Mohan F. Patel

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%.

Ossifying fibroma — One disease or six?An analysis of 39 fibro-osseous lesions of the jaws

Thirty-nine cases of benign fibro-osseous lesions of the jaws of which ten cases were reported as central ossifying fibromata are reviewed. Such lesions usually present in young adults with the exception of classical fibrous dysplasia which is normally first diagnosed in the second decade of life. All the lesions appear to be more common in females and with the exception of the peripheral ossifying fibroma show a prediliction for the mandible. It is argued that as there is no absolute histological distinction between bone and cementum and as cementum-like areas of calcification are seen in fibro-osseous lesions of all membrane bones the distinction between ossifying and cementifying lesions should be discontinued. It is also suggested that the benign fibro-osseous jaw lesions may represent different stages in the evolution of a single disease process.

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.

STNMP - A NEW CLASSIFICATION FOR ORAL CANCER

Abstract A new system for the notation of intra-oral carcinomata is 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 recognised 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 four stages are defined corresponding with the stages used in the conventional TNM classification. The STNMP classification has been applied to a random sample of 131 cases of intra-oral carcinomata with more than 5 years follow-up. Particularly in defining those patients with a good prognosis, that is 5 years plus survival, this system has proved to be considerably more accurate than the existing staging methods. It is proposed 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 have been evaluated and a discriminant analysis performed.

Histiocytosis x: Current concepts and a report of two cases

The current concepts of histiocytosis X are discussed, and the literature concering this rare disease of obscure aetiology reviewed. Two case reports of histiocytosis X presenting in similar sites in young children of similar ages, but with markedly different courses, are presented. The importance of early recognition of the disease, particularly by the dental surgeon who may see the first oral signs, is stressed. Attention is drawn to the danger of misdiagnosing the oral signs of histiocytosis X, particularly as periodontal disease. The possible aetiologies are examined and current treatment regimes discussed.

Clinical classification and staging in oral cancer

The literature regarding TNM-classification and staging as applied to oral cancer is reviewed and the shortcomings of the various systems are discussed. A new system for the classification and staging of carcinomata of the oral cavity is described. This system includes recording the site of the lesion (S) and the pathology (P) in addition to the conventional TNM criteria. The new system for staging involves the summation of arithmetic discriminants attached to each of the variables S, T, N, M and P. This system is more simple to use and is able to predict a more accurate prognosis for the patient.

Recurrent oral and oculogenital ulcerations (Behçet's syndrome)

The literature on Behçets syndrome is reviewed and four cases are presented. Two of the patients were men and two were women. The age at presentation varied from 21 to 55 years. All patients had the first manifestations of the disease before the age of 25 and two before the age of 10. None presented with the complete triad of symptoms. All four had oral ulceration and either ocular lesions (two cases) or lesions on the genitals (two cases). According to the present theories, the diagnosis of Behçets syndrome is established by the presence of any two of the triad of symptoms. We suggest that in order to be classified as having Behçets syndrome, a patient should have oral lesions and either genital and/or ocular ulcerations.

Horton's syndrome*

Abstract The literature on Hortons syndrome is reviewed and a series of 15 patients presented. The aetiology of migraine and its variants is discussed and the clinical features differentiating Hortons syndrome from classical migraine are considered.