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Background/purpose Although mandibular advancement oral appliances (OAs) are the most widely used and accepted therapeutic modality for obstructive sleep apnea (OSA), whether these maxillary and mandibular appliances should be semi-fixed or fixed remains uncertain. This randomized crossover pilot study compared the efficacy, side effects, and patient preference of semi-fixed and fixed OAs for the treatment of OSA. Materials and methods Patients with mild to moderate OSA were recruited and randomly assigned to either the semi-fixed or fixed OA group, whereby they used their assigned OA for the first 4 weeks, followed by assessments for sleep parameters (including the Apnea-Hypopnea Index [AHI]) and temporomandibular joint pain as a side effect. After a two-week washout period, patients were switched to the alternative OA for 4 weeks, followed by repeated assessments. Patient preference was assessed at the end of the completed treatment period. Results Fifteen patients were enrolled and completed the full study protocol. Both types of OAs were efficient in reducing the patient's AHI in comparison to baseline (i.e., without OA). However, there was no significant difference in AHI reduction between the semi-fixed and fixed OA devices. Regarding the side effect of temporomandibular joint pain and patient preference, the semi-fixed OA device was superior to the fixed OA device on both measures. Conclusion While both semi-fixed and fixed OAs are effective in treating patients with OSA, semi-fixed OAs are superior in regards to both patient preference and reduced side effects. Thus, semi-fixed OAs may be the preferred therapeutic modality for OSA.

Metastasis to lymph nodes from oral squamous cell carcinoma (OSCC) without neck dissection classification (lingual lymph nodes (LLN) and lateral retropharyngeal lymph nodes (LRPN) ) is rare and difficult to deal with. The aim of the present study was to assess the treatment modality and prognosis of LLN and LRPN in patients diagnosed with OSCC. This retrospective study involved a chart review of the clinical records of OSCC patients diagnosed with LLN or LRPN metastasis between June 2008 and March 2021. Data were collected and treatment outcomes were analyzed. Two OSCC patients with primary LRPN metastasis underwent LRPN dissection or superselective intra-arterial chemoradiotherapy. One patient with recurrent lateral LLN underwent surgery. Seven patients with recurrent LRPN and 7 patients with recurrent para-hypoid lymph nodes underwent chemoradiotherapy, bioradiotherapy, immune checkpoint inhibitors (ICIs) or best supportive care. The cumulative 1-year overall survival rate was 25.8％ on LLN (especially para-hyoid lymph node) , and 33.3％ on LRPN. Cetuximab or ICIs are important to determine an effective treatment strategy for LLN or LRPN metastasis in the future.

Salvage surgery for recurrent oral squamous cell carcinoma (OSCC) often leads to a poor quality of life (QOL). The present study described three cases that resulted in favorable locoregional control with cetuximab in combination with radiotherapy (Cmab + RT). Case 1 had regional recurrence of OSCC at the lower right mastoid area 4 months after primary surgery. Case 2 had regional recurrence of OSCC at the parotid area 7 months after primary surgery. Case 3 had local recurrence of OSCC at the masticatory muscle and Rouviere's lymph nodes 1 year and 3 months after primary surgery. In all cases, Cmab + RT was performed, and disease-free survival was confirmed 4 months, 2 years and 6 months, and 10 months after Cmab + RT, respectively. Immunohistochemically, all resected tumors had no expression of 110-kDa catalytic subunit of class IA phosphatidylinositol 3-kinase (PI3Kp110α). In conclusion, if salvage surgery for recurrent OSCC results in a significantly low QOL, then shifting to chemoradiotherapy may be appropriate as a treatment strategy. In addition, strong evidence indicated that PI3Kp110α expression is associated with Cmab therapy efficacy.

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