ABSTRACT
There are more than 45,000 new cancer cases involving the head and neck diagnosed each year within the United States. Squamous cell carcinoma accounts for the majority of cases, often occurring within the oral cavity and oropharynx. This article reviews current literature and various controversial topics involving the diagnosis and treatment strategies for patients with oral cavity/oropharyngeal cancers. Although not considered cancer within the oral cavity, maxillary sinus squamous cell carcinoma is discussed.
Subject(s)
Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/therapy , Mouth Neoplasms/diagnosis , Mouth Neoplasms/therapy , Oropharyngeal Neoplasms/diagnosis , Oropharyngeal Neoplasms/therapy , Paranasal Sinus Neoplasms/diagnosis , Paranasal Sinus Neoplasms/therapy , Combined Modality Therapy , Diagnostic Imaging , Endoscopy , Humans , Laser Therapy , Neoadjuvant Therapy , Neoplasm Metastasis , RoboticsABSTRACT
PURPOSE: No consensus has been reached regarding the best treatment for repair of fractures of the severely atrophic mandible (<10 mm vertical height). The most complete Cochrane review of the published data could not substantiate a single best practice recommendation for treating these fractures. The present study reports the results of such treatment by placing miniplates at the inferior border of the mandible of 23 fractures of the mandibular body in 16 patients. MATERIALS AND METHODS: This was a consecutive case series during a 30-year period performed by a single surgeon at several practice locations using the technique of extraoral plating at the inferior border. All patients were prospectively monitored clinically and radiographically for achievement of bony union and for complications of sensory disturbances of the lower lip, delayed healing, and hardware removal. The mean observation time was 23.1 months (range 1 to 60), with only 2 cases observed for less than 6 months. RESULTS: All the patients achieved clinical union of their fractures. Two cases of fibrous union did not reach ossification until 5 months after surgery. The hardware removal rate was 13.6%, and the infection/prolonged inflammation rate was 13.6%. There was 1 case of malunion. Those patients who had dentures were able to return to denture wearing postoperatively. CONCLUSIONS: Miniplate fixation of fractures of the severely atrophic mandible at the inferior border is safe and effective.
Subject(s)
Bone Plates , Fracture Fixation, Internal/instrumentation , Jaw, Edentulous/surgery , Mandible/pathology , Mandibular Fractures/surgery , Adult , Aged , Aged, 80 and over , Atrophy , Denture, Complete, Lower , Device Removal , Female , Follow-Up Studies , Fracture Healing/physiology , Fractures, Malunited/etiology , Humans , Lip Diseases/etiology , Male , Mandible/surgery , Middle Aged , Paresthesia/etiology , Postoperative Complications , Prospective Studies , Surgical Wound Infection/etiologyABSTRACT
Arteriovenous malformations (AVMs) within the mandible are rare and potentially life-threatening conditions that can pose a therapeutic dilemma. We present the case of a child with significant spontaneous gingival bleeding, radiographic evidence of a space-occupying lesion of the mandible, and delayed diagnosis and treatment because of parental reluctance to accept invasive treatment. Imaging studies and intravascular embolization with coils limited, but did not stop blood flow to this lesion. Resection of the mandible was the definitive treatment. The AVM was removed from the resected segment and the bone was replaced as a free graft, thereby avoiding a second site morbidity. Two years after surgery the replaced segment was well consolidated with moderate vertical resorption-remodeling.
