Job Role Of An Oral Cancer Surgeon

The Role of Advanced Diagnostic Tools in Early Detection of Potentially Malignant Diseases and Oral Cancers

An   oral cancer surgeon , also known as a maxillofacial surgeon, is a dentist who treats diseases of the mouth, teeth, and jaw. Oral cancer, a universal condition, has become an obstacle over the past few years due to its essential morbidity and mortality. The high morbidity of this deadly disease is attributed to its late diagnosis/presentation at an advanced stage. Being multifactorial, oral squamous cell carcinoma (OSCC) results from genetic and epigenetic instability.

However, in many cases, oral cancer is preceded by precursor lesions named oral potentially malignant disorders (OPMDs), the early diagnosis of which makes it beneficial for patients with a potential increase in product longevity. Many diagnostic tools/aids have been invented with the aim of early detection of oral precancer and cancer.

Basic chair procedures or relatively advanced assistive devices are considered failures due to various limitations and individuality. The emergence and use of molecular methods in health diagnosis, OPMD, and oral cancer require molecular typing. Various diagnostic tools for OSCC include lab-on-a-chip, microfluidics, nanodiagnostics, liquid biopsy, omics technology, and synthetic biology.

Being multifactorial in origin with significant participation of altered genetics and epigenetics, oral cancer will demand high-end diagnostics for designing personalized therapies. Surgical instruments remove tumors and other abnormal growths in the oral and facial regions. Provide immediate treatment of facial injuries, including facial lacerations, intra-oral lacerations, and fractured facial bones.

Oral cancer often develops from potentially malignant lesions (precancer). Potentially malignant lesions (PML) are oral mucosal lesions at increased risk for malignant transformation compared to healthy mucosa. At the World Health Organization Congress in 2005, “potentially malignant diseases” were suggested as a term for malignant and precancerous conditions (Leukoplakia, erythroplakia, oral lichen planus, and actinic cheilitis are the most common precancerous lesions. Leukoplakia is a white spot or plaque that cannot be characterized clinically or histologically as any other lesion and is not associated with any physical or chemical causative factor except tobacco use.

It is usual in middle-aged and older men. Cancer develops from rom leukoplakia in 1-20% of cases. The primary activators of carcinogenesis are external factors such as smoking, alcohol, human papillomavirus, or chewing betel nuts. Suppose your doctor or dentist thinks you have mouth cancer. In that case, you may be referred to an   oral cancer specialist who specializes in diseases of the gums and related tissues in the mouth (periodontist) or a doctor who specializes in disorders affecting the ears, nose, and ears.

Currently Available Techniques

Standard diagnostic tests are currently available in clinical practice
Several diagnostic methods are routinely used in clinical practice, including vital staining, oral cytology, and optical imaging technology.

Vital staining: Vital staining is a traditional tissue staining method that uses toluidine blue, a metachromatic dye, to stain cells with increased DNA content and dysplastic or malignant cells with abnormal DNA.
A recent hospital-based diagnostic accuracy study was conducted to evaluate the effectiveness of toluidine blue staining, which served as an adjunct to standard clinical examination to facilitate early detection of malignant lesions of the oral cavity and oropharynx.

Fifty subjects with OPMD or malignant lesions underwent a detailed clinical examination and toluidine blue staining. As a result of comparing the staining results and histopathological examination, the toluidine blue test was malignant with a sensitivity of 92.6% and specificity of 67.9%. The overall diagnostic accuracy was 80%. The results suggest that toluidine blue staining can be a useful adjuvant diagnostic tool in oral and oropharyngeal cancers. In practice, it is a helpful way to identify lesions with possible malignant changes. When dysplastic or cancerous lesions are present, Lugol’s iodine results in no staining and a pale appearance compared to surrounding normal tissue.

Lugol’s iodine staining is another oral mucosal stain that can be used to visualize the oral mucosa by producing a brown or mahogany color when reacting with glycogen in the normal oral mucosa.

Oral Cytology

· Exfoliative oral cytology is the traditional method of collecting oral mucosal cells by scraping, brushing, or rinsing the exfoliated cells with a spatula or brush. Collected oral mucosal cell samples are fixed, stained, and morphologically examined and interpreted by an experienced pathologist. This method is derived from a cervical Pap smear and is simple, non-invasive, and relatively painless. Oral cytology was first used in 1963 to evaluate human oral mucosal lesions. However, as a screening method for oral precancer and oral cancer, it has not been as successful as cervical cancer screening [36]. It shows low sensitivity in the diagnosis of oral cancer. This may be attributed to an inadequate or non-representative sample, a high risk of procedural errors, or the subjectivity of interpretation by examiners.
Optical Imaging

OPMD and photodetection methods for oral cancer detection have been used clinically for many years. Chemiluminescence or fluorescent light is used as an intraoral detector for detecting lesions in the oral mucosa. The color of light reflected from the oral epithelium is used to evaluate the condition of the oral epithelium.
Conclusion

Since most cases of oral cancer are caused by potentially malignant tumors, highly detailed clinical examinations that visualize pathological lesions are essential. The toluidine blue test can aid clinical diagnosis but does not replace histopathological findings. Biopsy and histopathological findings are the gold standard for diagnosing oral cancer and were confirmed in this study. To treat advanced oral cancer, it is always recommended to consult the   best oral cancer specialist