Martin Kauke

The importance of log odds of positive lymph nodes for locoregional recurrence in oral squamous cell carcinoma

OBJECTIVESnLog odds of positive lymph nodes (LODDS) has been demonstrated as a very promising staging model for multiple cancer sites, as it avoids singularity and predicts prognosis significantly better than conventional nodal staging and lymph node ratio. However, published studies on the influence of LODDS for patients with OSCC are very seldom.nnnMATERIAL AND METHODSnRetrospective chart review of 499 patients with treatment-naive oral squamous cell carcinoma. Exclusion criteria were neoadjuvant chemoradiotherapy, T4b classification, perioperative death, unresectable disease, synchronous malignancy, follow-up < 3 months and inadequate information to correctly determine nodal yield. Statistical analysis was performed using univariate and multivariate analysis.nnnRESULTSnA significant correlation was found between locoregional recurrence and pathologic T classification (p=0.030), pathologic N classification p=0.013), extracapsular spread (p=0.034), grading (p=0.021), number of positive lymph nodes (p=0.042), lymph node ratio (p=0.009), LODDS (p=0.007) and treatment strategy (p=0.039). Multivariate analysis indicated lymph node ratio (p=0.029) and LODDS (p=0.015) as independent indicators for locoregional recurrence. Within the analyzed models, Nagelkerke R2 index and Someŕs D showed the strongest discrimination ability for LODDS.nnnCONCLUSIONnFor patients with oral squamous cell carcinoma, log odds of positive lymph nodes and lymph node ratio are independent indicators for locoregional recurrence. LODDS predicts locoregional recurrence better than conventional nodal staging system, lymph node ratio and the number of positive lymph nodes.

Size distribution and clinicoradiological signs of aggressiveness in odontogenic myxoma—three-dimensional analysis and systematic review

OBJECTIVESnTherapeutic assessment of odontogenic myxoma (OM) is poorly standardized. Unidimensional size criteria have shown to be unreliable in therapeutic decision-making. We evaluate the size distribution of OM and scan for associated clinicoradiological signs of aggressiveness. Additionally, we evaluate three-dimensional size delineation of OM aiming to improve future therapeutic assessment of this destructive neoplasm.nnnMETHODSnPrimarily, we reviewed the database PubMed for data concerning the size of OMs as radiologically determined. Afterwards, the impact of age, sex, locularity and location on the size was investigated by χ² test, Students t-test and regression analysis. Furthermore, we statistically evaluated the impact of size on the occurrence of clinicoradiological signs of aggressiveness. Secondly, we approximated the volume of five unpublished cases of OM by semi-automatic image segmentation of cone-beam CT images.nnnRESULTSnMultilocular OMs were significantly larger than unilocular ones (p < 0.002). Age (0.042) and multilocularity (<0.002) significantly impacted size. Size was significantly associated with cortical perforation (0.032) and multilocularity (<0.002), further regression analysis revealed tooth resorption (0.019), cortical perforation (0.005) and multilocularity (<0.002) as significant predictors of size. Employing the volume as a mean of comparison, we found that the biggest OM (38.42u2009ml; multilocular) was 124 times larger than the smallest (0.31u2009ml; unilocular). However, using the maximum diameter (cm) as a surrogate for size, the biggest lesion (6.3) was only 5.25 times larger than the smallest (1.2).nnnCONCLUSIONSnLocularity and volumetric size characterization might help in therapeutic decision-making and could help to improve our understanding of OM.

