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Oral Submucous Fibrosis: A Review on Biomarkers, Pathogenic Mechanisms, and Treatments
Oral submucous fibrosis (OSF) is a collagen deposition disorder that affects a patient’s oral function and quality of life. It may also potentially transform into malignancy. This review summarizes the risk factors, pathogenic mechanisms, and treatments of OSF based on clinical and bio-molecular evidence. Betel nut chewing is a major risk factor that causes OSF in Asia. However, no direct evidence of arecoline-induced carcinogenesis has been found in animal models. Despite identification of numerous biomarkers of OSF lesions and conducting trials with different drug combinations, clinicians still adopt conservative treatments that primarily focus on relieving the symptoms of OSF. Treatments focus on reducing inflammation and improving mouth opening to improve a patient’s quality of life. In conclusion, high-quality clinical studies are needed to aid clinicians in developing and applying molecular biomarkers as well as standard treatment guidelines.
Journal Article
0449 Effect Of Neck-bending On Upper Airway (UA) Caliber And Surrounding Soft-tissues In Controls And Apneics
Abstract
Introduction
Posture is a determinant of UA caliber and apnea frequency and severity. However, the effect of neck-bending on UA caliber and soft-tissues has not been well studied. We hypothesized that neck extension and flexion would increase and decrease UA caliber in controls and apneics.
Methods
UA MRIs were obtained in 24 controls (AHI<5; 1.5 ± 1.5 events/hour) and 33 apneics (AHI≥5; 33.2 ± 28.7) during neck flexion, extension, and neutral position and analyzed for airway measures in the retropalatal (RP) and retroglossal (RG) regions and soft-tissue movement.
Results
Apneics were older (48.9 ± 11.9 vs. 40.8 ± 14.6, p=0.0256) and more obese (33.9 ± 4.4 vs. 28.4 ± 5.6 kg/m2, p=0.0001) than controls; subjects were 49.1% male. During extension (23.9 ± 14.9°) controls showed increased minimum cross-sectional area (CSA), anteroposterior (AP) and lateral dimension in the RP (CSA: 38.2mm2, p=0.0068; AP: 2.6mm, p=0.0145; lateral: 3.8mm, p=0.0046) and RG (CSA: 71.5mm2, p=0.0176; AP: 2.9mm, p=0.0029; lateral: 4.9mm, p=0.0120) airway relative to neutral. Apneics (19.7 ± 9.3°) showed increased RP (CSA: 16.8mm2, p=0.0021; lateral: 2.2mm, p=0.0009) and RG (CSA: 70.6mm2, p<0.0001; AP: 2.8mm, p=0.0001; lateral: 4.7mm, p<0.0001) measures. During flexion, both controls (-16.5 ± 8.2°) and apneics (-11.9 ± 5.7°) showed reduced RP lateral dimension (-2.2mm [p=0.0120] and -1.1mm [p=0.0245]) and RG CSA (-28.2mm2 [p=0.0072] and -12.3mm2 [p=0.0595]). Compared to extension, controls in flexion showed reduced RP (CSA: p=0.0011; AP: p=0.0030; lateral: p=0.0016) and RG (CSA: p=0.0033; AP: p=0.0010; lateral: p=0.0022) measures, RP lateral wall narrowing (p=0.0305), and greater posteroinferior movement of the soft palate (p=0.0019) and all tongue quadrants (p≤0.0042). Compared to extension, apneics in flexion showed reduced RP (CSA: p=0.0006; AP: p=0.0502; lateral: p<0.0001) and RG (CSA: p<0.0001; AP: p=0.0001; lateral: p<0.0001) measures, significant total lateral wall narrowing (p=0.0010), and greater posteroinferior movement of the soft palate (p=0.0005) and all tongue quadrants (p<0.0008).
Conclusion
Controls and apneics showed reductions in both RP and RG airway caliber during neck flexion and increases during extension, primarily due to movement of surrounding soft-tissues. These data provide important insights into the role of head and neck position on UA caliber.
Support (If Any)
Funded by NIH P01 HL094307.
Journal Article
122 Burning Mouth Syndrome as a Focus of Delusion
Abnormalities: Disheveled: Cacosmious. Personal hygiene poor. Facial expression odd and inappropriate. Loud but low quantity of speech. Unable to interpret similarities or proverbs. Calculation: poor.
In those who present with BMS, query as to the delusional nature of their symptoms is warranted and may suggest a treatment strategy.
Journal Article
Potentially Malignant Oral Disorders and Cancer Transformation
Cancer in the oral cavity is often preceded by precursor lesions. Nine oral mucosal disorders are known to have an increased risk of malignant transformation. The etiology varies from disorders caused by exogenous factors such as tobacco and autoimmune inflammation to idiopathic or inherited genetic aberrations. In this review, these potentially malignant disorders (PMDs) are described regarding clinical presentation and histopathological architecture. Special attention is paid to the underlying etiologies of PMDs and the potential pathways leading to cancer. The clinical perspective focuses on the importance of accurate and timely diagnosis.
Journal Article
An Inactivated Enterovirus 71 Vaccine in Healthy Children
Enterovirus 71 (EV71), a cause of hand, foot, and mouth disease, may be associated with poliomyelitis-like paralysis. In this report from China, a vaccine was shown to significantly decrease EV71-associated illness in children.
Epidemics of hand, foot, and mouth disease in children have emerged recently in Asia and have been caused primarily by enterovirus 71 (EV71) and coxsackievirus A16,
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which typically show two peak epidemic incidences each year, in May and October.
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An important clinical concern regarding hand, foot, and mouth disease is central nervous system injury, which occurs during the disease course in some severe cases and may result in a poor outcome.
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Infection with the EV71 C4 genotype accounts for 40.1 to 55.4% of cases of hand, foot, and mouth disease, with considerable associated mortality, including thousands of deaths . . .
Journal Article