Oral squamous cell carcinoma (OSCC) is considered to be one of the most fatal diseases worldwide, owing to its late diagnosis and lack of availability of established reliable biomarkers. The aim of this study was to highlight the significance of immunosuppressive cytokines as potential biomarkers in OSCC. Whole unstimulated saliva was collected from each individual (30 OSCC patients and 33 age- and gender-matched healthy controls). Immunosuppressive cytokines, including IL-4, IL-10, IL-13, and IL-1RA, were evaluated in each sample using Luminex multianalyte profiling (xMAP) technology on BioPlex instrument. Our results showed that all the studied salivary cytokines were raised in OSCC patients as compared to controls, where IL-10 and IL-13 salivary levels showed statistically significant difference (p = .004 and p = .010, respectively). Mean levels of salivary cytokines in three histologically defined OSCC categories, compared employing one-way ANOVA, showed that salivary levels of IL-1RA were highest in patients having poorly differentiated OSCC tumors as compared to those having moderately and well-differentiated tumors (p = .000 and p = .002, respectively). Among OSCC individuals, duration of smokeless tobacco correlated positively with IL-1RA (p = .036). We conclude that salivary levels of immunosuppressive cytokines, IL-4, IL-10, IL-13, and IL-1RA, could prove to be potential biomarkers of OSCC and can be further investigated as markers of early detection and disease progression.

BackgroundCervical metastasis has a tremendous impact on the prognosis in patients with carcinomas of the head and neck and the frequency of such spread is greater than 20% for most squamous cell carcinomas. With emerging evidence, focus is shifting to conservative neck procedures aimed at achieving good shoulder function without compromising oncologic safety. The purpose of this study was to analyze the pattern of nodal metastasis in patients presenting with squamous cell carcinoma of buccal mucosa.Materials and methodsThis was a prospective clinical analysis of patients who were histologically diagnosed with squamous cell carcinoma of the buccal cavity and clinically N1 and had not received treatment anywhere else. Patients were analyzed for age and sex distribution, tumor staging, location, and metastasis.ResultsThe incidence of metastatic lymph node in T4 (n=44) was the highest, that is, level I was 100% (44/44), level II was 43.18% (19/44), level III was 15.90% (7/44), and level IV was 4.5% (2/44). Level V was free of metastasis. Among T3 (n=10) lesions, incidence of metastasis in level I was 100% (10/10), level II was 20% (2/10), and level III, IV, and V were free of metastasis. Among T2 (n=6) lesions, incidence of lymph node metastasis in level I was 100% (6/6) and all other levels of lymph nodes were found free of metastasis.ConclusionLymphatic spread from carcinoma of the buccal mucosa is low. Involvement of level IV is seen in only 3% of patients. A more conservative approach to the neck in patients with carcinoma of the buccal mucosa is recommended.

One of the most common oral diseases affecting people wearing dentures is chronic atrophic candidiasis or denture stomatitis (DS). The aim of the paper is to provide an update on the pathogenesis, presentation, and management of DS in general dental practice settings. A comprehensive review of the literature published in the last ten years was undertaken using multiple databases, including PubMed via MEDLINE, EMBASE, and Scopus. The eligible articles were analyzed to identify evidence-based strategies for the management of DS. Despite its multifactorial nature, the leading cause of DS is the development of oral Candida albicans biofilm, which is facilitated by poor oral and denture hygiene, long-term denture wear, ill-fitting dentures, and the porosity of the acrylic resin in the dentures. DS affects between 17 and 75% of the population wearing dentures, with a slight predominance in elderly females. The mucosal denture surfaces and posterior tongue are the common sites of DS, and the affected areas exhibit erythema, the swelling of the palatal mucosa and edema. Oral and denture hygiene protocols, adjusting or re-fabricating poorly adapting dentures, smoking cessation, avoiding nocturnal denture wear, and the administration of topical or systemic antifungals are the mainstay of management. Alternate treatments such as microwave disinfection, phytomedicine, photodynamic therapy, and incorporation of antifungals and nanoparticles into denture resins are being evaluated for the treatment of DS but require further evidence before routine use in clinical practice. In summary, DS is the most common oral inflammatory lesion experienced by denture wearers. Most patients with DS can be managed in general dental practice settings. Effective management by general dental practitioners may be supported by a thorough understanding of the pathogenesis, the recognition of the clinical presentation, and an awareness of contemporary treatment strategies.

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Background: One of the most crucial parts of any operation is postoperative monitoring and management. Numerous clinical strategies for administering analgesic drugs have been developed to reduce postoperative pain in patients. High opioid doses before, during, and after surgery might cause respiratory depression, sleepiness, nausea, vomiting, itching, difficulties urinating, and ileus. Most surgeries cause maxillo-mandibular fixation (locked jaw). In the early postoperative period, ventilatory depression and vomiting are common that’s why this study focuses on the two types of drug intervention and measures the effects. Objective: To evaluate the efficacy of bupivacaine inferior alveolar nerve block vs intra-venous tramadol (opioid) in postoperative pain control. Study Design: Prospective, randomized control trial Study Setting: The study was conducted in Jinnah Hospital, Lahore from 6 April 2022 to 6 October 2022. Methodology: The non-probability sampling technique was used to recruit the patients. Patient aged between 18 – 40 years with simple mandibular parasymphyis fracture was included in the study. However, patients with diabetes, ischemic heart disease & bone diseases were excluded from the study. The patients were divided into two groups. One group received bupivacaine while the other group received tramadol (opioid). The pain of the patient was calculated using the Visual Analog Scoring system. The frequency of pain was recorded postoperatively between 0-3hrs, 3-6hrs, 6-12hrs, and 12-24hrs. The data were analyzed by using SPSS version 22. Results: Fifty-two patients were recruited in this trial and randomly assigned to the bupivacaine group and tramadol group, there were no significant differences between the two groups in terms of demographic data including age, gender, BMI and mean operation time (P>0.05) as shown in table 1. The Visual Analog and Category Pain Scale (VAS) significanlty reduced in both the groups. The more decline in pain was observed from 12hrs to 24hrs in bupivacaine group from 4.46±0.64 to 2.27±1.00 respectively. In addition, a repeated-measures ANOVA was utilized to evaluate the VAS ratings between the two groups, revealing that the VAS values in the bupivacaine group were considerably lower than those in the tramadol group 16 and 24 hours after surgery (P=0.001 and P=0.000, respectively). Practical implication: The study's justification is the dearth of local or regional information on this topic. Therefore, the objective of this research was to evaluate the effectiveness of tramadol intravenously against bupivacaine inferior alveolar nerve block for postoperative pain control in mandibular parasymphysis fractures. Conclusion: In conclusion, 2mL.5% Injection Bupivacaine (1:200000) administered at the fracture site in the mandibular parasymphysis fractures area post-operation relieved somatic wound pain better than tramadol without major side effects. Thus, local infiltration of bupivacaine over the section incision is recommended for safe and efficient post-operative pain. Keywords: Bupivacaine, Tramadol, Mandibular Parasymphysis Fractures, Alveolar Nerve Block

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