Martin D. Batstone

Management and recurrence of keratocystic odontogenic tumor: a systematic review

OBJECTIVES The objective of this study was to evaluate the most up-to-date treatment modalities and respective recurrence rates for keratocystic odontogenic tumor (KCOT). STUDY DESIGN A systematic review of the literature from 1999 to 2010 was undertaken examining treatment and recurrence rates for KCOT. Four inclusion criteria were defined for articles to then be analyzed against 8 standards. RESULTS Of the 2736 published articles, 8 met the inclusion criteria. When merging the data, enucleation and enucleation with adjunctive measures (other than Carnoys solution) had recurrence rates of 25.6% and 30.3%, respectively. Marsupialization with adjunctive measures produced a recurrence rate of 15.8%, whereas enucleation with Carnoys solution presented a recurrence rate of 7.9%. Only one resection case had recurrence (6.3%). CONCLUSIONS The enucleation technique with the use of adjunctive procedures (other than Carnoys solution) provides a higher recurrence rate than any other treatment modality.

Frequency of odontogenic cysts and tumors: a systematic review

A systematic review of the literature from 1993 to 2011 was undertaken examining frequency data of the most common odontogenic cysts and tumors. Seven inclusion criteria were met for the paper to be incorporated. In the preliminary search 5231 papers were identified, of these 26 papers met the inclusion criteria. There were 18 297 odontogenic cysts reported. Of these there were 9982 (54.6%) radicular cysts, 3772 (20.6%) dentigerous cysts and 2145 (11.7%) keratocystic odontogenic tumors. With the reclassification of keratocystic odontogenic tumor in 2005 as an odontogenic tumor, there were 8129 odontogenic tumors reported with 3001 (36.9%) ameloblastomas, 1163 (14.3%) keratocystic odontogenic tumors, 533 (6.5%) odontogenic myxomas, 337 (4.1%) adenomatoid odontogenic tumors and 127 (1.6%) ameloblastic fibromas. This systematic review found that odontogenic cysts are 2.25 times more frequent than odontogenic tumors. The most frequent odontogenic cyst and tumor were the radicular cyst and ameloblastoma respectively.

Preoperative Doppler assessment of perforator anatomy in the anterolateral thigh flap

Despite its many evident merits as a donor site, the principal disadvantage of the anterolateral thigh flap is the variability in its vascular anatomy. Preoperative assessment by Doppler of the vascular perforators has been advocated as routine. We report the accuracy of this method, and describe the strategy for rescue where adequate perforators are not evident. Eighty-six consecutive patients were marked preoperatively using hand-held Doppler and the pattern was compared with intraoperative findings. Assessment by Doppler predicted a median of 3 (range 0-8) perforator signals, and a median of 2 (range 0-5) was found intraoperatively. This overall trend towards false positives was exaggerated in thin thighs, but in the obese there were more false negative results. In 79% of cases explored medially it would have been possible to raise an apparently viable anteromedial thigh flap. As this can be done without extending the incision, it is the option of choice for rescue, although use of more proximal perforators may often be possible.

Dental management of patients irradiated for head and neck cancer

Patients undergoing radiation therapy as either primary, adjuvant, combination therapy or palliative management of head and neck malignancies are prone to a range of dental complications. Strategies for prevention and management of such complications may be controversial. This article aims to highlight the current understanding and management of the dental needs for patients before, during and after radiation therapy.

MARGINAL MANDIBULAR NERVE INJURY DURING NECK DISSECTION AND ITS IMPACT ON PATIENT PERCEPTION OF APPEARANCE

Neck dissection to remove cervical lymph nodes is common practice in head and neck cancer management. The marginal mandibular nerve may be injured during neck dissection, particularly of level 1. The rate of injury to this nerve is underreported in the literature and its impact on patients is not well defined.

Concurrent chemoradiotherapy compared with surgery and adjuvant radiotherapy for oral cavity squamous cell carcinoma.

