Laurence Newman

Sarcomas of the head and neck: a 10-year retrospective of 25 patients to evaluate treatment modalities, function and survival

Sarcomas of the maxillofacial region are rare but aggressive. Traditional treatment for those in the long bones has comprised neoadjuvant chemotherapy followed by resection, with or without radiotherapy. This philosophy has often been extrapolated to the management of sarcomas of the head and neck. We have treated 25 cases during the last 10 years (August 1997-2007), present our results, and evaluate the treatments and survival. The group contains both hard and soft tissue sarcomas, including 17 cases of osteosarcoma of the jaw. The overall survival was 80%. Our results are broadly in line with most comparable published series. We report disease status, microscopic response to chemotherapy, and functional outcome, and compare and contrast osteosarcomas of the jaws and the long bones. We think that in patients with sarcomas of the head and neck, particularly of the jaws, early radical resection should be considered the primary treatment with the aim of local control. Radiotherapy and chemotherapy should be considered if there are inadequate resection margins or distant spread. The role of neoadjuvant chemotherapy is questionable; because of the rarity of the disease, multicentre randomised trials should be encouraged to evaluate it.

How serious are oral infections

Life-threatening conditions following dental infections have been rare since antibiotics were introduced into the world of medicine. However, infections spreading through the soft tissues of the head and neck are encountered occasionally and mortality is still reported as a result of sepsis or airway embarrassment. A case of Ludwigs angina from odontogenic infection that progressed into mediastinitis and pericarditis is presented. The steps adopted in the management of this case highlight the significance of early recognition and diagnosis of the source of deep cervical infections, the importance of securing the airway, effecting surgical drainage and aggressive intravenous antibiotic therapy.

Post operative maxillary cyst: Report of an unusual presentation

A postoperative maxillary cyst is a rare, delayed complication of operations on the maxillary sinus, trauma. or infection, particularly in Japan. As far as we know this is the first reported case in a patient of African origin. The cyst presented as a midline palatal swelling that arose from the nasal, rather than the antral, mucosa. Awareness of this condition will expedite its correct diagnosis and management. In most cases, enuclcation is the treatment of choice.

Aneurysmal bone cyst—A lesion in the mandibular ramus

The aneurysmal bone cyst occurs predominantly in the long bones and vertebral column although lesions have been seen in the clavicle, ribs, innominate bone, skull and bones of the hands and feet (Shafer et al., 1974). A case is reported of such a lesion presenting in the ascending ramus of the mandible.

Response to comment by Kanatas et al. "Re: Sarcomas of the head and neck: a 10-year retrospective of 25 patients to evaluate treatment modalities, function, and survival. Br J Oral Maxillofac Surg 2011 April 6 [Epub ahead of print]".

The comment by Kanatas et al.1 based on their series of 74 ead and neck sarcomas is in line with our results in a recent etrospective analysis of 107 cases presented at the BAOMS nnual Scientific Meeting in June 2011 (“Sarcomas of the ead and neck: a 13-year retrospective experience of a UK arcoma Centre”).2 In this series we report the outcomes of 54 patients with one sarcomas and 53 with soft tissue sarcomas, managed etween 1997 and 2010 at the University College London ospital in the setting of the Head & Neck MDT in conjuncion with the Sarcoma MDT of the London Sarcoma Service. e demonstrate overall survival rates of 91% at 2 years and 3% at 5 years in 51 bone sarcomas, 67% at 2 years and 56% t 5 years in 50 soft tissue sarcomas (Fig. 1). Overall survival stimates were 79% at 2 years and 64% at 5 years (comlete follow-up data available for 101 patients). Although our utcomes are comparable to the majority published in the litrature we agree that comparisons of survival results among ifferent studies are difficult because of the heterogeneity of arcomas and their biologic aggressiveness, the variations in he composition of studied populations in each series and the iversities in the follow-up time spans published by different roups. With regard to bone sarcomas in particular, the mainstay reatment strategy consists of preoperative “neoadjuvant” ystemic combination chemotherapy followed by surgery nd postoperative “adjuvant” chemotherapy. The role of adiotherapy in bone sarcomas is limited as these tumours re considered radioresistant, therefore radiotherapy may be mployed as a treatment option when surgery is not possible.3 We conclude that improved outcomes in sarcoma treatent depend on management in a reference centre by a 1