搜索结果：Oral radiology

Dermoid cysts of the oral floor are rare cystic lesions of the oral cavity characterized by ectodermal-derived tissue. Normally, lesions appear round or ovoid on imaging. We report a rare case of a gourd-shaped dermoid cyst on the oral floor. An 11-year-old boy with a painless swelling in the oral floor and submental region was referred to our hospital, and magnetic resonance image presented a ground-shaped lesion through the bilateral mylohyoids. A cystic lesion was suspected, and excision was performed under general anesthesia. The excised lesion was then gourd. Pathological examination revealed a dermoid cyst. The patient's postoperative course was uneventful, and no recurrence was observed.

Background Tobacco use remains a major public health concern in India, with significant health, social, and economic consequences. Understanding patterns of use and behavioral triggers in clinical populations is essential for designing targeted cessation strategies. Objective To describe patterns of tobacco use, behavioural triggers, and nicotine dependence among patients attending a Tobacco Cessation Center (TCC) in Pune, India. Methods A retrospective descriptive analysis was conducted using anonymized intake records of 5,403 patients attending a TCC at a dental hospital between June 2017 and June 2023. Data on age, sex, marital status, occupation, type of tobacco use, behavioral triggers, nicotine dependence (assessed using the Fagerström test for nicotine dependence and its modified version for smokeless tobacco), quit attempts, and monthly expenditure were extracted. Descriptive statistics were used to summarize the data. Results The majority of participants were male (76.6%), married (85.2%), and belonged to the 41-60 years age group (42.1%). Smokeless tobacco was the most commonly used form of tobacco (71.9%), followed by smoking (27.0%), while dual use was reported by 1.1% of participants. Craving was the most frequently reported behavioral trigger for tobacco use (73.5%), followed by stress (17.7%) and peer influence (5.2%). Skilled professionals (39.2%) and unemployed individuals (32.3%) constitute the major occupational groups. Moderate nicotine dependence was the most commonly observed category (50.4%), followed by low dependence (33.8%) and high dependence (15.8%). Conclusion Tobacco use in this clinical population was predominantly observed among middle-aged males, with craving and stress reported as common triggers. The findings highlight the need for targeted, context-specific tobacco cessation strategies focusing on behavioral support and nicotine dependence management. However, given the descriptive design, no causal inferences can be made.

Mature T-cell lymphomas (TCL) are aggressive malignancies with limited effective therapies. Duvelisib (DUV), a dual inhibitor of PI3K-δ and PI3K-γ, has shown promising activity in TCL. Azacitidine (AZA), a hypomethylating agent, has demonstrated efficacy in TCL and may enhance the activity of PI3K inhibitors through epigenetic modulation and immune regulation. We conducted a phase I, open-label, 3 + 3 dose-escalation study of oral duvelisib in combination with oral azacitidine (BMS-986345) in patients with relapsed or refractory TCL. The primary objective was to identify the maximum tolerated dose (MTD) of the combination. Fourteen patients (N = 14) were enrolled with a median age of 63.5 years. The median number of prior therapies was two. Grade ≥ 3 toxicities, expressed for the full treated population (N = 14), included neutropenia (29%), anemia (21%), AST elevation (21%), ALT elevation (14%), thrombocytopenia (14%), and leukocytosis (14%). Most adverse events were grade 1-2 and manageable. The ORR was 46% (N = 6), with 31% (N = 4) complete responses (CR) and 15% (N = 2) partial responses (PR). All four evaluable patients with a T-follicular-helper (TFH) phenotype achieved CR, a hypothesis-generating observation given the small denominator. Median PFS was 2.2 months (95% CI 1.8-NE) and median OS 10.2 months (95% CI 6.3-NE); however, median duration of response was not reached, and three responders were censored at the time of allogeneic transplant. On-treatment suppression of AKT phosphorylation was enhanced during combined therapy. Duvelisib plus oral azacitidine had a manageable safety profile and encouraging activity, particularly in the TFH subtype, where responses were deep and enabled a bridge to allogeneic transplant. Randomized evaluation focused on the TFH subtype is warranted. TRIAL REGISTRATION: NCT05065866.

