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Objective:To analyze survival in patients with advanced oral cancer from prospective clinical trials. Methods:From 2008 to 2010, 256 patients with oral cancer at clinical stage III/IVA were randomly categorized into two groups. Patients in the experi-mental group received neo-adjuvant chemotherapy, surgery, and post-operative radiation, and patients in the control group underwent surgery and post-operative radiation. All patients were routinely followed-up after treatments. Survival was analyzed using Kaplan–Meier method and log-rank test, and differences were considered statistically significant at P value lower than 0.05. Results: Each group was composed of 128 patients. With the median follow-up period of 60 months, the 5-year overall survival rate was 61.7%and the disease-free survival rate was 53.9%. The overall survival rate (P=0.350) and the disease-free survival rate (P=0.160) were not sig-nificantly different between the experimental and control groups. Patients with positive pathological response to neo-adjuvant chemo-therapy exhibited significantly improved overall survival (P＜0.05). Conclusion:Radical surgery should be emphasized to improve the prognosis of oral cancer. Functional reconstruction could also improve the quality of life and survival of patients. Despite that neo-adju-vant chemotherapy could not improve the survival of patients with advanced oral cancer in entirety, it could benefit patients exhibiting positive treatment responses.
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Objective:To review our patients who underwent cranio-maxillofacial resection in the recent 10 years and explore the indication of the operation. Methods:From 2003 to 2013, 116 patients underwent cranio-maxillofacial resection in our department for the treatment of tumors involving the skull base. Tumors that involved the skull base were divided into 3 types according to skull base invasions shown in the coronal planes of CT and MRI scans. Type 1 tumor was adjacent to the skull base with free bone (n=45), type 2 tumor involved the skull base with intact dura (n=30), and type 3 tumor involved dura with free brain (n=41). All patients underwent cranio-maxillofacial resection by oral and maxillofacial surgeons and neurosurgeons. The defects after cranio-maxillofacial resection were reconstructed immediately with adjacent local or regional flaps (n=62) and free vascularized flap (n=54) according to different de-fects, respectively. Results:Cranio-maxillofacial resection was successfully performed in all patients. No intraoperative complication was found. The overall success rate of soft tissue flaps and free flaps was 98.3%and 96.4%, respectively. Three patients with intracrani-al infection (n=2) and bleeding in the internal carotid artery were dead postoperatively even though they underwent salvage surgery. The overall rate of complications was 14.7%, and the dead rate was 2.6%. Recurrence or distant metastasis was found in 36 patients dur-ing the follow-up period. Conclusion: For the indication of cranio-maxillofacial resection, the balance between tumor resection and postoperative function, survival rate, and quality of life should always be considered. This technique includes the balance between func-tion and form, survival and quality of life, donor and recipient sites, and primary and secondary functions.
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Objective:To assess the effectiveness of free vascularized bone flap transfer for treatment of advanced osteoradionecrosis of the mandible (ORNM). Methods:We reviewed 53 patients who were treated for ORNM by radical resection and reconstruction with free vascularized bone flaps in our institute between January 2003 and January 2015. Results:Among the 53 vascularized bone flap patients, 48 (90.57%) had fibula osteocutaneous and 5 (9.43%) had deep circumflex iliac artery (DCIA). Postoperative complications occurred in 5 (10.42%) of the 48 fibula osteocutaneous patients (4 cases of vein thrombosis and 1 case of arterial crisis). In three of these patients, flap was salvaged back to normal in a timely manner by vascular exploratory surgery. However, pectoralis major myocutaneous flap was conducted as a second procedure for the other two patients. Meanwhile, complications occurred in 2 (40%) of the 5 DCIA transfer patients (1 case of vein thrombosis and 1 case of arterial crisis). None of these two flaps was salvaged back. Necrosis transfer bone was finally removed. No obvious donor site complications were noted. The mean follow-up time was 28 months. Our results showed that 88.57%of the patients with ORNM were stable, 85.71%of the patients can open their mouth at 2-3 figures, 85.72%of the patients can eat soft or semi-liquid food, and 80%patients can speak clearly and can be understood by others around them. No significant difference was found in mouth opening and face type of the patients with or without the intact condyle. However, the temporomandibular joint area discomfort of the patients with intact condyle was obviously less than that of patients with removed condyle. Conclusion:Radical resection, followed by vascularized bone flaps, especially fibula osteocutaneous, is still the best way to treat ORNM, as long as the indications are chosen appropriately, intraoperative work is conducted properly, and postoperative complications are controlled.
