Introduction: an oro-antral communication is defined as a permanent pathological connection between the maxillary sinus and the septic oral cavity. Several flaps can be used for the closure (buccal flap, palatal flap, combination techniques) but relapses occur often in case of a large defects and underlying general conditions. Bichat fad pad flap is a multipotent pedicled fatty tissue that is easily accessible from the oral cavity that can be used for the closure of medium-sized defects, even in immunocompromised patients due to its stem cell capacity. Materials and methods: the medical information of the patients diagnosed with oro-antral communications who were admitted and treated in the Oral and Maxillo-Facial Clinic Targu Mures, between 2013 and 2020 were analyzed. A database containing general information, reported causes, associated diseases, surgical methods used during admission, and relapses, was created. The information was statistically processed. The written consent and ethical approval were obtained. Results: the study shows that from a total of 140 cases, 72 were treated using buccal advancement flap, 49 using Bichat fat pad flap, and 19 using palatal flaps. The dimensions of the communications ranged between 0.3 cm and 1.5 cm. Several statistically significant results could be found when comparing the surgical methods. Of the 72 patients treated with buccal advancement flaps, 25 presented relapses as opposed to the patients treated with Bichat fat pad flaps who showed no complications, p < 0.05. Analysing this aspect further, all large defects (10 cases) ranging from 0.6 cm to 1.5 cm treated with advancement buccal flaps (Rehrmann flaps) showed relapses (p < 0.05). Considering the general conditions, out of 7 patients who received radiotherapy 4 presented relapses, as opposed to the healthy patients, p < 0.05. Regarding the reintervention for the relapsed cases, the majority of the cases treated a second time with buccal advancement flap (5 out of 7 cases) failed as opposed to the Bichat fat pad flap with no further relapses (p < 0.05). Conclusions: the most frequently used surgical treatment is the buccal flap, which also has the highest relapse rate. Both primary treatment with Bichat fat-pad flap and re-treatment of relapses using this flap have had 100% success rates, even in patients with general associated conditions, in contrast with patients treated by using the buccal flap. The dimensions of the oro-antral communication and general conditions are crucial factors for the success of the surgical treatment.

Osteonecrosis of the jaw represents interference by external and internal factors in the natural bone remodeling system. Numerous bone remodeling agents (BMAs), such as bisphosphonates, denosumab, and tyrosine kinase inhibitors, can lead to medication-related osteonecrosis of the jaw (MRONJ). This is a serious condition that ocurs as a side-effect of treatment in patients with osteoporosis or malignancies. Antiresorptive drugs are medications that target osteoclasts with the aim of preventing bone resorption and are used to treat osteoporosis, osteopenia, and a variety of other conditions, such as Paget’s disease. They are also used in cancer patients with active bone metastases where antiresorptive treatment is used for the prevention of skeletal complications. Poor dental health, infections, and especially dental surgery are the primary causes of MRONJ, while other risk factors, such as smoking, alcohol abuse, and diabetes mellitus, can also influence its development. Prevention is the key component of management, and thus awareness of the risk factors among prescribers is very important. The aim of our study was to evaluate current knowledge about MRONJ among BMA prescribers in an academic hospital and their awareness about oral health and dental check-ups. By using a custom-designed questionnaire addressed to general and internal medical practitioners, endocrinologists, rheumatologists, and oncologists as an instrument for collecting data, we tried to identify trends in BMA prescription among different specialists and their recommended preventative measures, with the aim of creating new strategies to prevent the occurrence of MRONJ. The survey revealed a low awareness among physicians of the potential risk factors and underlined the need for a concerted effort to improve patient management. In this sense, a multidisciplinary team approach that includes the patient, the drug prescriber, the dentist, and the oral surgeon could significantly improve the quality of life of patients with MRONJ.

Aim. The aim of this retrospective study was to identify the clinical, radiological, and histological characteristics of patients diagnosed with osteonecrosis of the jaw (ONJ) and treated at the Oral and Maxillo-Facial Surgery Clinic of the Emergency Clinical County Hospital of Targu Mures between 2017 and 2022. The study aimed to analyze correlations between patient characteristics, particularly their history of bone modifying agent use or local radiotherapy during cancer treatment, in order to identify specific patient profiles that could aid in evaluating treatment response and guide individualized treatment strategies. Methods. Fifty-two patients diagnosed with ONJ were included in the study. The patients were divided into two groups based on their medical history: the bone modifying agent use group and the radiotherapy group. Clinical, radiological, and histological data were collected and analyzed. Statistical analysis, including p-values, was performed to compare patient characteristics between the two groups. Results. Patients in the radiotherapy group were significantly older than those in the bone modifying agent use group (66 years vs. 56.9 years, p=0.001). There was a higher proportion of males in the radiotherapy group compared to the bone modifying agent use group (90% vs. 22%, p<0.001). Jaw involvement was more prevalent in the radiotherapy group compared to the bone modifying agent use group (95% vs. 66%, p=0.018). Histological analysis showed a similar frequency of Actinomyces species in both groups (50% vs. 34%, p=0.264). Conclusions. The findings of this study suggest the existence of two distinct patient profiles based on their treatment history (bone modifying agent use vs. radiotherapy) in ONJ. Patients in the radiotherapy group were older, predominantly male, and exhibited a higher prevalence of jaw involvement. Histological analysis revealed no significant differences in Actinomyces species frequency between the two groups. These distinct patient profiles may indicate different responses to treatment, emphasizing the need for individualized treatment strategies tailored to specific patient characteristics. Further research is warranted to validate these findings and develop personalized approaches for managing ONJ.