Subject(s)
Arteriovenous Malformations/surgery , Mandible/blood supply , Osteotomy/methods , Plastic Surgery Procedures/methods , Arteriovenous Malformations/complications , Blood Loss, Surgical , Bone Plates , Bone Remodeling/physiology , Bone Resorption/physiopathology , Bone Transplantation/methods , Child , Embolization, Therapeutic , Follow-Up Studies , Gingival Hemorrhage/etiology , Humans , Male , Mandible/surgery , Surgical Wound Infection/etiology , Treatment FailureABSTRACT
Low-grade mucoepidermoid carcinoma (LG MEC) is a rare tumor which can occur in the minor salivary glands as intraoral lesion, more frequently in the palate and very rarely in the floor of the mouth. Traditionally, the diagnosis has been made on surgical resection specimens only. There is new growing evidence that these lesions can be accurately diagnosed by a fine-needle aspiration (FNA) biopsy procedure. In this article, we report a case of LG MEC of the floor of mouth diagnosed by FNA and confirmed by subsequent surgical resection. We also provide clues for high index of suspicion for these rare lesions, both clinically and morphologically.
Subject(s)
Carcinoma, Mucoepidermoid/diagnosis , Mouth Neoplasms/diagnosis , Salivary Gland Neoplasms/diagnosis , Biopsy, Fine-Needle , Diagnosis, Differential , Female , Humans , Middle Aged , Salivary Glands, Minor/pathology , Sialadenitis/pathologyABSTRACT
BACKGROUND: Fine needle aspiration (FNA) biopsy has been rarely used in oral and oropharyngeal lesions. The goal of this study was to assess the value and accuracy of FNA biopsy in the diagnosis of oral and oropharyngeal lesions particularly in regards to discriminating benign from malignant tumors. METHODS: Sixteen cases of FNA biopsies obtained of various intraoral and oropharyngeal masses or lesions performed at our institution during the eight-year period from 1998 to 2006 were retrospectively reviewed. The aspiration cytologic diagnoses were correlated with the histologic examination of the corresponding resected lesions. RESULTS: Sixteen cases of intraoral lesions evaluated by FNA biopsies during the period of 1998-2006 were reviewed. The sites of involvement were: lip 1, maxillary sinus 3, pharynx/oropharynx 5, floor of mouth 4, buccal mucosa 2 and peritonsillar area 1. Patients' age ranged from 30 to 87 with an average of 54 years. Male to female ratio was 1:3. Cytologically, 7 cases were diagnosed as suspicious/malignant, and 9 cases as benign (including 6 benign neoplasm, 1 atypical, and 2 reactive or "descriptive"). Fifteen cases had corresponding surgical resection for histologic examination, of these, 9 cases were interpreted as malignant, and 6 as benign. There were no false positive diagnoses of malignancy on FNA. Two cases were interpreted as benign or atypical cytologically, but were found to be malignant on histologic examination. CONCLUSION: FNA biopsy of intraoral and oropharyngeal masses is a valuable procedure for the initial evaluation of various lesions. It provides helpful information about these lesions and avoids hasty or unnecessary surgical biopsy. It is a rapid and relatively noninvasive procedure. Furthermore, aspiration biopsy is an important tool in the diagnosis and management of these lesions, both neoplastic and non-neoplastic, and can be sometimes complemented by ancillary studies for more accurate interpretation. However, its sensitivity in the diagnosis of malignancy is lower than that of histologic samples. This is probably due to the superficial nature and small size of these lesions, the limited space for maneuvering the needle and difficulty in immobilizing the lesion to obtain adequate samples, rather than to interpretation or inherent limitations of the technique itself.