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Objective:To analyze the clinical manifestations, radiographic features, and pathological classification of the juvenile ossifying fibroma (JOF) of the jaws and discuss its clinical management and prognosis. Methods: From January 2005 to December 2014, 15 patients with JOF who underwent surgery were retrospectively investigated with regard to clinical and radiologic data. On the basis of the standards of the World Health Organization in 2005, JOF was divided into juvenile psammomatoid ossifying fibroma (JPOF) and juvenile trabecular ossifying fibroma (JTOF). Results:Among the 15 patients, 10 were female and 5 were male. Patient age ranged from 7 years old to 18 years old with a mean of 10.93 years old. Nine cases were located in the mandible and 6 in the maxilla. The clinical manifestation was painless swelling of the jaw, but 20%of the cases showed jaw swelling with pain. Various JOF radiolog-ic appearances, such as radiolucent, mixed radiopaque-radiolucent, or ground-glass pattern, were observed. Ten of the 15 patients were JTOF and 5 were JPOF With regard to treatment, 4 patients underwent conservative surgery, 3 patients lived with tumors, and 11 pa-tients underwent radical surgery during the follow-up period; no lesion recurrence occurred. Nine patients underwent reconstruction, that is, 5 cases with fibula flap graft, 3 cases with free iliac graft, and 1 case with costal cartilage graft. Conclusion:JOF is a rare form of benign fibro-osseous lesions and occurs in adolescents. Mandible and maxilla are two of the most common locations. Early diagnosis and treatment and strict clinical and radiological follow-up is important in the clinic because of the aggressiveness and high recurrence rate of JOF. Operation time and treatment options should be selected according to the patients' specific situation.
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Objective To review our patients who underwent reconstruction of the defect after combined cranio-maxillo-facial resection in recent years.Methods From January,2005 to January,2011,88 patients underwent reconstruction of the defect after combined cranio-maxillo-facial resection.Different reconstructive techniques were used according to the defect classifications in dura,skull base bone,and facial tissues.For dural defects,no repair (37 cases),primary closure (25 cases),and dural repair (26 cases) were performed,respectively.Dural repair materials included thigh fascia lata (2 cases),temporalis fascia (2 cases),pericranium (1 case) and artificial dural patch (21 cases).Bone reconstruction of the skull base were performed in 61 patients with titanium mesh (57 cases),free iliac bone graft (1 case),free cranial bone graft (2 cases) and Medpor (1 case),respectively.Limited facial soft and hard tissue defects in 44 patients were reconstructed with temporalis system of flaps (36 cases),sternocleidomastoid myocutaneous flap (6 cases),and pterygoid muscle flap (2 cases),respectively.Extensive facial soft and hard tissue defects in 44 patients were reconstructed with free latissimus dorsi myocutaneous flap (26 cases),free pectoralis major myocutaneous flap (12 cases),free anterolateral thigh perforator flap (5 cases cases) and free anteromedial thigh perforator flap (1 case),respectively.Results The overall success rate of 88 flaps was 100％.Cerebrospinal fluid leak was found in 4 patients,wound infection was found in 2 patients,intracranial infection was found in 2 patients,respectively.Six patients with cerebrospinal fluid leak or wound infection were cured by conservative treatment.Two patients with intracranial infection were dead although they underwent salvage surgery.Overall rate of complications was 9.1％,dead rate was 2.3％.Conclusion Successful reconstruction of the defect after combined cranio-maxillo-facial resection can be achieved by watertight dural repair,bone reconstruction of the skull base and well-vascularized tissue covered.Regional flap and free tissue transfer are both preferred reconstructive technique depending on the anatomic site and the extent of the defect.
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<p><b>OBJECTIVE</b>This retrospective study is to analyze the outcomes of cN0 stage tongue squamous cell carcinoma and to discuss a reasonable neck management for these cases.</p><p><b>METHODS</b>Totally 132 cases of cN0 stage tongue squamous cell carcinomas were included. Seventy-one cases were performed neck dissection(group ND), 61 cases were under wait-and-see (group WS). The clinical, pathological and follow up data of two groups were analyzed.</p><p><b>RESULTS</b>The cumulative three-year-survival between group ND and group WS were 87.3% and 83.4% respectively. In group ND, the survival of T1 and T2 cases were 89.3% and 83.3% respectively, while 89.6% and 58.3% in WS. For T2b cases which the size was larger than 3.0 cm, the survival of group WS was greatly lower than that of group ND. Both in ND and WS groups. The pathologically poor differentiation cases got poor survival than middle and well cases.</p><p><b>CONCLUSION</b>The wait-and-see policy is recommanded for T1 stage cN0 tongue squamous cell carcinoma. For T2 cases that the tumor size is smaller than 3.0 cm, the wait-and-see is also reasonable, while the neck dissection should be considered in cases of poor differentiation. For large T2 cases, the selective neck dissection should be performed.</p>