N. Kalavrezos

Patterns of invasion and routes of tumor entry into the mandible by oral squamous cell carcinoma.

An understanding of the patterns, spread, and routes of tumor invasion of the mandible is essential in deciding the appropriate level and extent of mandibular resection in oral squamous cell carcinoma.

Factors that influence the method of mandibular resection in the management of oral squamous cell carcinoma.

The method of conservative (rim) resection of the mandible is now well established and provides good control of disease in the primary site. There are few audits of this technique in terms of margins of resection for both rim and segmental resection of the mandible. Consecutive previously untreated patients managed with resection of the mandible as part of their treatment for oral and oropharyngeal squamous cell carcinoma were recruited for the study. The presence and extent of tumour invasion of the mandible was recorded and a retrospective analysis made to establish the incidence of unnecessary segmental resections. The invasion rate was 33% (8/35) for rims and 83% (54/65) in segmental resections of the mandible, which compares favourably with previous studies and indicates a reasonable accuracy of resection. In between 6 and 11 of the 62 cases (10-17%) a rim resection could have achieved a satisfactory resection margin and retained a functioning lower border of the mandible. The accuracy of resection in terms of margins was greater for mandibular resections (94% clear margins) than soft tissues (62% clear margins). The number of compromised margins was significantly greater in the invaded rim resection group (P=0.018). This study indicates that a more conservative mandibular resection was possible in a few cases. This is unlikely to have an adverse effect on the close or involved margin rate, which depends mainly on the accuracy of the soft tissue resection. Angling the horizontal rim resection to take into account tumour entry at the point of contact will help to ensure a clear bone margin if a conservative approach to mandibular resection is an option.

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.

Predictors of swallowing outcome in patients treated with surgery and radiotherapy for advanced oral and oropharyngeal cancer.

Retaining effective swallowing is a key element when optimising outcomes in the management of head and neck cancer. We report the functional swallowing outcomes for a cohort of 31 individuals with advanced oral and oropharyngeal cancer who underwent free or pedicled flap reconstruction of surgical defects. Swallowing was assessed pre and immediately post surgery and at four months post treatment. Swallowing assessments were related to site, size and volume of defect and composition of flap reconstruction. The effect of radiotherapy on swallowing was assessed among 17 of the 31 individuals who were submitted to radiotherapy after surgery. The proportion of patients on a total oral diet four months post treatment varied significantly by site of defect (Fishers exact test p=0.006), from 100% (7/7) of patients with a lateral defect to only 22% (2/9) of patients with a central defect. The proportion of patients on a total oral diet at the final assessment did not vary by flap reconstruction or radiotherapy.

Salivary gland FNA cytology: role as a triage tool and an approach to pitfalls in cytomorphology.

To highlight the importance of salivary gland fine needle aspiration (FNA) cytology as a triage tool for surgery and to determine its sensitivity and specificity. To discuss the diagnostic pitfalls and potential role of ancillary techniques in diagnosis and prognosis.

Carcinoma Cuniculatum Arising in the Tongue

Carcinoma cuniculatum (CC) is a rare, distinct clinico-pathological variant of squamous cell carcinoma (SCC) that is defined histologically by the characteristic infiltrative pattern of a deep, broad, and complex proliferation of stratified squamous epithelium with keratin cores and keratin-filled crypts. Herein, we present a case report of CC of the oral tongue and discuss its diagnosis, management, and outcome, as well as briefly review the world literature. To our knowledge, this is the first documented case of CC of the tongue to be reported in the English literature. We draw attention to its clinico-pathological features and highlight that awareness of this entity as a distinct variant of SCC facilitates its correct management.

Factors affecting swallow outcome following treatment for advanced oral and oropharyngeal malignancies

Treatment for tumors of the oral cavity and the oropharynx disrupts normal swallow function. The ability for oral diet postoperatively varies and may be influenced by surgery and patient‐related factors.

Head and neck sarcomas: A single institute series

BACKGROUND Sarcomas are tumours of mesenchymal origin, accounting for 1% of all malignancies. METHODS This is a retrospective analysis of 107 head and neck sarcoma cases, treated over a period of thirteen years. RESULTS Fifty-four patients had with craniofacial bone sarcomas (BSs) (male: 33; female: 21) with high grade osteosarcoma being the most predominant type. The soft tissue sarcomas (STS) (53 patients; male: 28, female: 25) were histologically diverse with rhabdomyosarcomas and myxofibrosarcomas being the predominant types. The majority of BSs were managed with neoadjuvant chemotherapy followed by surgery, whereas in STSs treatment included predominantly surgery followed by radiotherapy. Overall survival estimates were 79% at 2years and 64% at 5years (mean follow-up period was 48months). CONCLUSIONS The mesenchymal origin of sarcomas, the pattern of disease spread and the different extent of cancellous bone infiltration in contrast to epithelial tumours, dictate distinct principles for surgical clearance.

Multiple-site osteosarcomas of the jaw in a single patient. A true case of a metachronous lesion?

A case of multiple-site osteosarcomas in the jaw of a 56-year-old patient is reported. The disease occurred consecutively at three different sites (left maxilla, left mandible, right mandible) separated by time intervals of 12 and 18 months, respectively. Metachronous osteosarcomas of the long bones is a rare form of osteosarcoma and implies multiple lesions appearing at different times, each one behaving clinically as a primary lesion. The pathogenesis of this disease is unknown as it is unclear whether the lesions represent independent primary tumours or metastatic disease.

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