ABSTRACT
La enfermedad de Rosai Dorfman es un desorden multisistémico de etiología y patogénesis desconocidas, pero se piensa que representa un proceso reactivo histiocítico a un agente infectante en lugar de una neoplasia u otra condición primaria. Se han informado en la literatura menos de 1 000 casos que han estado asociados con disímiles enfermedades. Se hace referencia de un caso clínico atendido en la República Democrático Federal de Etiopía en el año 2003 con compromiso panglandular y diagnósticos previos inciertos hasta su conclusión definitiva(AU)
Rosai-Dorfman syndrome is a multisystemic disorder of unknown aetiology and pathogenesis, but it is thought that it represents a reactive histiocytic process to an infective agent instead of a neoplasia or other primary condition. Less than 1 000 cases associated with different diseases have been reported in literature. Reference is made to a clinical case cared for in the Federal Democratic Republic of Ethiopia in 2003 with panglandular compromise and uncertain previous diagnoses until its definitive conclusionRosai-Dorfman syndrome is a multisystemic disorder of unknown aetiology and pathogenesis, but it is thought that it represents a reactive histiocytic process to an infective agent instead of a neoplasia or other primary condition. Less than 1 000 cases associated with different diseases have been reported in literature. Reference is made to a clinical case cared for in the Federal Democratic Republic of Ethiopia in 2003 with panglandular compromise and uncertain previous diagnoses until its definitive conclusion(AU)
Subject(s)
Humans , Male , Adolescent , Histiocytosis, Sinus/diagnosis , Histiocytosis, Sinus/surgeryABSTRACT
Se realizó un estudio descriptivo transversal en 76 pacientes portadores de fisura labio palatina en la consulta de Cirugía Maxilofacial del Hospital General Especializado San Paulos de la Ciudad de Addis Ababa, durante la prestación de servicio asistencial internacionalista. El 60,5 por ciento de los pacientes resultó ser del sexo masculino; un gran porcentaje de pacientes (26,3; 22,4 y 17,1 por ciento), sobrepasaba la "edad de oro" de la atención apropiada de sus deformidades. La fisura unilateral completa derecha (47,1 por ciento) predominó sobre los otros tipos de fisura. El 82,9 por ciento de los pacientes fue objeto de la reparación según el método de Millard II; se obtuvieron resultados satisfactorios en el 88,9 por ciento de los casos(AU)
A descriptive cross-sectional study was conducted among 76 patients carriers of cleft lip and palate in the office of Maxillofacial Surgery of San Paulos General Specialized Hospital in the city of Addis Adaba, during the rendering of internationalist health care services. 60,5 percent of the patients were males. A great percentage of these patients (26,3; 22,4 y 17,1 per cent) exceeded the golden age to receive the appropriate treatment of their deformities. The complete right unilateral cleft (47,1 per cent) prevailed over the other types of clefts. 82,9 per cent of the patients underwent repairing according to Millard I method. Satisfactory results were attained in 88.9 per cent of the cases(AU)
Subject(s)
Humans , Male , Infant, Newborn , Adolescent , Adult , Cleft Palate/surgery , Cleft Lip/surgeryABSTRACT
La enfermedad de Rosai Dorfman es un desorden multisistémico de etiología y patogénesis desconocidas, pero se piensa que representa un proceso reactivo histiocítico a un agente infectante en lugar de una neoplasia u otra condición primaria. Se han informado en la literatura menos de 1 000 casos que han estado asociados con disímiles enfermedades. Se hace referencia de un caso clínico atendido en la República Democrático Federal de Etiopía en el año 2003 con compromiso panglandular y diagnósticos previos inciertos hasta su conclusión definitiva(AU)
Rosai-Dorfman syndrome is a multisystemic disorder of unknown aetiology and pathogenesis, but it is thought that it represents a reactive histiocytic process to an infective agent instead of a neoplasia or other primary condition. Less than 1 000 cases associated with different diseases have been reported in literature. Reference is made to a clinical case cared for in the Federal Democratic Republic of Ethiopia in 2003 with panglandular compromise and uncertain previous diagnoses until its definitive conclusionRosai-Dorfman syndrome is a multisystemic disorder of unknown aetiology and pathogenesis, but it is thought that it represents a reactive histiocytic process to an infective agent instead of a neoplasia or other primary condition. Less than 1 000 cases associated with different diseases have been reported in literature. Reference is made to a clinical case cared for in the Federal Democratic Republic of Ethiopia in 2003 with panglandular compromise and uncertain previous diagnoses until its definitive conclusion(AU)