This study evaluates the diagnostic value of CT/MRI-based nodal morphology and three-plane size criteria for identifying pathologically positive (pN+) cervical lymph nodes (LNs) in oral squamous cell carcinoma (OSCC). OSCC patients who underwent neck dissection (2020-2021) were included. Preoperative CT/MRI were reviewed by an observer blinded to clinicopathological information. Visible LNs were assessed for morphologic abnormality and size in short-axial (SAD), maximum-axial (MAD), and craniocaudal (CC) diameters. Sensitivity and specificity of each imaging parameter were calculated using pathology as the reference standard. CT/MRI scans from 148 patients were analyzed. Sensitivity/specificity for detecting pN+ LNs were: 56%/76% (abnormal morphology-alone), 57%/72% (morphology ± SAD >1.0 cm), 83%/28% (morphology ± MAD >1.0 cm), 86%/29% (morphology ± CC >1.0 cm), and 88%/24% (morphology ± any-plane >1.0 cm). Among 64 morphologically abnormal LNs, 25, 6, and 5 measured ≤1.0 cm in SAD, MAD, and CC, respectively, with pN+ rates of 16/25 (64%), 4/6 (66.7%), and 3/5 (60%). In morphologically "normal" (homogenous) LNs, sensitivity/specificity for pN+ detection by >1.0 cm size threshold were: 3%/95% (SAD), 62%/36% (MAD), 68%/39% (CC), and 72%/32% (any plane). Abnormal LN morphology is the most reliable CT/MRI indicator of pN+ disease in OSCC, irrespective of nodal size, although sensitivity remains modest. In morphologically normal LNs, three-plane size assessment, particularly MAD and CC, improves detection of pN+ beyond SAD. These findings support a morphology-first approach to CT/MRI nodal evaluation and inform an exploratory OSCC-specific decision framework incorporating morphology, multi-plane size assessment, and lymphatic drainage patterns.

Background Patients with locally advanced oral cavity squamous cell carcinoma (OCSCC) often experience symptoms that interfere with eating, swallowing, comfort, and daily functioning. Surgery followed by adjuvant radiotherapy (RT) remains the standard treatment for operable disease, whereas definitive concurrent chemoradiotherapy (CCRT) is used selectively in patients who are unsuitable for, unwilling to undergo, or unable to undergo timely surgery. Objective This study compared short-term symptom burden and functional outcomes between patients with locally advanced OCSCC treated with definitive CCRT and those treated with surgery followed by adjuvant RT. Methods This prospective, non-randomized comparative cohort study was conducted at two cancer centers in Bangladesh from January 2023 to October 2024. Sixty-eight previously untreated patients with stage III or IVA OCSCC were included. Thirty-four patients received definitive CCRT, and 34 underwent surgery followed by adjuvant RT. Symptom burden and functional status were assessed using the Functional Assessment of Cancer Therapy Head and Neck Symptom Index-10-item version (FACT-HNSI-10). The primary outcome was the change in the FACT-HNSI-10-derived raw symptom burden score from baseline to post-treatment assessment. Secondary outcomes included changes in pain, dysphagia, bleeding or ulceration, and respiratory distress. Results FACT-HNSI-10-derived raw symptom burden scores decreased significantly after treatment in both groups, indicating improvement in symptom burden according to the scoring approach used in this study. The mean score decreased from 30.2&#xb1;0.8 to 24.8&#xb1;1.3 in the chemoradiotherapy group and from 30.0&#xb1;1.0 to 24.4&#xb1;1.3 in the surgery plus adjuvant RT group (both p<0.001). The mean change did not differ significantly between groups (5.4&#xb1;1.3 vs. 5.6&#xb1;1.0; p=0.471). Pain, dysphagia, bleeding or ulceration, and respiratory distress decreased during short-term follow-up in both arms. Conclusions Both treatment pathways were associated with short-term decreases in FACT-HNSI-10-derived raw symptom burden scores and improvements in symptom burden. No statistically significant difference was observed between groups in short-term functional improvement. These findings should be interpreted cautiously because of the small sample size, non-randomized design, and limited follow-up. They do not establish oncologic equivalence.

