Reconstruction of Orbital Exenteration Defects with Cross-median Forehead Flaps.

The aim of this study was to examine the role of forehead flaps in the reconstruction of orbital defects after exenteration. Patients undergoing orbital exenteration and reconstruction using median forehead flaps from January 2002 to August 2019 were enrolled in this retrospective study. All the patients were evaluated for wound complications, functional results, and tumor relapse. In total, 105 patients completed the study. Twenty-nine complications in 24 of these patients were assessed. The most common complications were wound dehiscence (11%), partial necrosis of the flap (6%), and bleeding (4%). A major complication occurred in two patients (2%), necessitating surgical correction. Only one patient had a local relapse. Sixty patients received osseointegrated implants, and 58 of them were treated with facial prostheses. The follow-up periods ranged from 6 to 189 months. Thus, forehead flap reconstruction after exenteration is a reliable method with a low complication rate. This technique can be used for primary or secondary reconstruction, and excellent long-term functional results can be achieved. A relapse-oriented follow-up is certainly possible.

Long-term results of endosseous implants as retention elements of orbital epitheses, reconstruction techniques, and aftercare after radical tumor resection.

PURPOSE: The aim of this study was to examine the long-term results of implants in orbital reconstruction after exenteration. MATERIALS AND METHODS: From 1998 to 2012, patients undergoing implant-supported rehabilitation after subtotal or total exenteration due to a tumor were included in a retrospective study. All the patients were evaluated for soft tissue reconstruction, irradiation, complications, abutments, hygiene index, implant mobility, and long-term success. RESULTS: Forty-eight patients (aged between 27 and 81 years) were selected. A total of 187 implants were inserted. All the patients were supplied with epitheses after implantation in the long term. Of the 187 implants, nine implants placed on five patients were lost. The mean follow-up period was 34 months (ranging from 6 to 144 months). The 5-year survival rate was 88%. CONCLUSION: On the basis of this retrospective study of 48 patients with 187 implants, the following observations were made: (1) The 5-year survival of implants in nonradiated bone was 92%, and (2) the 5-year survival of implants in radiated bone was 86%. Extraoral implants should be presented as an option in orbital rehabilitation after exenteration.

Contribution of PET/CT to prediction of outcome in children and young adults with rhabdomyosarcoma.

UNLABELLED: The purpose of this retrospective study was to evaluate the role of (18)F-FDG PET or PET/CT in the prediction of patient outcome in children and young adults affected by rhabdomyosarcoma. METHODS: Forty-one patients with histology-proven rhabdomyosarcoma who underwent PET or PET/CT were identified (age range, 1-20 y; mean age ± SD, 9.9 ± 5.8 y). Tumor maximum standardized uptake value (SUV(max)) and visually rated metabolic activity, as well as the presence of metabolically active lymph nodes and distant metastases, were compared with event-free and overall survival. Multivariate Cox regression analyses were performed to compare the prediction of outcome according to metabolic tumor intensity in relation to established prognostic factors. RESULTS: Kaplan-Meier analyses revealed a significantly shorter overall survival in primary tumors visually rated as highly metabolically active or with a ratio of SUV(max) to SUV of the liver above 4.6. In addition, metabolically active lymph node and distant site involvement was indicative of significantly lower survival rates. On multivariate Cox regression analysis, the impact of intensity or SUV(max) of the primary tumor on outcome failed to attain significance, although PET performed better than some of the prognostic factors established in larger patient groups (P = 0.081). CONCLUSION: (18)F-FDG PET/CT is a valuable tool for initial staging in children affected by rhabdomyosarcoma. (18)F-FDG PET/CT may be an additional predictor of outcome and may be used to refine risk-adapted therapy. PET performed better than some established risk factors. The borderline significance level of primary tumor metabolism in multivariate testing may be an effect of the limited sample size. Further prospective evaluations are warranted.