasive orthognathic surgery were included (n = 44). The full papers were evaluated in detail and categorized as articles on a minimally invasive surgical approach (n = 4), endoscopically assisted orthognathic procedures (n = 17), or the use of a piezoelectric device in orthognathic surgery (n = 25); two articles were each included in two categories. Although a small incision and minimal dissection is the basic principle of a minimally invasive technique, most articles (90.9%) reported the endoscope and piezoelectric instrument as important tools in minimally invasive orthognathic surgery. Evidence from available studies suggests that patients undergoing minimally invasive orthognathic surgery have less morbidity and make a faster recovery. Further research should aim to obtain higher levels of evidence.     

Salivary gland injury resulting from exposure to radioactive iodine: case reports

BACKGROUND: Radioactive iodine 131 ((131)I) is an effective treatment for differentiated thyroid carcinomas. (131)I targets thyroid tissue and is picked up by the salivary glands. Collateral damage results in the development of radiation sialadenitis. CASE DESCRIPTION: The authors describe salivary gland injuries that developed in two patients who received therapeutic doses of (131)I used to treat thyroid carcinoma. Accurate assessment of the glandular damage was achieved via a radioisotope study using technetium Tc 99m pertechnetate. CONCLUSION AND CLINICAL IMPLICATIONS: In the majority of cases, when a patient receives therapeutic doses of (131)I, the patient develops an asymmetric radiation sialadenitis. Obstructive symptomatology is to be expected. Oral dryness occurs less often and is related directly to high dosages and the passage of time. Clinicians should be aware of the condition to avoid unnecessary diagnostic and therapeutic measures.     

牙胶尖粘附碘仿充填根管的临床应用

牙胶尖粘附碘仿充填根管的临床应用汪达江根管充填是根管治疗中的重要步骤。临床上大多采用糊剂加牙胶尖的充填方法，无论何种糊剂都呈流体状态，充填上颌后牙根管及其他细小根管较为困难，费时费力，在没有先进完备充填器械的基层口腔科不易达到预期效果。口腔临床工作者...     

Endoscopic holography: a minimally invasive oral biopsy technique

It is important to see the nature of the cells when diagnosing oral lesions. This is often done microscopically by removing lesions, either scraping individual cells (cytology) or cutting out blocks of tissue (biopsy). The problems encountered with these techniques involve the patient's discomfort, possibility of spreading a tumor (e.g., an incisional biopsy of malignant melanoma), delayed healing, and time required for the lab work (shipping of specimen, sectioning, staining, path review, etc.). Many dentists are hesitant to suggest biopsies of minor lesions because of the trauma, pain, and cost incurred by the patient. The use of direct tissue examination using light endoscopes, intraoral video, or macrophotography is of limited value because the poor resolution of the images will not identify pathology on a cellular level.