The recently proposed consensus frameworks for staging and grading in gerodontology represent an important advance toward multidimensional assessment of oral health in older adults. While staging characterises current oral health status by integrating disease burden, oral function, frailty, and care dependency, grading complements this approach by estimating future vulnerability based on oral, systemic, behavioural, and social determinants. Together, these frameworks provide a more comprehensive foundation for personalised, risk-informed geriatric oral healthcare. This correspondence discusses their complementary roles, highlights alignment with contemporary healthy ageing initiatives including the World Health Organisation's Integrated Care for Older People (ICOPE) framework and considers opportunities for integration into comprehensive geriatric assessment. We further discuss key implementation challenges related to clinical feasibility, interdisciplinary collaboration, and adaptation across diverse healthcare systems, particularly in low- and middle-income countries. Finally, we propose pragmatic implementation strategies, including tiered assessment pathways, to facilitate routine clinical adoption. Successful validation and implementation of these complementary frameworks have the potential to strengthen person-centred care, improve interdisciplinary communication, and advance equitable oral healthcare for ageing populations worldwide.

Nasotracheal intubation is commonly used in maxillofacial surgeries but often causes complications, with epistaxis being the most frequent. Selecting the more patent nostril and appropriate tube size can help reduce bleeding. Flexible nasal endoscopy (FNE) is traditionally used for this assessment but is invasive. Virtual nasal endoscopy (VNE), a non-invasive imaging technique, may offer an alternative. This randomized controlled study aimed to compare the incidence of epistaxis during nasotracheal intubation when guided by VNE vs FNE. Sixty-four patients were enrolled. Preoperatively, VNE using OsiriX Lite software identified the more patent nostril and endotracheal tube (ETT) size. On surgery day, FNE was performed to assess the same. Patients were randomized into Group V (virtual) or Group E (endoscopy), with nostril side and Ring-Adair-Elwyn (RAE) tube size chosen accordingly. Incidence and severity of epistaxis during laryngoscopy and before throat packing, ease and time of insertion, manipulations, and number of attempts were recorded. The incidence and severity of epistaxis were significantly less in group V than group E at laryngoscopy (18.8% vs 59.4%, P < 0.001) and during throat packing (31.2% vs 84.4%, P < 0.001). The time taken for ETT insertion, tube impingement, and manipulations was also significantly reduced in group V. Our study showed that the incidence of epistaxis was significantly less in VNE than in FNE-guided intubation.

Most oral malignant tumors are primary, and the incidence of oral metastatic tumors is low at 1%-2.4%. We report a rare case of mandibular metastatic lung cancer with multimodal imaging. A 67-year-old man presented with pain of the left side of mandible within 2 weeks. On clinical examination, swelling and redness of the gingiva of the left lower molar regions were found. Panoramic radiography revealed a mass like radiopacity on the left mandible, however, no destruction in the left mandible. CT showed metal artifact in the left mandible. On intraoral ultrasonography, the mass revealed clear boundary, hypoechoic echogenicity, homogeneous internal architecture, no vascular signals by color Doppler imaging and heterogeneous hard by strain elastography. Furthermore, MR imaging was performed. The lesion in the left mandible showed low-signal intensity and homogeneous enhancement on T1-weighted images. T2-weighted and STIR images showed high-signal intensity. diffusion-weighted MR imaging of the lesions revealed high-signal intensity, and the apparent diffusion coefficient values of the lesion was 1.08&#x2009;&#xd7;&#x2009;10-&#x2009;3 mm2s-&#x2009;1. The radiological diagnosis in the mandibular lesion was malignant tumor. Histopathological diagnosis by incisional gingival biopsy was adenocarcinoma. Thereafter, 18F-fluorodeoxyglucose PET/CT was performed, and revealed focal hypermetabolic area in the left side of mandible and right upper lobe of lung. Histopathological diagnosis by biopsy of the right upper lobe of lung was adenocarcinoma. Therefore, this case was diagnosed as mandibular metastatic lung adenocarcinoma. This case suggests that multimodal imaging could be effective for diagnoses of oral metastatic tumor.

