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Hypercoagulable disorders can compromise success of free flap reconstruction. Factor V Leiden is one such disorder for which only one previously reported case of successful free tissue transfer in the head and neck has been described. We report a 70-year-old woman with factor V Leiden treated for stage IVA squamous cell carcinoma of the mandible with a composite resection and reconstruction with an osteocutaneous scapular free tissue transfer. The free tissue transfer occurred without complications, in the setting of intraoperative heparin, postoperative aspirin, and enoxaparin. The free tissue transfer continues to be viable at her most recent follow-up appointment. The hypercoagulable patient represents a diverse presentation of increased coagulation risk in the perioperative period. Considering a patient’s history and understanding available treatment adjuncts can factor heavily in a patient with factor V Leiden successfully undergoing free tissue transfer for head and neck defects.

Adenoid cystic carcinomas (ACC) constitute 1% of all head and neck malignancies and are very rare in the oral cavity. With < 60 oral ACCs described, their pathobiology is incompletely understood. Here, we report a case of oral cavity ACC in a 54-year-old woman. Since recent studies have demonstrated that several human tumors overexpress the hydrogen sulfide (H 2 S)-synthesizing enzymes cystathionine-β-synthase (CBS), cystathionine γ-lyase (CSE), and 3-mercaptopyruvate sulfurtransferase (3-MST), and also show dysregulated H 2 S levels, we examined these biomarkers in the oral ACC and compared the results to those of adjacent benign oral epithelium. Western blotting was used to compare the protein expression of CBS, CSE, 3-MST, nicotinamide phosphoribosyl transferase, and mitoNEET in ACC and adjacent benign oral mucosae. High-performance liquid chromatography was used to quantify the differences in tissue H 2 S concentrations between the two biopsy types. We found that all the proteins examined here were increased in the ACC compared to adjacent benign oral mucosae. Interestingly, H 2 S concentrations were decreased approximately 30% in ACC compared to benign mucosae. Thus, in one example of this rare tumor type, the enzymes that synthesize H 2 S are increased, while tissue H 2 S levels are lower than those found in adjacent benign oral mucosae. Although limited to a single rare tumor type, to our knowledge this is the second time H 2 S concentrations have been directly quantified inside a human tumor. Last, our results may indicate that alterations in H 2 S synthesis and metabolism may be important in the pathobiology of ACC.

Mucoepidermoid carcinoma (MEC) is the most common malignant epithelial neoplasm of the salivary glands. MECs of the mouth floor are rare, with only a few cases reported. Here we report a MEC of the mouth floor in a 55-year-old woman. Since several studies have shown that hydrogen sulfide (H 2 S)-synthesizing enzymes are often increased in malignant tumors compared to benign counterpart tissues, we used western blotting to compare the protein levels of cystathionine-β-synthase (CBS), cystathionine γ-lyase (CSE), and 3-mercaptopyruvate sulfurtransferase (3-MST) in a mouth floor MEC to adjacent benign oral mucosae. We also used high-performance liquid chromatography to quantify possible differences in tissue sulfur fraction concentrations between the two biopsy types. Last, we used western blotting to examine nicotinamide phosphoribosyl transferase (Nampt), mitoNEET, and phospho-ser727-Stat3 levels in the biopsies. We found that all the proteins and phospho-ser727-Stat3 are increased in the MEC compared to benign mucosae. Interestingly, free H 2 S levels, acid-labile, and the sulfane sulfur factions were essentially the same between the MEC and benign tissue. Although limited to a single and unusual tumor type, to our knowledge this is only the third time H 2 S concentrations were directly quantified inside a human tumor. Last, our results replicate those of two previous studies where the H 2 S-synthesizing enzymes are increased in a malignant tumor, while free H 2 S is either not increased or only slightly increased, suggesting that malignant tumors rapidly metabolize H 2 S as part of tumor maintenance and growth.

Hydrogen sulfide (H S) and the enzymes that synthesize it, cystathionine-b-synthase, cystathionine γ-lyase, and 3-mercaptopyruvate, are increased in different human malignancies. Due to its short half-life, H S concentrations have not been directly measured in a human malignancy. Here we directly measured in vivo H S levels within oral squamous cell carcinoma (OSCC). Punch biopsies of OSCC and benign mucosae from 15 patients were analyzed by HPLC, western blotting, and tissue microarray analyses. H S concentrations were significantly higher in OSCC compared to adjacent benign oral mucosae. Western blot and tissue microarray studies revealed significantly increased cystathionine-b-synthase, cystathionine γ-lyase, and 3-mercaptopyruvate, phopho-Stat3, mitoNEET, hTERT, and MAPK protein levels in OSCC. H S concentrations and the enzymes that synthesize it are significantly increased in OSCC. Here, for the first time H S concentrations within a living human malignancy were measured and compared to adjacent counterpart benign tissue.

Peripheral odontogenic fibroma (POF), an extraosseous variant of the central odontogenic fibroma, is considered an uncommon benign gingival lesion with a small recurrence rate. Clinically, it mimics a variety of benign neoplasms, metastases and reactive lesions, but it is most commonly confused with the peripheral ossifying fibroma. In this report, we describe a healthy 32-year-old male who was seen with a recurrent POF of the right maxilla. The surgical excision site was repaired using a free palatal graft, leading to a favorable outcome in an esthetic region of the oral cavity.

AIDS-related lesions have decreased significantly since the advent of highly active anti-retroviral therapy (HAART). We describe an untreated, homeless 44-year-old male with a six-year history of HIV who presented himself with Kaposi sarcoma, candidiasis, scrofula and a generalized severe periodontitis. This report highlights the importance of identifying and diagnosing AIDS-related oral lesions seen in an untreated HIV-positive patient.

Peripheral odontogenic fibroma (POF), an extraosseous variant of the central odontogenic fibroma, is considered an uncommon benign gingival lesion with a small recurrence rate. Clinically, it mimics a variety of benign neoplasms, metastases and reactive lesions, but it is most commonly confused with the peripheral ossifying fibroma. In this report, we describe a healthy 32-year-old male who was seen with a recurrent POF of the right maxilla. The surgical excision site was repaired using a free palatal graft, leading to a favorable outcome in an esthetic region of the oral cavity.

This chapter deals with a method of reconstructing soft tissue defects to various regions of the body. The anterior lateral thigh (ALT) perforator free flap has the ability to provide either individual components or any combination of skin, fascia, and muscle to reconstruct soft tissue defects of the head and neck region. ALT free flap harvest is contraindicated in patients who have had previous vascular bypass procedures in the lower extremities. Due to the variable nature of the ALT skin perforators, patients should be consented for modification of the flap design and for flap harvest from the contralateral thigh. Postoperatively, the patient is typically kept intubated and transferred to the intensive care unit (ICU) for monitoring of the flap. Feeds via nasogastric, orogastric, gastrostomy, or jejunostomy tube are initiated 36–48 hours postoperatively.

Early identification of crop disease can aid the farmers to take timely precautions and countermeasures for its removal. In this paper, a real-time system to identify the type of disease present in a crop based on leaf images using machine learning is proposed. A deep convolutional neural network architecture is proposed to classify the crop disease, and a single shot detector is used for identification and localization of the leaf. These models are deployed on an embedded hardware, Nvidia Jetson TX1, for real-time in-field plant disease detection and identification. The disease classification accuracy achieved is around 96.88%, and the classification results are compared with existing convolutional neural network architectures. Also, the high success rate of the proposed system in the actual field test makes the proposed system a completely deployable system.