Rui Fernandes

Oral maxillary squamous carcinoma: An indication for neck dissection in the clinically negative neck

This multicenter study was undertaken to characterize the metastatic behavior of oral maxillary squamous carcinoma and to determine the role of selective neck dissection.

Head and neck osteosarcoma.

OBJECTIVE The objective of the study was to discuss the optimal management and treatment outcomes for patients with head and neck osteosarcomas. STUDY DESIGN Review article. METHODS Review of the pertinent literature. RESULTS Osteosarcomas account for approximately 1% or less of all head and neck cancers. The vast majority occur in the mandible and maxilla. The median age is in the fourth decade, with a wide range. They are more likely to recur locally after treatment and distant metastases are observed less often than with the more common osteosarcomas arising in the long bones. The optimal treatment is complete resection. The role of adjuvant chemotherapy is ill-defined. The vast majority of recurrences are observed within 5 years. The 5-year disease-specific and overall survival rates are approximately 60% to 70%. CONCLUSIONS Osteosarcoma of the head and neck is a rare entity that occurs primarily in the mandible and maxilla. The optimal treatment is surgery. Adjuvant radiotherapy should be considered for those with close or positive margins. The role of adjuvant chemotherapy is ill-defined. The likelihood of cure is approximately 60% to 70%.

Neck Masses: Evaluation and Diagnostic Approach

Oral and maxillofacial surgeons frequently deal with patients who present with an unknown neck mass. Formulation of a differential diagnosis is essential and requires that the surgeon bring to bear a host of skills to systematically arrive at a definitive diagnosis and ensure that the correct treatment is rendered. This article highlights some of the skills needed in the workup of neck masses and reviews some of the available techniques that aid in achieving the correct diagnosis.

Oral and maxillofacial surgeons treating oral cancer: a preliminary report from the American Association of Oral and Maxillofacial Surgeons Task Force on Oral Cancer.

p d l h l p i r ral cancer (ie, cancer of the lip, tongue, floor of the outh, palate, gingiva, alveolar mucosa, buccal muosa, or oropharynx) accounts for approximately 2% f all cancers diagnosed annually in the United tates. In 2006, approximately 30,990 diagnoses f oral cancer were made and 7,430 persons died of he disease. Roughly 50% of the patients diagnosed ith oral cancer will die in the next 5 years. wenty-five percent will die of a second primary ancer, and 25% will die of comorbid conditions or nrelated illnesses. Approximately 90% of oral

Versatility of supraclavicular artery island flap in head and neck reconstruction of vessel-depleted and difficult necks.

PURPOSE The advent of microvascular free tissue transfer has given reconstructive surgeons a vast repertoire of treatment options for reconstruction of head and neck defects. However, the success of free flaps in head and neck reconstruction depends on the presence and quality of the recipient vessels in the neck for microvascular anastomosis. The supraclavicular artery island flap can be used to reconstruct a variety of head and neck defects, allowing the reconstructive surgeons to circumvent some of the problems inherent in vessel-depleted necks. The present study reports the use of the supraclavicular artery flap (SCAF) in the reconstruction of vessel-depleted neck and in difficult necks. MATERIALS AND METHODS The present study was a retrospective study of patients who had undergone reconstruction with an SCAF and who also had a difficult neck or vessel-depleted neck in the head and neck surgery section from 2011 to 2012. Our inclusion criteria were patients treated at our institution with an SCAF who also had undergone multiple previous neck surgeries or patients with severely restricted donor options for soft tissue reconstruction. We excluded any patient for whom we did not have adequate follow-up or if the flap procedure was not performed by the faculty of the head and neck section. RESULTS We identified 8 patients with a total of 9 SCAFs. One patient received bilateral SCAFs. Of the 8 patients, 6 were men and 2 were women. With the exception of 1 patient, all had received previous radiotherapy to the head and neck region. All the patients had undergone multiple surgical procedures. The flap survival was 100%. However, 2 patients had partial loss of the flap, and 2 had partial donor site wound dehiscence. Our overall complication rate was 38%, including dehiscence of the flap and partial loss of the flap. CONCLUSIONS The SCAF is a sound option for reconstructing defects in the head and neck region in patients with previous radiotherapy and in multiple neck surgeries. The surgeon and patient should be aware of the high incidence of complications associated with this reconstructive option.