Background Head and neck cancers represent a significant global health burden, with radiotherapy being a cornerstone treatment modality. However, treatment-related nutritional complications significantly impact patient outcomes and quality of life. This study aimed to evaluate the impact of radiation therapy on nutritional status and explore the relationship between treatment-induced weight loss and clinical outcomes in head and neck cancer patients undergoing definitive or adjuvant radiotherapy. Methodology A prospective observational study was conducted over 18 months (September 2015 to March 2017) involving 83 patients with histopathologically confirmed head and neck squamous cell carcinoma receiving radiotherapy or chemoradiotherapy at a tertiary care center. Nutritional assessment was performed using anthropometric measurements and Patient-Generated Subjective Global Assessment (PG-SGA) at baseline, week three, treatment completion, and six weeks post-treatment. Statistical analysis was performed using SPSS version 21.0. Results The study population had a mean age of 57 years with a male predominance (81.93%). The oral cavity was the most common primary site (43.37%). Baseline malnutrition prevalence was 78.31%, increasing to 100% during treatment. Critical weight loss (>5%) occurred in 90.36% of patients, with significant site-specific variations (p = 0.029). Universal weight loss was observed in larynx/hypopharynx and oropharynx patients compared to 82% in oral cavity cancers. Treatment volume correlated significantly with weight loss at weeks 5, 6, and 12 (p < 0.05). Conclusions Radiotherapy for head and neck cancer results in universal malnutrition with significant anatomical site-specific variations. Proactive nutritional intervention strategies are essential, particularly for patients with larynx/hypopharynx and oropharynx primaries.

Acquired partial lipodystrophy (APL) is characterized by loss of subcutaneous adipose tissue, primarily affecting the upper body. We aim to characterize the clinical and metabolic profiles of patients with APL and explore whether variations in clinical presentation and adipose tissue distribution are associated with the development and severity of metabolic disease. This multicenter study included 36 patients with APL (median age: 38, 24-49; 25th -75th percentiles; 12 males, 24 females). For comparison, 37 patients with familial partial lipodystrophy type 2 (FPLD2) due to typical codon 482 LMNA variants (median age: 42, 32-56, 25th -75th percentiles 10 males, 27 females) were included. The median follow-up duration was 60&#xa0;months (7.5-102, 25th -75th percentiles). Low complement 3 levels were detected in 18 of 34 patients with available assessment (52.9%). Autoimmune disorders were common, affecting 14 patients (38.9%). Metabolic abnormalities were variably observed among patients with APL, with diabetes documented in 17 patients (47.2%), hypertriglyceridemia in 21 patients (58.3%), and hepatic steatosis in 22 patients (61.1%). Chronic kidney disease developed in 19 patients (52.8%), pancreatitis in 3 (8.3%), and polycystic ovaries in 8 (42.1%) of reproductive-age women. A subgroup of patients with APL (n&#x2009;=&#x2009;11, 30.6%) had reduced gluteofemoral adipose tissue and exhibited more severe metabolic abnormalities than those with fully preserved adipose tissue in these regions. All patients in this subgroup had diabetes; 7 of 11 had triglyceride levels&#x2009;>&#x2009;500&#xa0;mg/dL, and hepatic steatosis was present in 10 of 11. Kaplan-Meier estimates indicated earlier onset of diabetes (p&#x2009;<&#x2009;0.001) and hypertriglyceridemia (p&#x2009;=&#x2009;0.005) in this subgroup. Patients with APL show a heterogeneous clinical profile, and our observations reveal a phenotypic overlap with more generalized adipose tissue loss in some patients diagnosed as APL under current classifications. In this subset, reduced gluteofemoral fat is linked to earlier onset and greater severity of metabolic complications, highlighting the importance of fat distribution in metabolically protective regions.

