Aleksandar Milenović

Salivary and serum interleukin 1 beta, interleukin 6 and tumor necrosis factor alpha in patients with leukoplakia and oral cancer

Objectives: The aim of study was to compare salivary and serum concentrations of interleukin 1 beta (IL-1β), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) in patients with oral leukoplakia, oral cancer and healthy controls. Study design: Eighty eight patients (28 with oral cancer, 29 leukoplakia, and 31 healthy controls) were included in this study. Cytokine concentrations were measured by commercial enzyme linked immunoassay. Results: Salivary IL-1β and IL-6 were significantly higher in oral cancer patients than in patients with leukoplakia and control group (p<0.05). No differences in concentrations of salivary TNF-α between either of the groups were observed. Serum concentrations of IL-1β were below level of detection in all but two participants. No significant differences between the groups were observed in serum concentrations of IL-6. Serum TNF-α was significantly higher in control subjects than in oral cancer patients. Conclusions: Patients with oral cancer have elevated levels of inflammatory cytokines in their saliva. Whether this elevation can be used for monitoring the malignant transformation of oral leukoplakia remains to be answered by further follow up studies. Key words: Cytokines, oral, leukoplakia, cancer.

Latissimus dorsi-scapula free flap for reconstruction of defects following radical maxillectomy with orbital exenteration.

A total of 21 patients with latissimus dorsi-scapula free flap reconstruction immediately following radical maxillectomy together with orbital exenteration are presented. Orbital exenteration was performed in all patients due to tumour invasion at the time of diagnosis. There was no total flap failure. Two tissue components subdivided into separate flap units with individual vascular pedicles linked by a single vascular source provide an ideal reconstructive solution for massive defects of the mid-face and orbit. Separate arcs of rotation of each flap unit permit greater mobility necessary for complex three-dimensional reconstruction. A vertically positioned angle of the scapula enables simultaneous reconstruction of the malar eminence and alveolar ridge whereas spontaneous intraoral epithelialisation of the latissimus dorsi muscle requires no additional procedure. For these reasons, in our opinion, combined latissimus dorsi-scapula free flap should be considered the first choice in reconstruction of defects following total maxillectomy with orbital exenteration.

Evaluation of pretreatment serum interleukin-6 and tumour necrosis factor alpha as a potential biomarker for recurrence in patients with oral squamous cell carcinoma

Background Oral squamous cell carcinoma (OSCC) constitutes 3 percent of all cancers with predominant occurrence in middle aged and elderly males. Tumour recurrence worsens disease prognosis and decreases quality of life in patients with OSCC. Proinflammatory cytokines such as interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-α) have been suggested to play a certain role in variety of tumours. The aim of this study was to investigate the relationship of pretreatment serum IL-6 and TNF-α levels on tumour recurrence in patients with OSCC in order to identify potential biomarkers for the early detection of disease recurrence. Material and Methods The patients with newly diagnosed OSCC were treated and followed from the first visit from November 2006 until January 2008. Serum IL-6 and TNF-α concentrations were measured. The records of the patients were re-examined in July 2012 and data were recorded about cancer characteristics and tumour recurrence. Disease free survival was analyzed by Kaplan-Meier survival curves, log rank test and Cox proportional hazards regression. Results Serum IL-6 was shown as an independent risk factor for tumour recurrence. Conclusions Pretreatment serum IL-6 concentration may be a useful biomarker for identification of OSCC patients with increased risk of the disease recurrence. Key words: Serum IL-6, serum TNF-α, oral cancer, recurrence.

Application of Diode Laser in Oral and Maxillofacial Surgery

Laser devices have gained in importance since the eighties and they are often claimed to be omni-use instruments. Though many applications turned out to be almost impracticable, an unaltered interest in laser technology has remained to date. The broad spectrum of applications for the diode laser means that it is now the most widely used device in laser dentistry. Diode lasers offer an interesting – but not unlimited – field of application in modern dentistry: oral and maxillofacil surgery and endodontic surgery.

Underestimated value of communicating vein between deep and superficial venous system of radial forearm free flap.

To the Editor: We read an article by Selber et al regarding the venous drainage of radial forearm free flap with great interest. The authors favor using only 1 venous system by performing anastomosis on a single vein, either cephalic vein (CV) or one of the venae comitantes (VC) (together almost 84% of the cases). In only 9 cases of 370, they performed single anastomosis using a common vein in which these 2 venous drainage systems coalesce together. This fact is interesting because practice in our Department is proportionally inverse. A small interconnecting vein between 2 venous systems of radial forearm free flap has been described by several authors and named as a profundus cubitalis vein, perforating vein, and communicating vein. We also favor performing single venous anastomosis. During harvest of radial forearm free flap, a communicating vein between deep and superficial venous system is included whenever possible. As a result of this, drainage of 2 venous systems is joined together and slow venous outflow is prevented; in fact blood outflow is even increased. After doing arterial anastomosis, observation of venous outflow on 3 free vein ends (2 VC and single CV) is performed for about a minute. The fastest draining vein end is used for anastomosis. There is no need for stopping blood flow again through the flap; the other 2 veins can be left open while doing venous anastomosis. This way ischemia time and reperfusion injury of the flap are decreased. After completion of microanastomosis, the other 2 vein ends are ligated and venous outflow is increased and redirected to the single vein that is used for venous anastomosis. By using both venous drainage systems conjoined only through single anastomosis, either a larger VC or CV, we did not experience significant problems in terms of venous congestion. In fact we believe it is a superior technique as compared with using only one venous system separately, either superficial or deep. In contrast, doing dual venous anastomosis prolongs the surgical time and could only lead to decrease in venous outflow and thrombosis. There have not been any problems in finding a communicating vein. The key is to dissect high enough in the cubital fossa. Usually it is found a bit more proximal than the level of division of brachial artery. Doing single or dual venous anastomosis has been an issue in the literature. We believe that doing single anastomosis is at least as safe as doing dual anastomosis, but with inclusion of a communicating vein in the flap it becomes more safe and reliable regarding venous congestion or thrombosis.