Clinicopathological parameters affecting nodal yields in patients with oral squamous cell carcinoma receiving selective neck dissection

INTRODUCTIONnNodal yield has been demonstrated as a very promising marker for the prognostic outcome of patients with oral squamous cell carcinoma. However, studies on the importance of clinicopathological factors affecting the number of resected lymph nodes are rare, especially for patients without pathologically proven cervical lymph nodes.nnnMATERIAL AND METHODSnRetrospective chart review of 264 patients with treatment naive oral squamous cell carcinoma and histopathologically proven negative cervical lymph node status, who received selective neck dissection of levels I-III/IV. Exclusion criteria were neoadjuvant chemoradiotherapy, comprehensive or bilateral neck dissection, T4b classification, perioperative death, unresectable disease, synchronous malignancy, follow-up <3 months and inadequate information to correctly determine nodal yield. Statistical analysis was performed by using univariate and multivariate analysis.nnnRESULTSnThe mean nodal yield was 22.31 with a standard deviation of 16.01 and a mean number of 17 nodes. Gender (pxa0=xa00.018), age (pxa0=xa00.03), tumor classification (pxa0<xa00.001) and perineural invasion (pxa0=xa00.012) were significantly associated with nodal yield. Multivariate analysis indicated T-classification (pxa0=xa00.049) and age (pxa0=xa00.020) as independent factors. Nodal yield was significantly associated with locoregional recurrence (pxa0=xa00.041; Cutoff valuexa0=xa017).nnnCONCLUSIONnAdvanced age and T-classification independently affect lymph node yields in patients with oral squamous cell carcinoma. Hence, they have to be considered for interpretation of both nodal yield and recommended minimum lymph node counts. Furthermore, resection of more than 17 lymph nodes is associated with a significantly lower risk of locoregional recurrence.

Volumetric analysis of keratocystic odontogenic tumors and non-neoplastic jaw cysts – Comparison and its clinical relevance

The keratocystic odontogenic tumor (KCOT) is capable of causing vast osseous destruction. Histopathological examination is pivotal for diagnosis. The diagnostic process can sometimes be hindered by tissue inflammation of KCOTs with loss of defining criteria, resulting in misdiagnosis as an odontogenic jaw cyst. We discuss the possible merits of volumetric analysis when facing this particular diagnostic dilemma and for pathophysiological characterization of KCOTs. We included 114 patients, of whom 27 were histopathologically diagnosed with a KCOT and 87 with dentigerous (nxa0=xa041) and periapical cyst (nxa0=xa046). Semiautomatic segmentation and radiological analysis of preoperative cone beam computed tomography (CBCT) image data was carried out using ITK-SNAP. The mean volumetric extent of KCOTs is significantly higher compared to non-neoplastic odontogenic jaw cysts (pxa0=xa00.001). The mean volume and standard deviation for KCOTs and non-neoplastic odontogenic jaw cysts was 10381xa0mm3xa0±xa06410 and 5813xa0mm3xa0±xa04425, respectively. Volumetric analysis reveals that KCOTs significantly exceed the mean size of non-neoplastic odontogenic jaw cysts, adding an argument in favor of the neoplastic nature of KCOTs. In the case of difficult histopathological examination, lesions with a size exceeding a value of about 3000xa0mm3 could be considered for close clinico-radiologic follow-up.

Analysis of clinicopathological risk factors for locoregional recurrence of oral squamous cell carcinoma – Retrospective analysis of 517 patients

INTRODUCTIONnRecurrence is one of the main reasons for poor prognosis of OSCC. The mortality rate is approximately 90% and the 5-year overall survival rate decreases from 90% to 30% when recurrence is diagnosed. Identification of clinicopathological risk factors predicting recurrence may be helpful for patient individualized management and improvement of therapy. Therefore we investigated in our study the incidence of locoregional recurrences and their association with clinicopathological factors to identify possible significant risk factors.nnnMATERIAL AND METHODSnOur retrospective study consisted of 517 patients, who were diagnosed and treated between 2003-2013 at the Department for Oral and Maxillofacial Plastic Surgery, University of Cologne. Inclusion criteria were patients with treatment naive oral squamous cell carcinoma and primarily curative intended surgery with negative resection margins. Contingency tables and χ2-test were performed to analyse associations between clinicopathological features and recurrence. Multivariate analysis was performed using binary logistic regression analysis.nnnRESULTSnWe found out a significant correlation in univariate analysis between locoregional recurrence and number of resected cervical lymph nodes (p=0.013), number of positive cervical lymph nodes (p=0.041), postoperative radiatio (p=0.018), extracapsular spread (p=0.028) as well as grading (p=0.016). In multivariate analysis only grading was shown as independent risk factor for recurrence.nnnCONCLUSIONSnHistological grading has been demonstrated as an independent risk factor for locoregional recurrence in the multivariate analysis. Furthermore, univariate analysis indicated the number of resected and positive lymph nodes, postoperative radiatio and extracapsular spread as significant risk factors. Taking these results into account, the mentioned parameters, especially histological grading, need to be considered for an individualized therapy management of patients with OSCC.