We previously reported short-term efficacy (2-months) results of an advanced pneumatic compression device (APCD) versus usual care (UC) for treatment of head and neck cancer survivors (HNCS) with symptomatic treatment na&#xef;ve lymphedema (HNLEF). Herein we report the long-term (4 & 6-month) outcomes of that trial. This multi-site, prospective randomized clinical trial was conducted at academic and community-based sites. Eligibility criteria included: HNCS without evidence of cancer, previously untreated HNLEF evaluable on exam or imaging, and at least 1 associated symptom with severity of &#x2265;4 out of 10. Participants were randomized 1:1 to either daily use of an APCD for 6-months or UC per institutional standards. Measurement tools included: Patient-reported outcome (PRO) measures, Clinician reported outcome (CRO) measures, digital photographs, and computed tomography (CT). Measures were at baseline 2, 4 (no CT) and 6-months. 236 participants were enrolled (119 APCD, 117 UC). Tumor distribution by group was as follows: APCD=Larynx 29.4%, Salivary Glands 1.7%, Oral Cavity 37.8%, Paranasal Sinuses 1.7%, Pharynx 25.2%, Unknown Primary 4.2%); UC=Larynx 16.2%, Salivary Glands 5.1%, Oral Cavity 48.7%, Paranasal Sinuses 1.7%, Pharynx 21.4%, Unknown Primary 6.8%. Of the UC group, 17.1% (n= 20) underwent neck bilateral dissection, as did 12.6% (n=15) of the APCD group. Symptom improvement garnered during initial treatment was maintained over time in both groups with no significant difference between groups. CRO measures demonstrated improvement in internal HNLEF (Modified Patterson Scale, p <0.01 both groups) and external HNLEF (grading criteria, APCD p<0.01; UC p=0.06) in the APCD group. Statistically significant differences at two of 19 anatomic subsites favored the APCD group. At 6-months the digital photography showed improvement with no between group difference. CT findings at 6-months verified significant improvement in soft tissue swelling in both groups (p<0.01 both groups) that was not present at 2-months with no between group difference. At 6-months, the analysis indicated that APCD and UC resulted in improved symptom control of similar magnitude. CROs, imaging and digital photography demonstrated improvement in anatomic lymphedema in both groups over time. Select CRO outcome measures demonstrated marginal differences between groups that favored the APCD. Both interventions provided long-term benefit to patients with treatment na&#xef;ve lymphedema. NCT04797390.

Hereditary Sensory and Autonomic Neuropathy Type VIII (HSAN-VIII) is a rare autosomal recessive disorder resulting from homozygous mutations in the PRDM12 gene. This gene encodes a protein critical for the development of sensory neurons responsible for nociception. This case report delineates the clinical presentation, with a particular focus on the oral manifestations and subsequent therapeutic interventions in an affected patient. We report the oral manifestations and dental management of a 10-month-old female diagnosed with HSAN-VIII. Genetic analysis via whole-exome sequencing confirmed a homozygous mutation in the PRDM12 gene. The patient's phenotype was characterized by congenital insensitivity to pain and thermal stimuli, self-mutilating behaviors, autonomic dysfunction manifesting as hypohidrosis and alacrima, absent corneal reflexes, and recurrent episodes of dermal and osteomyelitic infections. Significant orofacial findings included extensive soft tissue injuries such as almost amputated tip portion of the tongue. A multidisciplinary management strategy was implemented for comprehensive care. The profound scarcity of clinical data on HSAN-VIII frequently leads to diagnostic delays, which critically impedes the timely implementation of preventative strategies against the disease's myriad complications. The effective management of these patients necessitates a coordinated, interdisciplinary approach involving specialized medical and dental teams, as well as the establishment of standardized treatment protocols. Significant knowledge gaps persist regarding the long-term management of HSAN-VIII, underscoring the imperative for further international collaborative research.

