Leena Ali Alaroomy

Objectives: The present work aimed to examine the early and late histopathological changes occurring in the lower lips of rats, as a result of hyaluronic acid injection, and to determine whether it could really bring us closer to the ideal soft tissue filler material. This research highlights the importance of experimental studies on this subject since adverse reactions have been observed routinely in dental practice. Material and Methods: The present study was carried out on 36 adult male albino rats with age ranging from 2 to 3 months and weight ranging from 150 to 200g. Rats were divided into two equal groups, each consisting of 18 rats; group I (control group) and group II (experimental group). Rats in the experimental group were injected with hyaluronic acid (0.07 ml), whereas rats in the control group were injected with 0.9% sodium chloride. Each group was further subdivided into 3 subgroups: A, B and C according to the time of sacrifice at one week, one and a half months and three months respectively. Results: The results showed inflammation triggered by the injection of hyaluronic acid. On examining the specimens histologically using Hematoxylin and Eosin stains, Toluidine Blue stain and immunohistochemistry with anti-CD68 antibody, there was a significantly greater inflammatory response in the groups at early intervals with hyaluronic acid compared with the control (PConclusions: Based on the histopathological, histochemical and immunohistochemical results of this study, undesirable effects of hyaluronic acid filler injection can be detected at early intervals following its injection. Fortunately, all the undesirable effects are transient and decrease by time, reaching levels comparable to normal. Overall, HA was well-tolerated by tissues, reflecting how this filler material possesses a biocompatible property. Clinical Relevance: This study introduces hyaluronic acid as a favorable dermal filling material to improve skin contour, and lip augmentation, reduce depression in the skin, and treatment of facial wrinkles with minimal side effects and reasonable cost.

Background: Injectable hyaluronic acid is a type of temporary dermal filler. Hyaluronic acid is found naturally throughout the body, with the highest concentrations in the joints, eyes, and skin. Injectable hyaluronic acid is used to reduce the appearance of fine lines and wrinkles, facial folds, and to create structure, framework and volume to the face and lips. Objectives: The present work aimed to examine the early and late histopathological changes occurring in the lower lips of rats, as a result of hyaluronic acid injection, and to determine whether it could really bring us closer to the ideal soft tissue filler material. This research highlights the importance of experimental studies on this subject, since adverse reactions have been observed routinely in dental practice. Material and methods: The present study was carried out on 36 adult male albino rats with age ranging from 2 to 3 months and weight ranging from 150 to 200g. Rats were divided into two equal groups, each consisting of 18 rats; group I (control group) and group II (experimental group). Rats in the experimental group were injected with hyaluronic acid (0.07 ml), whereas rats in the control group were injected with 0.9% sodium chloride. Each group was further subdivided into 3 subgroups: A, B and C according to the time of sacrifice at one week, one and a half months and three months respectively. Results: The results showed inflammation triggered by the injection of hyaluronic acid. On examining the specimens histologically using Hematoxylin and Eosin stains, Toluidine Blue stain and immunohistochemistry with anti-CD68 antibody, there was a significantly greater inflammatory response in the groups at early interval with hyaluronic acid compared with the control (PConclusion: Based on the histopathological, histochemical and immunohistochemical results of this study, undesirable effects of hyaluronic acid filler injection can be detected at early intervals following its injection. Fortunately, all the undesirable effects are transient and decrease by time, reaching levels comparable to normal. Overall, HA was well-tolerated by tissues, reflecting how this filler material possesses a biocompatible property.