Pericoronitis is characterized by inflammation of the tissues surrounding an erupting tooth and occurs most commonly in lower wisdom teeth. The extent of inflammatory phenomena can significantly affect the patient’s quality of life because of the pain, bleeding, and discomfort caused by it. The treatment of pericoronitis is carried out locally by irrigation and debridement in the early stages, but also generally by antibiotic therapy, when purulent secretion is present under the operculum and in the periodontal area. This study aims to evaluate the effect of beech bark extract (BBE) in the treatment of pericoronitis of the lower third molar. Parameters evaluated were pain, trismus, and bleeding index in a clinic study. Four groups of 20 patients were evaluated and grouped according to the irrigation solution used during the treatment: chlorhexidine 0.2% (CHX), BBE and chlorhexidine mixture solution 0.2% (1:1), and BBE and saline solution (control). The evaluation was carried out before and after the irrigation. Following the assessment of pain and trismus, a significant decrease in pain and a significant increase in mouth opening after 3 days was observed in patients treated with BBE, CHX, and BBE + CHX (p = 0.00). In the case of control patients, no significant decrease in pain (p = 0.83) was observed after 3 days, nor was there a significant increase in the opening of the oral cavity (p = 0.157). The evaluation of the inflammation index showed a significant decrease in gingival bleeding after 3 days for most patients treated with tested solutions (p < 0.05). It was concluded that irrigation with BBE was more effective in reducing pain, trismus, and bleeding compared to the other solutions (control, CHX, BBE + CHX), and this natural extract can be a choice in case of pericoronitis debut.

Background/Objectives: Oral squamous cell carcinoma (OSCC) remains a significant global health concern, characterized by high morbidity and mortality, particularly in advanced stages. Increasing evidence suggests that systemic inflammation plays a critical role in tumor progression and patient outcomes. This retrospective cohort study aimed to evaluate the prognostic value of systemic inflammatory markers—specifically the neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR)—in correlation with histopathological parameters in patients with OSCC. Methods: A total of 157 patients diagnosed with histopathologically confirmed OSCC between January 2019 and December 2024 were included. Clinical, laboratory, and histopathological data were analyzed, including lymphovascular and neural invasion and worst pattern of invasion (WPOI). Statistical analyses, including ROC curve analysis, Kaplan–Meier survival analysis, and Cox regression, were performed to determine the prognostic significance of NLR and LMR. Results: The cohort demonstrated a predominance of male patients (81.5%), with the highest incidence observed in the 61–70 age group. WPOI showed a statistically significant association with survival outcomes (p = 0.003), with type 5 invasion correlating with increased mortality. ROC analysis identified optimal cutoff values of 2.88 for NLR and 1.87 for LMR. Elevated NLR and decreased LMR were significantly associated with poorer survival (p = 0.0001). Kaplan–Meier analysis confirmed reduced overall survival in patients with NLR ≥ 2.88 and improved survival in those with LMR ≥ 1.87. Cox regression analysis identified NLR as an independent predictor of mortality (HR = 2.05, p = 0.025), while LMR demonstrated a non-significant protective trend. Conclusions: These findings support the prognostic relevance of systemic inflammatory markers in OSCC. Unlike many previous studies evaluating inflammatory biomarkers alone, the present study additionally explored the relationship between NLR/LMR and histopathological invasion patterns, particularly WPOI, highlighting the potential interaction between systemic inflammation and tumor aggressiveness in OSCC. Further prospective, multicenter studies are required to validate these results and establish standardized clinical thresholds.

Background: Parapharyngealspace schwannomas are rare benign tumors that may become significantly enlarged prior to producing symptoms. Their deep anatomical location and proximity to major neurovascular structures may pose significant challenges for diagnosis and surgical management. Case Presentation: A 51-year-old woman presented with a slowly enlarging, painless right-side neck mass. Contrast-enhanced CT-scan demonstrated a large, well-circumscribed post-styloid parapharyngeal mass measuring approximately 44 × 53 × 73 mm, displacing rather than invading the adjacent carotid vessels. Paraganglioma was included in the differential diagnosis. MRI-scan was not performed because the CT-scan provided sufficient anatomical information for surgical planning in our clinical setting. The tumor was completely removed through an extended transcervical–cervico-parotidial approach without capsular lesions. The origin nerve was not identified intraoperatively. The histopathological exam confirmed a benign schwannoma. No clinically apparent neurological deficit was observed at the 6- and 12-months follow-ups. Literature Review: A focused literature review of PubMed, Scopus, and Web of Science was performed to contextualize the clinical findings and surgical management. The literature highlights the difficulty of determining the nerve of origin preoperatively and the overlap between post-styloid schwannomas and paragangliomas on imaging studies. Surgical excision remains the main treatment, although evidence regarding optimal surgical technique, long-term functionality and disease-control outcomes remain controversial. Conclusions: This case-study highlights the diagnostic challenges of large post-styloid parapharyngeal schwannomas and the limitations of imaging studies in establishing the nerve of origin. Surgical management should be individualized according to tumor anatomy, spatial neurovascular relationships, and anticipated functional risks.