Finite element (FE) modeling is widely used in biomechanical research, enabling computational investigations of anatomical structures. To develop accurate FE models, high-resolution medical imaging such as computed tomography (CT) is essential. However, CT exposes patients to ionizing radiation. Recently, radiation-free three-dimensional zero-echo-time magnetic resonance imaging (3D ZTE MRI) has shown promising results for bone visualization. Therefore, this feasibility study investigated whether 3D ZTE MRI is reliable for creating subject-specific FE models. Human femora from four female subjects were imaged using 3D ZTE MRI. Static FE analyses of the femora were performed in Abaqus/CAE, assuming a biphasic homogenous linear-elastic material. A sensitivity analysis was conducted to evaluate varying bone material properties. After loading with 2000 N, the mean displacement of the femoral head amounted to -1.30 &#xb1; 0.26 mm (vertical) and -9.03 &#xb1; 2.21 mm (horizontal), while the femoral neck exhibited compressive (inferior: -1366.03 &#xb1; 182.70 &#xb5;m/m) and tensile (superior: 1038.69 &#xb1; 135.82 &#xb5;m/m) strains. Overall, the results demonstrate displacement and strain predictions similar to previous experimental and computational studies based on CT data. Therefore, despite several simplifications, these findings confirm the feasibility of radiation-free 3D ZTE MRI for subject-specific FE modeling, enabling future simultaneous assessment of bone morphology and surrounding soft tissues.

This study evaluated the safety and efficacy of an iodinated contrast agent for videofluoroscopic swallowing studies (VFSS) in patients with swallowing disorders, compared with barium sulfate contrast agents. The study included 20 patients who underwent VFSS at Hiroshima University Hospital in 2025 for dysphagia evaluation. Iodixanol (Visipaque 270&#xae;; GE Healthcare Pharma Co., Ltd., Chicago, Illinois) was used as the iodinated contrast agent. For comparison, VFSS images obtained with Barytester&#xae; (FUSHIMI Pharmaceutical Co., Ltd., Kagawa, Japan) in the same patients served as barium sulfate controls. The frequency of adverse events associated with oral Visipaque 270&#xae; administration was assessed. VFSS images obtained with Barytester&#xae; and Visipaque 270&#xae; in the same patients were compared to evaluate imaging performance. To determine whether image evaluation outcomes were equivalent between Visipaque 270&#xae; and Barytester&#xae;, an equivalence test was performed using the two one-sided tests procedure. Visipaque 270&#xae; was associated with no adverse events, including gastrointestinal or other adverse events. Image evaluations using Visipaque 270&#xae; and Barytester&#xae; were statistically equivalent. VFSS was performed using the iodinated contrast agent Visipaque 270&#xae;. No adverse events related to oral Visipaque 270&#xae; administration were observed, and contrast enhancement on VFSS images was comparable to that achieved with Barytester&#xae;. Japan Registry of Clinical Trials, jRCTs061240040; registered 26 July, 2024.