Outcomes of Sinonasal Cancer Treated With Proton Therapy

PURPOSE To report disease outcomes after proton therapy (PT) for sinonasal cancer. METHODS AND MATERIALS Eighty-four adult patients without metastases received primary (13%) or adjuvant (87%) PT for sinonasal cancers (excluding melanoma, sarcoma, and lymphoma). Common histologies were olfactory neuroblastoma (23%), squamous cell carcinoma (22%), and adenoid cystic carcinoma (17%). Advanced stage (T3 in 25% and T4 in 69%) and high-grade histology (51%) were common. Surgical procedures included endoscopic resection alone (45%), endoscopic resection with craniotomy (12%), or open resection (30%). Gross residual disease was present in 26% of patients. Most patients received hyperfractionated PT (1.2 Gy [relative biological effectiveness (RBE)] twice daily, 99%) and chemotherapy (75%). The median PT dose was 73.8 Gy (RBE), with 85% of patients receiving more than 70 Gy (RBE). Prognostic factors were analyzed using Kaplan-Meier analysis and proportional hazards regression for multiple regression. Dosimetric parameters were evaluated using logistic regression. Serious, late grade 3 or higher toxicity was reported using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4. The median follow-up was 2.4 years for all patients and 2.7 years among living patients. RESULTS The local control (LC), neck control, freedom from distant metastasis, disease-free survival, cause-specific survival, and overall survival rates were 83%, 94%, 73%, 63%, 70%, and 68%, respectively, at 3 years. Gross total resection and PT resulted in a 90% 3-year LC rate. The 3-year LC rate was 61% for primary radiation therapy and 59% for patients with gross disease. Gross disease was the only significant factor for LC on multivariate analysis, whereas grade and continuous LC were prognostic for overall survival. Six of 12 local recurrences were marginal. Dural dissemination represented 26% of distant recurrences. Late toxicity occurred in 24% of patients (with grade 3 or higher unilateral vision loss in 2%). CONCLUSIONS Dose-intensified, hyperfractionated PT with or without concurrent chemotherapy results in excellent LC after gross total resection, and results in patients with gross disease are encouraging. Patients with high-grade histology are at greater risk of death from distant dissemination. Continuous LC is a major determinant of survival justifying aggressive local therapy in nearly all cases.

Survival of microvascular free flaps in mandibular reconstruction: A systematic review and meta-analysis

Free tissue transfer is commonly used in the reconstruction of post‐ablative defects of the mandible. Due to lack of statistical power, comparing the survival of various free flaps, even in large studies, is challenging. The purpose of this study was to perform a meta‐analysis comparing the survival of the most commonly used free flaps for mandibular reconstruction.

Incidence, risk factors and management of delayed wound dehiscence after craniotomy for tumor resection.

Dehiscence after a wound has healed is a known complication of craniotomy for tumor resection. We conducted a retrospective analysis of 64 patients who underwent craniotomy for tumor resection followed by radiation or radiosurgery between 2006 and 2010. Five patients (7.8%) were identified who showed wound dehiscence from two to eight months after the craniotomy wound had healed. Four patients had previously undergone additional craniotomies, additional radiosurgery or had been treated with the anti-angiogenic factor, bevacizumab. These treatments may be risk factors for developing delayed dehiscence and, in combination, may potentiate local wound healing problems. Potential mechanisms and management strategies are discussed.

Low-Grade Mucoepidermoid Carcinoma of the Intraoral Minor Salivary Glands With Cervical Metastasis: Report of 2 Cases and Review of the Literature

O t a m h n m c e w b ucoepidermoid carcinomas (MECAs) are salivary land tumors that involve the major and minor saliary glands with a strong predilection for the parotid nd the palate, respectively. MECAs represent 10% to 5% of all salivary gland tumors. Stewart et al in 945 classified these tumors into 2 subdivisions, “reltively favorable” and “highly favorable,” based on utcome. Subsequently, reports of aggressive behavor of some of these “benign” tumors with local, egional recurrence and distant metastasis necessiated modification of the original classification. Thus, n the basis of histologic appearance and degree of ifferentiation, this tumor is classified as low grade or ell differentiated, composed largely of mucus-secretng cells, often forming glandular spaces; and high rade or poorly differentiated, characterized by squaous cells with rare mucus-secreting cells. Some uthors classify MECA into 3 rather than 2 categories,

Reconstruction of subtotal defects of the lower lip: a review of current techniques and a proposed modification.

r t t unctional and cosmetic restoration of the lips dates ack to 1000 BC in India and continues to challenge he reconstructive surgeon today. Typically, deects of the lower lip result from ablative oncologic urgery and trauma. Since the middle of the nineeenth century, more than 200 different techniques or reconstruction of the lower lip have been decribed. Gonzalez-Ulloa in 1956 introduced the oncept of facial esthetic subunits for burn surery. Since that time, this esthetic conscious aproach to resection of lesions in the head and neck egion has become the standard, especially in nasal urgery. It is widely accepted that defects of less than one hird of the lower lip can be primarily closed after edge excision. Defects measuring one third to ne half of the lower lip can be reconstructed in umerous ways, such as the commonly used lip witch technique described by Abbe and Estander. For more challenging subtotal defects of he lower lip, the Gate flap as described by Fujiori or the fan-shaped flap based on the facial rtery may also be used. The most commonly sed flap for the near total lower lip defects reains that which was described by Karapanzic. e introduced this commonly used flap after modfying the circumoral rotation-advancement flap by