Alexander D. Rapidis

Oral cancer: the behaviour and response to treatment of 194 cases.

During the 16 year period 1960-1975, 350 cases of Oral Cancer were seen in the Department of Oral and Maxillo-Facial Surgery at the London Hospital. Detailed records were available for 250 patients. After excluding tumours of the salivary glands, sarcomata and tumours of the reticulo-endothelial system 194 cases remained and these were subjected to a computer analysis. The overall 5 year survival figure, not corrected for age and sex was, 32.8%. The local recurrence rate for all sites was 44%, 90% of these recurred within 2 years of diagnosis. The overall uncorrected 5 year survival figure for females was 42.1% and that for males was 22.9%. Analysis of the material has not provided a satisfactory explanation for this; lesions do not present at an earlier stage in females neither do they occur in younger patients. The distribution of the lesions by site and histology was the same for both sexes. Survival rates analysed by clinical staging at presentation confirm that the prognosis for early stage lesions is very much better than for late stage lesions, the 5 year survival for Stage I being 50% whereas that for Stage IV is only 20%.

Contemporary management of cancer of the oral cavity

Oral cancer represents a common entity comprising a third of all head and neck malignant tumors. The options for curative treatment of oral cavity cancer have not changed significantly in the last three decades; however, the work up, the approach to surveillance, and the options for reconstruction have evolved significantly. Because of the profound functional and cosmetic importance of the oral cavity, management of oral cavity cancers requires a thorough understanding of disease progression, approaches to management and options for reconstruction. The purpose of this review is to discuss the most current management options for oral cavity cancers.

Fine-needle aspiration cytology in tumors and tumor-like conditions of the oral and maxillofacial region

Fine‐needle aspiration cytology (FNAC) is a well established diagnostic technique. The purpose of the current study was to evaluate its diagnostic accuracy, sensitivity, and specificity in tumors and tumor‐like conditions in the oral and maxillofacial region.

Prognostic significance of STNMp and velocity of tumor growth in oral cancer

Regression analysis using actuarial life tables has been applied to the STNMP system for the grading and staging of oral cancer. Based on 170 patients, the five‐year survival figures were 78% for Stage 1, 67% for Stage 2, 36% for Stage 3, and 20% for Stage 4. This represents a considerable improvement in prognostic differentiation over existing TNM system applied to the same cohort of patients. A further variable, velocity of tumor growth, was also assessed and shown to be of value in predicting the ultimate survival of the patients.

Dermoid cyst of the floor of the mouth. Report of a case

Abstract The current concepts of dermoid cysts in the floor of the mouth are discussed and the literature concerning the histogenesis and histopathology of this unusual lesion reviewed. A typical case report is presented and the differential diagnosis and management discussed.

Histiocytosis X: An Analysis of 50 Cases

Evidence is presented to support the authors view that Letter-Siwe disease, Hand-Schüller-Christian disease and eosinophilic granuloma are but variants of a single disease entity--histiocytosis X. The clinical behaviour of the disease and its prognosis are related to the age ofonset of the disease. Details of 50 cases of histiocytosis X have been analyzed. The mean age of presentation was 15 years 4 months. The male:female ratio was 3:2, 54% of patients in this series had disease confined to the jaws and oral cavity, males being more likely than females to have disseminated disease.

STNMP: a new system for the clinico-pathological classification and identification of intra-oral carcinomata.

A new system for the notation of intra‐oral carcinomata has been described. It differs from all previous TNM classifications in that both the site (S) and the pathology (P) have been taken into consideration in addition to the conventional tumour (T), node (N) and metastasis (M) generally used. Both of these additional features have been recognized as important factors in assessing the prognosis of the patient. This new system additionally functions as a means of disseminating the maximum of clinical information succinctly and in a readily communicable format. A further innovation has been the introduction of a means of quantitatively assessing the significance of particular clinical and pathological features and from these values predicting the prognosis. For comparative purposes we have defined four stages corresponding with the stages used in the conventional TNM classification. We have applied the STNMP classification to a random sample of 136 cases of intra‐oral carcinomata with more than 5 years follow‐up. Particularly in defining those patients with a good prognosis, i.e. 5 year plus survival, this system has proved to be considerably more accurate than the existing staging methods. We propose that for a trial period this system should be widely used in parallel with the conventional TNM classification and staging in order to evaluate its true worth in the clinical situation. With further use it will probably be necessary to adjust the numerical weighting given to particular features, but this can only be accurately assessed when a very large number of patients has been evaluated. Our figures support the clinical impression that patients with poorly differentiated squamous cell carcinomata have a shorter survival than those with well differentiated lesions and that the degree of differentiation of the tumour is directly proportional to the survival of the patient. When considering the site of the tumour we have based our grading on the known survival curves for squamous cell carcinomata at different sites.

Lipomata in oral tissues

The literature on Lipomata and intra-oral Lipomata is reviewed and a series of 24 cases presented. In this series the mean age of presentation of the male patients was 53.8 years, whereas that of females was 63.1 years 33.3% of the tumours occurred on the inner aspect of the checks and of these 8 cases, six were males. Of the eight lesions occurring the floor of the mouth and retromolar areas, all but one occurred in females. Evidence is presented to support to the claim that intra-oral lipomata are indeed common benign neoplasms.

Fractures of the coronoid process of the mandible: an analysis of 52 cases

Fractures of the coronoid process occur infrequently. In the present study, 52 cases of fracture of the coronoid process are presented and analysed and the relevant literature is reviewed. Coronoid fractures constituted 2.9% of all facial fractures. Of the 52 cases, 12 were isolated coronoid fractures (23%), whereas in the remaining 40 cases, coronoid fractures coexisted with other maxillofacial injuries. The clinical picture, diagnosis and therapeutic modalities of coronoid fractures are discussed.

Management of locally advanced HPV-related oropharyngeal squamous cell carcinoma: where are we?

HPV-related (HPV+) oropharyngeal cancer (OPC) has a better prognosis compared to HPV unrelated (HPV−) OPC. This review summarizes and discusses several of the controversies regarding the management of HPV+ OPC, including the mechanism of its treatment sensitivity, modern surgical techniques, chemotherapy regimens, and treatment de-intensification protocols. We also discuss and reconsider potential adverse prognostic factors such as tumor EGFR expression, tumor hypoxia, and patient smoking history, as well as the significance of retropharyngeal adenopathy. Finally, we discuss elective nodal treatment of uninvolved lymph node stations. While this review does not exhaust all controversies related to the management of HPV+ OPC, it aims to highlight some of the most clinically relevant ones.