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175 In addition, both nicotinecontaining and nicotinefree ejuice have been found to cause biologic disruptions including oxidative stress, DNA breakage, metanuclear anomalies, liposomal dysfunction, and solvent and lipid accumulation, and cytotoxicity in human gingival fibroblasts, 67 , 176 , 177 , 178 , 179 , 180 vocal fold epithelial cells and fibroblasts, 181 , 182 head and neck squamous cell carcinoma cell lines, 67 , 183 , 184 , 185 noncancerous oral and oropharyngeal epithelial cells, 139 , 178 , 186 , 187 , 188 , 189 , 190 , 191 , 192 middle ear epithelial cells, 193 , 194 , 195 nasal epithelial cells, 196 , 197 and organotypic cultures/organoids