Background: Extera skeletal (Extraosseous) Ewing sarcoma is a rare primary tumor of the soft tissue, with an extremely high mortality rate and a bad prognosis which primarily affects young individuals. It occurs without particular clinical signs and can impact several different areas, which may delay diagnosis. Histopathological examination and immunohistochemistry are crucial for making a definite diagnosis. Besides this, early diagnosis is necessary for succeeding of the management. Case report: The objective of the present case report was to document a rare case of EES which originated from the floor of the mouth. A 37-year-old male patient came to our clinic with sublingual rapidly growing swelling. He was suffering from difficulty in opening his mouth and a feeling of dysphagia. The patient revealed during a history-taking procedure that he had undergone one surgery to remove the mass that had previously developed in the same area, knowing that he had been diagnosed in the first as a non-specific inflammatory reaction. Clinical examinations revealed a dome shape soft tissue mass. The biopsy specimen underwent histopathological and immunohistochemical analysis, which demonstrated poorly differentiated small blue round cells with positive immuno-expression of CD-99, NKX2-2, FLI-1, and Vimentin. The final diagnosis was EES based on the clinical presentation, histopathological pattern, and findings of the immunohistochemistry investigations. Radiotherapy and chemotherapy were chosen as treatment modalities for the case. Unfortunately, the patient died after three months due to the occurrence of multiple distant metastasis areas. Conclusion: Regardless of the relative rarity of Extraosseous Ewing sarcoma, it should be taken into account as a possible differential diagnosis for intraoral soft tissue masses, and accurate diagnosis with precise histopathological and immunohistochemical evaluations should be done as soon as possible. Moreover, improvement of management procedures of such cases generally provides the best chances for patient survival.

Background: Extera skeletal (Extraosseous) Ewing sarcoma is a rare primary tumor of the soft tissue, with an extremely high mortality rate and a bad prognosis which primarily affects young individuals. It occurs without particular clinical signs and can impact several different areas, which may delay diagnosis. Histopathological examination and immunohistochemistry are crucial for making a definite diagnosis. Besides this, early diagnosis is necessary for succeeding of the management. Case report: The objective of the present case report was to document a rare case of EES which originated from the floor of the mouth. A 37-year-old male patient came to our clinic with sublingual rapidly growing swelling. He was suffering from difficulty in opening his mouth and a feeling of dysphagia. The patient revealed during a history-taking procedure that he had undergone one surgery to remove the mass that had previously developed in the same area, knowing that he had been diagnosed in the first as a non-specific inflammatory reaction. Clinical examinations revealed a dome shape soft tissue mass. The biopsy specimen underwent histopathological and immunohistochemical analysis, which demonstrated poorly differentiated small blue round cells with positive immuno-expression of CD-99, NKX2-2, FLI-1, and Vimentin. The final diagnosis was EES based on the clinical presentation, histopathological pattern, and findings of the immunohistochemistry investigations. Radiotherapy and chemotherapy were chosen as treatment modalities for the case. Unfortunately, the patient died after three months due to the occurrence of multiple distant metastasis areas. Conclusion: Regardless of the relative rarity of Extraosseous Ewing sarcoma, it should be taken into account as a possible differential diagnosis for intraoral soft tissue masses, and accurate diagnosis with precise histopathological and immunohistochemical evaluations should be done as soon as possible. Moreover, improvement of management procedures of such cases generally provides the best chances for patient survival.

Hyaluronic acid (HA) is a naturally occurring biodegradable polymer with a variety of applications in medicine including scaffolding for tissue engineering, dermatological fillers and viscosupplementation for osteoarthritis treatment. HA is present in most connective tissues as well as, in body fluids such as synovial fluid and in the vitreous humor of the eye. Due to its versatility, hyaluronic acid has been a major component of biomedical research and has seen application in several fields such as tissue engineering and cancer treatments. This review aims to outline hyaluronic acid’s effect and applications in the biomedical world.

Background: Reconstruction of the maxillary defects following tumor ablation remains to be a challenge for surgeons. Virtual surgical planning (VSP), intraoperative cutting guides and stereolithographic models provides the head and neck reconstructive surgeon with powerful tools for complex reconstruction planning. Despite its use in fibular osteocutaneous reconstruction, application to the scapular free flap has not been as widely reported. The aim of this study was to compare aesthetic results and operation time of free scapular flap, with and without computer-aided design and computer-aided manufacturing (CAD/CAM) customized osteotomy guide, for reconstruction of maxillary defects. Methods: In this prospective randomized controlled clinical trial study, we randomly assigned 22 patients with maxillary defects who were scheduled to undergo maxillary reconstruction with either free scapular flap with CAD/CAM customized osteotomy guide; study group (n = 11) or free scapular flap without CAD/CAM customized osteotomy guide; control group (n = 11). All patients were followed up for 3 months. The aesthetic outcome, operation and ischemic times were evaluated and compared. Results: Aesthetic outcomes were evaluated objectively by means of differential surface area (sagittal and axial) measurement, which showed improved aesthetic outcome (contour symmetry) in the study group with a mean of (241.39 ± 113.74 mm²), compared to patients in control group with a mean of (358.70 ± 143.99 mm²). There were significant differences between the two groups (P < 0.05). Aesthetic outcomes were also evaluated subjectively by means of visual analogue scale (VAS) and patient’s satisfaction score (PSS). The postoperative aesthetic appearance was better in the study group with more patients satisfied than that in control group and there were statistically significant differences (P = 0.039). The mean total operative time was 678.81 min and 777.18 min in the study group and control group respectively (P < 0.05) and the mean ischemia time was 133.18 min and 195.72 min for study group and control group respectively (P < 0.05). The ischemia time and total operative time were shorter in the study group compared to those in the control group and there were no flap losses in both groups. Conclusion: The use of CAD/CAM prefabricated cutting guides facilitates scapular flap molding and placement, minimizes ischemic time and operating time as well as improves aesthetic outcomes. Trialregistration This trial was registered at ClinicalTrials.gov. Registration number: NCT03757286. Registration date: 28/11/2018

