ABSTRACT
Objective:To investigate the cervical lymphatic metastasis rates of clinically negative neck lymph node (cN0) maxillary malignant tumors,to compare the cervical lymphatic metastasis rates of the various pathological types,and to provide the reference for the treatment of the neck of the patients with cN0 maxillary malignant tumor.Methods:The clinical data of 277 cases with cN0 maxillary malignant tumor,treated in the department of oral and maxillofacial surgery of Peking University School and Hospital of Stomatology from 1990 to 2010,were reviewed.The cervical lymph node metastasis and the related clinical information were recorded.The clinical information including histopathology type of the tumors,tumor grade,primary site and TNM staging,as well as other demographic and clinical data,were retrieved from the electronic medical record system (EMRS) of the hospital.The pathogenesis of cervical lymph node metastasis in maxillary malignant tumors of different histopathological types,and the factors related to lymph node metastasis of upper cervical malignancy were analyzed by SPSS 19.0 statistical software.Results:The overall cervical lymph node metastasis rate of the 277 patients with cN0 maxillary malignant tumor was 15.5％ (43/277).Maxillary squamous cell carcinoma (SCC) had a strong cervical lymph node metastasis tendency and the rate was 33.0％.The overall metastatic rate of adenocarcinoma was 7.6％ lower than that of SCC,and the occurrence of cervical lymph node metastasis time was relatively late,but the metastasis rate of highly malignant grade salivary gland carcinoma was significantly higher than that of intermediate and low grade carcinoma (P =0.037).The metastatic rates of some highly malignant cN0 salivary gland carcinomas including adenocarcinoma,not other specified,high-grade mucoepidermoid carcinoma (MEC),and salivary duct carcinoma were exceeded 15％,while the metastasis rates of adenoid cystic carcinoma and myoepithelial carcinoma were lower.The metastasis rate of the sarcomas was very low with the rate of 4.9％.Conclusion:Selective neck dissection (SND) is recommended for cN0 maxillary SCC and feasible for some highly malignant cN0 salivary gland carcinomas including adenocarcinoma,not other specified,high-grade MEC,salivary duct carcinoma.The neck can be closely observed for the patients with maxillary sarcoma.
ABSTRACT
Objective:Three-dimensional reconstruction of the enhanced CT is increasingly becoming a valuable tool in head and neck neoplasms.The aim of this study is to reconstruct three-dimensional imaging of tumor and its surrounding important anatomical structure using iPlan CMF software,and to investigate the application of three-dimensional tumor mapping technique for the diagnosis and treatment of the head and neck neoplasms.Methods:In the study,13 cases with head and neck tumors in Department of Oral and Maxilloficial Surgery,Peking University School and Hospital of Stomatology from June 2014 to June 2015 were studied using spiral CT scanning technology based on the same scanning condition.iPlan CMF software was used to read the original CT data,and surface shaded technology was applied to reconstruct the spatial relationship of the tumor,vessel and skull.The distance between the tumor and its surrounding important anatomical structure could be measured.iPlan CMF software was also used to accomplish the virtual osteotomy to expose the tumor,vessel and skull.The preoperative preparation,operative situation and postoperative complication were reviewed.Results:In this study 6 patients were male and 7 female.The age range was from 23 to 65 years,and the median patient age was 50 years.The threedimensional reconstruction image clearly demonstrated the extent of the tumor size,location,and the relation to its surrounding important anatomical structure.According to the three-dimensional image,the surgical risk of the patients was evaluated.The preoperative preparation and surgeries were successfully performed for 10 patients.Blood transfusion for 3 patients was considered before the surgery and actually accomplished during the operation.The operations for 2 patients were performed with the help of doctors from other departments.Only one patient had hoarseness because the tumor resulted from the pneumogastric nerves.For 10 patients,the average operation time was (202 ± 135) min,and the average operation bleeding was (235 ± 252) mL.The other 3 patients were not suitable cases for surgery.Conclusion:The three-dimensional reconstruction of enhanced CT image with iPlan CMF software is very helpful to make the treatment plan to avoid damaging important anatomical structures and postoperative complications.