**8. Updates of therapeutic strategies in the management of the potentially malignant disorders of the oral and maxillofacial region**

The management of the potentially malignant disorders of the oral and maxillofacial regions has improved dramatically in recent years, leading to new therapeutic strategies aimed at improving patient outcomes based on the size and location of it along with the overall health of the individual patient. Here are some updates in therapeutic strategies.

Surgical Excision: Surgical excision is a widely used treatment modality for the management of the potentially malignant disorders of the oropharynx and mandible. The procedure requires complete debridement of the lesion with healthy tissue margins to ensure the removal of the potentially malignant cells. Over the years, advances in surgical techniques have improved patient outcomes by reducing postoperative pain, reducing scarring, and speeding up their recovery [65]. These developments aim to further enhance the precision and outcomes of surgical excision for the potentially malignant disorders.

Minimally invasive surgical techniques have revolutionized the field by reducing the need for multiple incisions and reducing trauma to surrounding tissue. These techniques use small instruments and specialized instruments to remove the lesions accurately while preserving healthy tissue. The benefits of minimally invasive treatment include reduced postoperative pain, shorter hospital stay, faster recovery time, and improved cosmetic outcomes [66]. Such improvements have significantly improved patient experience and overall clinical outcomes.

Robotic-assisted surgery has also emerged as an alternative for the management of the potentially malignant disorders. Robotic systems provide surgeons with improved dexterity, visibility, and control during surgery. This technology allows surgeons to perform complex procedures with precision and accuracy. The use of robots in oral and maxillofacial surgery has shown promising results in terms of improved outcomes and decreased complications [67]. However, it should be noted that robot-assisted surgery may not be suitable for cases all of it, so it will require special training and knowledge.

Navigation systems have become a valuable tool in debridement surgery. These systems use advanced imaging modalities such as computed tomography (CT) scans and three-dimensional (3D) images to provide real-time guidance to surgeons during surgery through the tumor location on the precision of its relationship to the surroundings. The integration of navigation systems into surgical workflows has improved surgical outcomes and patient safety, helping surgeons to make more accurate incisions and to reduce damage to vital physiological markers [68].

Where potentially malignant disorders are extensive or there are deep lymph nodes, extensive surgery may be necessary. These procedures may require the removal of a large portion of the affected area, including the removal of adjacent structures such as bone or tissue. After excision, restorative techniques are often used to restore esthetics and function. Recent advances in reconstructive surgery, such as the use of tissue engineering and regenerative techniques, have made it easier to restore complex defects with displaced consequences effectively. These techniques use biomaterials, grafts, and tissue grafts to replace removed tissue and promote optimal healing and functional recovery [69].

While surgical excision remains an effective treatment strategy for the potentially malignant disorders, it is important to note that it is not without potential risks and complications. The extent of these risks depends on various factors, including the stage and location of the lesion, the surgical skill and experience of the surgeon, and the overall health status of the patient [70]. Potential complications can include bleeding, infection, damage to adjacent structures, and functional impairment, particularly in cases involving more extensive surgical procedures. It is crucial for surgeons to carefully assess each patient and tailor the surgical approach to minimize the risks and optimize treatment outcomes [45].

Photodynamic Therapy (PDT): To reduce the risk of recurrence and progression, adjuvant therapies are often employed in conjunction with surgical excision. These therapies aim to target any remaining abnormal cells or reduce the risk of recurrence. One such approach is the use of photodynamic therapy (PDT) following surgical excision. PDT involves the administration of a photosensitizing agent, which selectively accumulates in precancerous cells. When exposed to a specific wavelength of light, the activated agent generates reactive oxygen species, leading to the destruction of precancerous cells [71]. Combining surgical excision with PDT offers a comprehensive treatment approach that targets both the bulk of the lesion and any remaining abnormal cells, thereby improving treatment outcomes [72].

#### *Genetic Revelation of the Potentially Malignant Disorders in the Oral and Maxillofacial… DOI: http://dx.doi.org/10.5772/intechopen.112697*

Laser Surgery: In recent years, the field of oral potentially malignant disorders management has witnessed advancements in nonsurgical treatment options as well. Laser surgery has emerged as a popular alternative to surgical excision. This technique utilizes focused beams of light to precisely target and remove potentially malignant disorders while minimizing damage to surrounding healthy tissues. Laser surgery offers advantages such as improved cosmetic outcomes, reduced postoperative discomfort, and selective destruction of precancerous cells [73]. The choice of laser type and wavelength depends on the characteristics of the lesion and the desired treatment outcome. Furthermore, laser surgery can be combined with photodynamic therapy to enhance its effectiveness through synergistic effects [74].

Topical Medications: Topical medications, such as retinoids and 5-fluorouracil (5-FU), are commonly used in the management of the potentially malignant disorders. Retinoids promote the differentiation of abnormal cells or cause cell death, helping normalize cell growth and reduce the risk of malignant transformation [75, 76]. On the other hand, 5-FU is an antimetabolite medication that interferes with DNA synthesis and inhibits the growth of abnormal cells. These topical medications have demonstrated efficacy in reducing the size and severity of lesions, preventing the development of new lesions, and improving overall outcomes. They are generally well-tolerated, with mild and temporary side effects such as skin irritation and redness [77].

Cryotherapy: Cryotherapy, utilizing extreme cold to freeze and eliminate abnormal cells, is an effective treatment for the potentially malignant disorders such as actinic cheilitis, leukoplakia, and verrucous carcinoma. It offers high cure rates and tissue healing promotion through angiogenesis and collagen formation. Successful outcomes depend on factors, such as lesion characteristics and clinician expertise. While generally safe, cryotherapy may cause side effects such as pain, blistering, and scarring [78]. Therefore, careful patient selection and postoperative care are crucial for minimizing adverse effects and optimizing treatment results. Cryotherapy serves as a valuable therapeutic option in the management of the potentially malignant disorders.

Chemoprevention: Chemoprevention aims to intervene at an early stage and halt or reverse the progression of the potentially malignant disorders, which is another area of advancement in the field. Retinoids have shown promise in preventing the progression of the potentially malignant disorders to oral cancer [79]. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as celecoxib, have demonstrated antiinflammatory and anticancer properties. Natural compounds, including green tea polyphenols such as epigallocatechin-3-gallate (EGCG), have also been investigated for their chemopreventive effects [80]. While the effectiveness of chemopreventive agents may vary depending on the specific lesion type and stage, they hold potential for reducing the burden of potentially malignant disorders and preventing their transformation into oral cancer.

In conclusion, surgical excision, along with other treatment modalities such as cryotherapy, remains a primary and effective treatment for the potentially malignant disorders of the oral and maxillofacial region. Recent advancements in surgical techniques, imaging, and diagnostics have improved precision, patient experiences, and monitoring. Adjuvant therapies such as photodynamic therapy, combined with surgical excision and cryotherapy, contribute to comprehensive lesion management. Nonsurgical options, such as laser surgery and topical medications, provide alternative approaches with cosmetic benefits. Furthermore, advancements in chemoprevention hold promise in preventing lesion progression. Interdisciplinary collaboration and

ongoing research are essential for refining strategies and optimizing outcomes in the management of the potentially malignant disorders.