Background: Ghost cell odontogenic carcinoma (GCOC) is an extremely rare odontogenic carcinoma that is typically characterized by admixture of atypical epithelial cells and ghost cells. Up to date, GCOC remains rare with around 50 cases have been reported. Herein we report a recurrent case of GCOC. Case presentation: A 41-year-old male was suffering from a recurrent fleshy intra-oral swelling in the right mandible associated with pain, paresthesia and facial asymmetry. By history taking, the patient reported that he was subjected to two surgeries to remove tumors that arose in the same place twice previously, knowing that he was diagnosed in the first as adenomatoid odontogenic tumor (AOT) and in the second as calcifying epithelial odontogenic tumor (CEOT). After thorough investigations the patient underwent another surgery with right hemi-mandibulectomy. Histopathological evaluation of the specimen showed atypical epithelial cells, hyperchromatic and pleomorphic ameloblast-like epithelial strands, ghost cells and dentin-like material, indicating the diagnosis of GCOC. Conclusions: GCOC is a rare but aggressive malignant tumor that has a diversity of histological features that may be misinterpreted with other benign calcifying odontogenic cysts and tumors. So, careful diagnosis and wide surgical resection with safety margins are mandatory to minimize its recurrence.

Odontogenic tumors (OTs) are considered important among oral lesions because of their clinicopathological heterogeneity and variable biological behavior. The purpose of this retrospective cross-sectional study was to evaluate the frequency and distribution of different types of odontogenic tumors based on the current 2017 WHO Classification of Head and Neck Tumors over a period of 5 years. This was achieved by reviewing the records of Cairo's educational hospitals and institutions and comparing the results with findings in the literature. The records of patients diagnosed with odontogenic tumors were obtained from six educational hospitals and a single institute in Cairo which included: Oral and Maxillofacial Pathology Department, Faculty of Dentistry, Cairo University; General Pathology Department, Faculty of Medicine, Cairo University; Oral Pathology Department, Faculty of Dentistry, Ain Shams University; Eldemerdash Hospital, Ain Shams University; El-Sayed Galal Hospital, Al-Azhar University; Ahmed Maher Teaching Hospital and National Cancer Institute. These records were reviewed over a 5-year (2014-2018) period and the odontogenic tumors were investigated for frequency, age, gender and site. The data were recorded, then analyzed using SPSS software. Intraosseous (central) odontogenic tumors constituted 2.56% of all 8974 registered oral and maxillofacial biopsies. A total of 230 cases of OTs were collected and reviewed. Of these, 97.8% were benign and 2.17% were malignant. The mandible was the most commonly affected anatomic location. Ameloblastoma, with a predilection for the posterior mandible, was the most frequent odontogenic tumor (55.65%), followed by cemento-ossifying fibroma (14.78%) and odontoma (9.13%). Females were more commonly affected than males. Most of the patients were in the third and fourth decades of life. There were no peripheral odontogenic tumors diagnosed in this period. Some similarities and differences between our findings and those of previous studies of various populations were witnessed. OTs may greatly diverge according to the version of the classification used and by the sample size of the study. Retrospective analysis of the relative frequency of OTs in different countries will be helpful in enhancing the understanding of OTs, which is important for both oral maxillofacial surgeons and pathologists. Key words:Odontogenic tumors, epidemiology, world health organization classification, oral pathology.