Despite advances in treatment, recurrence rates in oral squamous cell carcinoma (OSCC) remain high. Prognostic outcomes vary in terms of local recurrence, metastasis, and overall survival. A retrospective cohort analysis was conducted on OSCC patients who underwent primary surgery at the Department of Craniomaxillofacial and Facial Plastic Surgery, University Medical Center Frankfurt, between January 2014 and December 2020. Demographic data, tumor characteristics, surgical details, intraoperative frozen section results, and recurrence patterns were first assessed for availability. Subsequently, the available data relevant to each endpoint were analyzed. A total of 169 patients were analyzed (mean age: 64 years). The tongue was the most affected site and had the highest recurrence rate, followed by the floor of the mouth. Overall, 24.3% of patients experienced recurrence, with most cases occurring within the first year. T2 tumors had the highest recurrence rates. Between patients with and without adjuvant therapy, recurrence rates were comparable. Positive surgical margins were more common in recurrence cases, but no significant correlation was found between margin status and recurrence in patients without adjuvant therapy. Based on the analyzed data, achieving recurrence-free survival in OSCC does not solely depend on surgical technique or adjuvant therapy. Instead, early recognition of individual tumor characteristics and even tumor biology should guide personalized treatment planning. Notably, tumors of the tongue and floor of the mouth exhibited high recurrence rates regardless of disease stage, raising the question of whether primary chemoradiotherapy (CRT) could achieve better outcomes than surgery. Further studies are needed to evaluate the role of CRT as a first-line treatment for OSCC in these locations.

Background/Objectives: After tooth removal the crest may close before the socket has mineralised, leaving a covered socket residuum (CSR). Third molars are usually removed in young patients, often prophylactically. We examined what former third molar sites contain years later. Methods: Retrospective single-centre study of bone removed at revision of a radiologically diagnosed CSR at former third molar sites, consisting of the bone lid covering the residuum and, where labelled separately, tissue from its depth. For every section the routine pathology report was coded for a leading finding, and the cells were classified independently by whole-slide AI analysis without knowledge of the report. Results: Eighty-three sections from 28 patients (median age 54 years) were analysed. Fifty-one (61.4%) carried a distinguishing finding (53.0% without haematopoietically active marrow), most often marrow fibrosis (14.5%), granulocytic inflammation or osteomyelitis (13.3%) and lymphoplasmacytic infiltrate (10.8%). Of 24 patients with more than one section, 13 showed different findings in different sections. Fibroblasts and inflammatory cells were inversely related (r = −0.979), and the diagnoses formed a gradient from fibroblast-rich avital bone and unremarkable marrow to lymphocyte-rich inflammation (Holm-adjusted p ≤ 0.0065 for fibroblasts, lymphocytes and neutrophils). Conclusions: In this cohort, more than half of the sections from former third molar sites were histopathologically altered, with findings that varied within the same patient. Third molar removal is bone surgery requiring asepsis, removal of the follicle and debridement of the socket, and filling the socket to prevent a residuum deserves controlled evaluation.

Background/Objectives: After extraction, the crest may close before the socket has mineralised, leaving a covered socket residuum that may enclose the tissue lining the socket. We examined the socket wall histologically at the moment of extraction and compared it with the periapical region and the socket walls on preoperative cone-beam computed tomography (CBCT). Methods: Retrospective single-centre study of teeth extracted by one surgeon for a clinical indication in routine care. Before decortication according to the ARENA-Protocol^® (Alveolar Ridge Epithelialization after Non-viable Bone Debridement and Augmentation), a trephine core was taken along the long axis of the socket wall; soft tissue was submitted when present. Each specimen received a leading diagnosis from a predefined hierarchy. Results: Sixty-six specimens from 41 sockets in 23 patients were examined. Thirty-eight sockets (92.7%) were altered. Bone showed mainly chronic inflammation and marrow fibrosis, soft tissue mainly florid inflammation. The radiographic lesion lay periapically and was visible on CBCT and its three-dimensional visualisation, whereas the lateral wall from which the core was taken showed no distinct change on either and was nevertheless altered, also in all three sockets without a periapical finding. All 14 root-filled and 24 of 27 non-root-filled sockets were altered. Conclusions: In this cohort, the socket wall was altered at extraction in almost every case, and the alteration along the long axis of the socket was detected only histologically. If the crest closes over such a wall, a residuum may enclose altered tissue. Controlled studies are needed to test this.