ObjectiveTo evaluate the morphology of the pterygomaxillary junction (PMJ) in patients with unilateral cleft lip and palate (UCLP) and compare it with that of non-cleft individuals using cone-beam computed tomography (CBCT).DesignRetrospective comparative CBCT study.SettingDepartment of Oral and Maxillofacial Radiology, &#x130;nonu University.Patients/ParticipantsCBCT records obtained between January 1, 2015, and December 1, 2025, were reviewed. Fifty-three patients with UCLP and 53 age- and sex-matched non-cleft individuals meeting the inclusion criteria were included.InterventionsNot applicable.Main Outcome Measure(s)PMJ thickness, width, angle, sagittal plane angle, inter-pterygoid plate angle, and pterygomaxillary suture (PMS) height were measured and compared between groups.ResultsPMJ width was significantly lower in the UCLP group than in the control group (P&#x2009;<&#x2009;0.05). No significant differences were observed in PMJ thickness or PMS height (P&#x2009;>&#x2009;0.05). Inter-pterygoid plate angles were significantly greater, whereas sagittal plane angles were significantly smaller in UCLP patients compared with controls (P&#x2009;<&#x2009;0.05). No significant differences were detected in the remaining measurements.ConclusionsUCLP patients exhibit distinct PMJ morphological characteristics compared with non-cleft individuals. Variations in PMJ width and angular measurements may be relevant to posterior maxillary surgical procedures. CBCT-based assessment provides valuable anatomical information that may contribute to individualized surgical planning in patients with UCLP.

Malocclusion and occlusal wear are identified as potential risk factors for altered masticatory muscle function, pain, and temporomandibular joint (TMJ) dysfunction. This study aimed to assess the correlation between occlusal discrepancies, viscoelastic properties, and pain scores in the muscles of mastication-temporalis, masseter, pterygoids, and sternocleidomastoid muscles-in individuals with and without head and neck pain (HNP). This pilot exploratory study included 38 participants (10 men and 28 women) divided into 18 patients without HNP (control) and 20 with HNP (case). The following parameters were assessed: severity of tooth wear by the "Individual (personal) Tooth-Wear Index" by Ekfeldt et al. (1990); viscoelastic properties (tone, stiffness, and elasticity) of masticatory muscles (masseter, temporalis, sternocleidomastoid, lateral pterygoids, and medial pterygoid muscles) using Mytone Pro; and pain scores using the numeric rating scale. Stress and anxiety were assessed using the perceived stress scale (PSS) and the Hamilton anxiety (HAM-A) scale, respectively. Correlation analyses between occlusal wear and viscoelastic properties of each muscle of mastication were conducted using Pearson's correlation coefficient. For all analyses, statistical significance was set at p&#x2009; < 0.05. Participants with HNP exhibited greater mean occlusal wear (8.417&#x2009;&#xb1;&#x2009;4.54) than those without HNP (6.626&#x2009;&#xb1;&#x2009;3.72). The frequency and stiffness of the masseter and sternocleidomastoid muscles were significantly greater in individuals with HNP. Pain scores for the muscles of mastication were higher in patients with HNP than in those without HNP. The average pain scores in the muscles of mastication were notably higher in those with HNP (mean&#x2009;=&#x2009;5.9) than in those without HNP (mean&#x2009;=&#x2009;3.2). The relaxation time and creep were also reduced in the masticatory muscles of patients with HNP. However, no correlation was observed between masticatory muscle pain and occlusal wear. Stiffness and relaxation time in the masticatory muscles were greater in individuals with HNP. Occlusal wear affects the viscoelastic properties (tone, relaxation, and stiffness) of the masticatory muscles and is positively correlated with HNP. A multidisciplinary approach involving dentists, neurologists, and physiotherapists is essential for effectively managing patients presenting with headaches, occlusal discrepancies, muscle dysfunction, and craniofacial pain.