The purpose of this study was to compare survival and functional outcomes in patients with advanced oral cavity squamous cell carcinoma (SCC) treated with either surgery + adjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CRT).Background The purpose of this study was to compare survival and functional outcomes in patients with advanced oral cavity squamous cell carcinoma (SCC) treated with either surgery + adjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CRT). Methods Patients treated with curative intent by either surgery + RT or concurrent CRT were identified over a 6-year period (2001–2007). Disease and functional outcomes were analyzed on an intention-to-treat basis. Results Fifty-four patients underwent surgical excision and received postoperative RT. Fifty patients underwent concurrent CRT. Overall survival (OS) and disease-specific survival (DSS) was significantly higher in the surgically treated group (p < .001). Long-term enteral feeding tube support was more commonly required in those treated with CRT, whereas osteoradionecrosis rates were comparable between the 2 groups. Conclusion Treatment by surgery + adjuvant RT for advanced oral cavity SCC resulted in better disease control than treatment with CRT. This supports traditional surgical treatment algorithms for oral cavity cancer.

Primary chemoradiotherapy for oral cavity squamous cell carcinoma

OBJECTIVES To evaluate the survival of patients with oral cavity squamous cell carcinoma (SCC) treated with chemoradiotherapy (CRT) or radiotherapy (RT). To record the rate of osteoradionecrosis (ORN) and need for alternative feeding of patients with oral cavity cancer treated with CRT or RT. MATERIALS AND METHODS All patients with first presentation of oral cavity SCC treated with CRT or RT only at the Royal Brisbane & Womens Hospital (RBWH) between 2000 and 2007 were included. Patient Demographics (age, sex), ACE-27 Co-morbidity index, Staging (TNM staging system), Type of Chemotherapy and Dose of RT, Overall Survival (OS) and Disease-Specific Survival (DSS), Attempt at Salvage, development of distant metastases, development of ORN and success of treatment for ORN and requirement for alternative feeding (PEG/NGT) were recorded. RESULTS Fifty-four patients met the inclusion criteria. One patient died due to toxicity of treatment. The 5-year OS was 29%. The 5-year DSS was 30%. The rate of ORN amongst survivors was 36%. CONCLUSIONS CRT is successful in a small number of patients with oral cavity SCC. When compared to the published literature, surgery with or without post-operative RT has better survival rates. Salvage surgery does not appear to be a viable option for management of recurrence post CRT. The consequences of treatment, namely ORN and need for alternative feeding, are high.

Improved surgical margin definition by narrow band imaging for resection of oral squamous cell carcinoma: A prospective gene expression profiling study

Incomplete primary tumor excision contributes to localized postsurgical recurrence of oral squamous cell carcinoma (OSCC). The purpose of this study was to provide molecular evidence that surgical margin definition using narrow band imaging (NBI) resulted in more complete OSCC excision than conventional white light (WL) panendoscopy.

A prospective epidemiological study for odontogenic and non-odontogenic lesions of the maxilla and mandible in Queensland

OBJECTIVES Investigate the epidemiological profile for odontogenic and non-odontogenic intra-osseous lesions in the Queensland population (4.56 million) over 12 months. STUDY DESIGN The following data were prospectively collected from all Queensland histopathology laboratories in 2011: gender, age at diagnosis, location of lesion, histopathological diagnosis of the lesion and the patients postcode. RESULTS Six-hundred and thirty-three lesions were collected, comprising 540 odontogenic cysts and 93 odontogenic tumors. Radicular cyst was the most frequently diagnosed lesion (247/540, 45.7%). The overall incidence of odontogenic tumors was 20.4/million. Keratocystic odontogenic tumor was the highest (15.1/million), followed by ameloblastoma (2.41/million) with odontoma and calcifying cystic odontogenic tumor having the same incidence (1.1/million). The 39 non-odontogenic intra-osseous lesions had an overall incidence of 8.55/million. Nasopalatine cysts had an incidence of 2.19/million, followed by fibrous dysplasia and central giant cell granuloma (1.97/million). CONCLUSIONS Odontogenic tumors are 5 times less common than cysts. Non-odontogenic lesions are rare, with benign lesions 6.8 times more common than malignant lesions.

Penetrating orbital injury with wooden foreign body initially diagnosed as an orbital floor blowout fracture

This case involves a 24-year-old woman who sustained periorbital trauma including an unsuspected penetrating orbital foreign body (FB) injury, and initially presumed that because her vision in the eye was normal, and in spite of marked diplopia, that only bruising had occurred. It was therefore 5 days before she sought treatment. Consultation with an ophthalmologist then failed to disclose the penetrating injury, but confirmed diplopia in all gazes and an isolated orbital floor fracture was seen on computed tomography (CT) scans. She was referred to the Royal Brisbane Hospital Oral and Maxillofacial Unit for management of the orbital blowout fracture, where a suggestion of the presence of an organic FB was observed on CT scans, and subsequently successfully removed.