Clinical evaluation of non-syndromic scaphocephaly surgically corrected with the procedure of total vertex craniectomy

The present investigation constitutes a retrospective evaluation of the outcome in children who received surgical correction of a scaphocephalic phenotype by median total vertex craniectomy. Between September 2009 and September 2015, a total of 35 infants with non-syndromic scaphocephaly were treated according to the same standardized operative technique of total vertex craniectomy by a single surgeon approach. At the time of surgery, the patients were between 3 and 12 months of age, with a median of 5 months. The mean duration of the procedure was 94xa0min. The duration of postoperative follow-up was a mean of 24 months (range 6-49 months). A total of 34 (97%) patients were successfully treated by total vertex craniectomy and were thus classified as category I according to the Whitaker score. Only one individual was assigned to category IV, necessitating secondary major craniofacial corrective surgery. Aesthetic outcomes were excellent in 34 cases and poor in one case. No major complication occurred. The reoperation rate was 3%. The surgical method we present herein is a wide median craniectomy which can be applied in young individuals with non-syndromic single-suture scaphocephaly.

Does volumetric measurement of cervical lymph nodes serve as an imaging biomarker for locoregional recurrence of oral squamous cell carcinoma

INTRODUCTIONnRecent studies highlighted the prognostic superiority of lymph node volume towards the conventional N Classification. However, data on the importance of neck lymph node volume, obtained by semiautomatic segmentation of CT images, do not exist for locoregional recurrence in patients with oral squamous cell carcinoma (OSCC).nnnMETHODSnRetrospective chart review of 100 patients, who were diagnosed and treated between 2006-2014. Inclusion criteria were patients with treatment-naive oral squamous cell carcinoma and primarily curative intended surgery with negative resection margins, for whom a preoperative computed tomography (CT) of the head and neck region was performed. Furthermore, comprehensive neck dissection (level I-V) due to ipsilateral lymph node metastasis was chosen as inclusion criterion. Exclusion criteria were neoadjuvant chemoradiotherapy, T4b classification, perioperative death, unresectable disease, synchronous malignancy, follow-up < 3 months and inadequate information to correctly determine clinicopathological characteristics.nnnRESULTSnPathological N Classification (pxa0=xa00.001), central necrosis (pxa0=xa00.008) and lymph node volume (pxa0<xa00.001) significantly affected locoregional recurrence (pxa0<xa00.001). Multivariate analysis indicated N Classification (pxa0=xa00.06) and volume (pxa0<xa00.001) as indepedent risk factors for locoregional recurrence.nnnCONCLUSIONnVolumetric measurement serves as a better risk stratification tool than the conventional N Classification for OSCC. A lymph node volume of more than 6.86xa0cm3 goes along with a 20-fold higher risk for locoregional failure.