Subdural empyema, mastoiditis, and sinus venous thrombosis are rare infections that may lead to serious and potentially life-threatening complications. A 2-year-old male patient with no known underlying disease presented with a 2-day history of ear pain, sore throat, and fever. Physical examination revealed no significant pathology other than hyperemia of the left tympanic membrane. Intravenous ceftriaxone was initiated, and the patient was hospitalized because of persistent fever and poor oral intake. However, despite 3 days of treatment, the fever persisted, and an increase in acute phase reactants was observed. Subsequently, the patient developed hyperemia, swelling, and warmth in the area corresponding to the left mastoid region. Clindamycin was then added to the treatment regimen. Streptococcus pyogenes was isolated from the patient's blood culture. Brain magnetic resonance imaging revealed a partial thrombus in the left transverse sinus and a 2.5-cm subdural empyema in the lateral aspect of the left cerebellar hemisphere. Antithrombotic therapy was initiated for the patient. Ceftriaxone was administered intravenously for 14 days and clindamycin for 11 days. The total duration of oral and intravenous antibiotic therapy was completed in 6 weeks, and enoxaparin sodium was given for 3 months. This case highlights the need for awareness of the rare complications of persistent otitis media in pediatric patients. Conditions such as subdural empyema, mastoiditis, and sinus venous thrombosis can be successfully managed with timely diagnosis and appropriate treatment. Such complications should be considered in cases that do not respond clinically to appropriate antibiotic therapy.

Although deep learning for periodontitis diagnosis on panoramic radiographs has advanced rapidly, most studies use single-vendor data and cross-vendor generalization is rarely evaluated. Therefore, we evaluate the cross-vendor robustness of a hybrid CNN-CAD framework for automated four-stage periodontitis classification. Five hundred panoramic radiographs were retrospectively collected from three vendors (Instrumentarium, n=400; Vatech, n=50; PointNix, n=50). The framework extends a previously published hybrid pipeline by adding a YOLO-based CNN for missing-teeth quantification, enabling four-stage classification according to the 2017 World Workshop criteria. Three dataset configurations were evaluated: pooled multi-vendor training and two leave-one-device-out (LODO) splits. We compared segmentation backbones (U-Net, Dense U-Net, SegNet, Mask R-CNN) and YOLO detector variants. Agreement with three oral and maxillofacial radiologists (3, 5 and 10 years of experience) was assessed using mean absolute difference (MAD), Pearson and intraclass correlation, Bland-Altman, and Passing-Bablok analyses. Under pooled multi-vendor training, Mask R-CNN achieved Dice coefficients of 0.96, 0.92 and 0.94 for periodontal bone level, cemento-enamel junction level and teeth/implants respectively; CNNv4-tiny reached a mean AP of 0.86 for missing teeth. The MAD between automated and expert staging was 0.31, overall image-level ICC was 0.93 (95% CI 0.86-0.97; p<0.01), and Bland-Altman bias against the most experienced radiologist was 0.007. Under LODO, Dice coefficient dropped to 0.75-0.86 (all p<0.001 versus pooled), quantifying substantial vendor-induced domain shift. The hybrid framework achieves expert-level agreement under pooled multi-vendor training but degrades in held-out vendors, providing a quantitative reference for vendor-induced domain shift in panoramic radiograph AI and motivating vendor-aware training or domain adaptation in future clinical deployments. This work provides, to our knowledge, the first cross-vendor benchmark for deep-learning-based periodontitis staging on panoramic radiographs and quantifies vendor-induced domain shift directly addressing the external-validation gap recently identified in this journal.

Antiphospholipid syndrome (APS) is a prothrombotic autoimmune disorder that is associated with arterial and venous thrombosis. Cervical artery dissection is an uncommon cause of stroke and has rarely been reported with APS. We report the case of a 46-year-old man who presented with acute dizziness, vertigo, neck pain, and headache after jujitsu training. Neuroimaging showed right vertebral artery dissection from V1 to V4, and magnetic resonance imaging revealed a right cerebellar infarction. Evaluation revealed persistently elevated lupus anticoagulant titers on repeat testing at 12-week intervals, satisfying the 2023 criteria for primary APS. The dissection was likely mechanically triggered, while APS may have amplified thrombotic risk and altered secondary prevention toward long-term warfarin. Vertebral artery dissection may coexist with antiphospholipid syndrome (APS), but causality is unproven.Lupus anticoagulant is strongly associated with arterial thrombosis.APS should be considered in otherwise unexplained ischemic stroke.Vitamin K antagonist therapy is favored over direct oral anticoagulants in APS with arterial thrombosis.