Subject(s)
Humans , Male , Adolescent , Salivary Glands/injuries , Histiocytosis, Sinus/surgery , Histiocytosis, Sinus/diagnosis , Review Literature as TopicABSTRACT
Se realizó un estudio descriptivo transversal en 76 pacientes portadores de fisura labio palatina en la consulta de Cirugía Maxilofacial del Hospital General Especializado San Paulos de la Ciudad de Addis Ababa, durante la prestación de servicio asistencial internacionalista. El 60,5 por ciento de los pacientes resultó ser del sexo masculino; un gran porcentaje de pacientes (26,3; 22,4 y 17,1 por ciento), sobrepasaba la "edad de oro" de la atención apropiada de sus deformidades. La fisura unilateral completa derecha (47,1 por ciento) predominó sobre los otros tipos de fisura. El 82,9 por ciento de los pacientes fue objeto de la reparación según el método de Millard II; se obtuvieron resultados satisfactorios en el 88,9 por ciento de los casos(AU)
A descriptive cross-sectional study was conducted among 76 patients carriers of cleft lip and palate in the office of Maxillofacial Surgery of San Paulos General Specialized Hospital in the city of Addis Adaba, during the rendering of internationalist health care services. 60,5 percent of the patients were males. A great percentage of these patients (26,3; 22,4 y 17,1 per cent) exceeded the golden age to receive the appropriate treatment of their deformities. The complete right unilateral cleft (47,1 per cent) prevailed over the other types of clefts. 82,9 per cent of the patients underwent repairing according to Millard I method. Satisfactory results were attained in 88.9 per cent of the cases(AU)
Subject(s)
Humans , Male , Infant, Newborn , Adolescent , Adult , Cleft Lip/surgery , Cleft Palate/surgeryABSTRACT
PURPOSE: This study prospectively investigates the long-term success of iliac crest bone grafting and the secondary placement of osseointegrated implants in reconstructing maxillae with severely reduced bone mass. MATERIALS AND METHODS: Eight consecutive patients (7 women, 1 man), aged 18 to 69 (mean, 49.6), were treated by augmentation of their maxillae with corticocancellous autogenous iliac bone blocks. Forty-one Branemark implants of 7 to 15 mm in length and 3.75 mm in diameter were placed after a minimum delay of 6 months. Bone healing, maintenance of bone height, and implant stability were measured by clinical examination and radiographic control. RESULTS: One patient was lost to follow-up at 24 months after delivery of the prosthesis and one was lost at 75 months. The average duration of follow-up after loading of the implants was 90.5 months, and the longest was 154 months. Thirty-four of 41 (83%) of the implants survived to the end of the observation period. Four of 6 implants that failed were 7 mm in length and the other 2 were 10 mm in length. One 10-mm implant was "slept" because of poor positioning. All prostheses survived. There was one significant gingival infection that resulted in loss of 1.5 mm of bone after which the implant remained stable. None of the other implants were associated with crestal bone loss of more than 0.5 mm for the duration of this study. CONCLUSIONS: Delayed placement of osseointegrated implants in maxillae augmented by iliac bone grafts is predictable and successful in the long term.
Subject(s)
Alveolar Ridge Augmentation/methods , Bone Transplantation , Dental Implantation, Endosseous/methods , Dental Implants , Maxilla/surgery , Adolescent , Adult , Aged , Alveolar Bone Loss/surgery , Dental Implantation, Endosseous/adverse effects , Dental Prosthesis Design , Dental Restoration Failure , Female , Follow-Up Studies , Humans , Jaw, Edentulous/rehabilitation , Male , Maxillary Diseases/surgery , Middle Aged , Prospective Studies , Surgical Wound Infection , Treatment OutcomeABSTRACT
In the last decade chemotherapy has gained widespread acceptance in the treatment of oral and pharyngeal cancer. Current standard treatment for advanced lesions consists of concomitant radiation and chemotherapy. This approach has provided marginal improvement of prognosis for Stage III-IV disease. Recent studies have explored the idea that locally delivered cytotoxic drugs could further improve prognosis in this patient population. We review this literature with the objective of popularizing these data and suggesting future directions for treatment and clinical research for head and neck cancer.