Rigid External Distractor-Aided Advancement After Simultaneously Performed LeFort-III Osteotomy and Fronto-Orbital Advancement

Abstract Due to the complex development of the craniofacial skull, corrective surgery is a major challenge for patients with severe craniofaciostenosis. Although fronto-orbital advancement and simultaneous LeFort-III osteotomy in combination with distraction osteogenesis have been reported as a safe and successful method to obtain good esthetic and functional results, there is a lack of studies evaluating this method. Our retrospective study included 12 patients with syndromic craniofaciostenosis, who were primarily treated at our department in accordance with a standardized treatment protocol, consisting of a simultaneous fronto-orbital advancement with LeFort-III osteotomy in combination with a rigid external distractor (RED-II). Distraction distance, duration of operation, postoperative complications, perioperative hemoglobin concentration, esthetic outcome, and the subjective Whitaker Scale were used to evaluate the success of our surgical method. The esthetic outcome of all of our patients was assessed as good. Furthermore, the surgical outcome was assigned I for 11 patients and II for 1 patient, who suffered from wound healing disturbance at the left temporal site, which required revision 2 weeks postoperatively. The mean skeletal advancement of the midface was 16.4u200amm, ranging from 12 to 20u200amm. Our standardized treatment protocol, consisting of fronto-orbital advancement in combination with LeFort-III osteotomy and application of a rigid external distractor device (RED-III) for patients with severe syndromic craniofaciostenosis, goes along with low infection rates and more predictable and precise esthetic and functional outcomes than the conventional surgical technique without distraction osteogenesis.

Clinical Evaluation of Standardized Fronto-Orbital Advancement for Correction of Isolated Trigonocephaly

Abstract Corrective surgery of trigonocephaly is a major challenge, owing to the complex development of the craniofacial skull. Although reports on the clinical success of standardized fronto-orbital advancement have been promising, there is a lack of studies, assessing this method. Hence, the aim of our study was to evaluate the clinical outcome of a standardized fronto-orbital advancement procedure for correction of isolated nonsyndromic trigonocephaly, in our patient cohort. The retrospective study included 30 patients from 2008 to 2015. Inclusion criteria were treatment-naive children with isolated nonsyndromic trigonocephaly, being treated with standardized frontoorbital advancement in our department. We considered postoperative complications and the Whitaker Score to evaluate the success of the clinical outcome. Surgery was performed at a mean age of 9.3 months. The mean operation time was 153 minutes. All patients were assigned I according to the Whitaker score. One patient suffered from a small inconsequential subdural hematoma. Another patient suffered from dural tears, which were identified and treated intraoperatively. No major complications occurred within our patient cohort. The standardized fronto-orbital advancement is a safe and successful method, as it is associated with a high morphological outcome and low complication rate.

The importance of lymph node ratio for patients with mandibular infiltration of oral squamous cell carcinoma

PURPOSEnLymph node ratio (LNR) essentially improves assessment of prognosis and therapeutic decision making for patients with oral squamous cell carcinoma, as it considers both the number of positive lymph nodes and the number of dissected lymph nodes. Mandibular infiltration by oral squamous cell carcinoma is a vital clinicopathological feature, significantly worsens prognosis. However, to the best of our knowledge, data on the influence of LNR on prognosis for patients with OSCC and mandibular infiltration are not available.nnnMATERIALS AND METHODSnA retrospective chart review of 89 patients with treatment-naive oral squamous cell carcinoma and histopathologically proven mandibular infiltration (pT4a) was performed. Exclusion criteria were primarily curative intended surgery (radical tumor resection, neck dissection and segmental mandibulectomy) with negative resection margins. Exclusion criteria were neoadjuvant chemoradiotherapy, erosive infiltration of the mandible, T4b classification, perioperative death, unresectable disease, synchronous malignancy, follow-up <3 months, and inadequate information to correctly determine clinicopathological characteristics.nnnRESULTSnWe observed a significant correlation on univariate analysis between locoregional recurrence and pathologic N classification (pxa0=xa00.004), perineural invasion (pxa0=xa00.005) and lymph node ratio (pxa0<xa00.001). On multivariate analysis, lymph node ratio (pxa0=xa00.028) was shown to be an independent indicator for locoregional recurrence.nnnCONCLUSIONnLNR predicted locoregional recurrence better than the conventional nodal staging system and therefore might serve as a more precise risk stratification tool. LNR >7% led to a 11.419-fold higher risk for locoregional recurrence of patients with mandibular infiltration due to OSCC.