[INFLUENCE OF NECK DISSECTION ON THE CORRESPONDING MOTOR AND SENSORY NERVES]. / UTJECAJ DISEKCIJE VRATA NA ODGOVARAJUCE MOTORICKE I OSJETNE ZIVCE.

OBJECTIVE: Radical neck dissection (RND), utilized for treatment of lymph node metastases in patients with head and neck cancers, can result in clinically significant functional disturbance secondary to the corresponding nerve damage. However, there is only limited data relative to post-operative analysis of impact of RND on the cranial and cervical nerves after neck dissection especially regarding the technique used such as electroknife or scalpel. STUDY DESIGN: 48 patients (42 men and 6 women) with intraoral cancer were enrolled. A total of 55 dissections were performed, including 7 patients who received bilateral dissections. Analysis of motor and sensory nerves was conducted seven days and three months later with regard whether electroknife or scalpel was used. RESULTS: The most frequent post-operative loss of motor function was seen in accessory and hypoglossal nerves; within sensory nerves the lingual nerve was most frequently dysfunctional. Permanent diaphragm dysfunction was seen in 15% of investigated patients. CONCLUSION: We might conclude that routine evaluation of sensoneural and motor nerve function of all potentially damaged nerves should be performed after RND, especially regarding diaphragm paralysis. There were no differences in postoperative nerve function of the examined nerves with regard to the technique used (electroknife/scalpel).

Evaluation of pretreatment serum interleukin-6 and tumour necrosis factor alpha as a potential biomarker for recurrence in patients with oral squamous cell carcinoma.

BACKGROUND: Oral squamous cell carcinoma (OSCC) constitutes 3 percent of all cancers with predominant occurrence in middle aged and elderly males. Tumour recurrence worsens disease prognosis and decreases quality of life in patients with OSCC. Proinflammatory cytokines such as interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-α) have been suggested to play a certain role in variety of tumours. The aim of this study was to investigate the relationship of pretreatment serum IL-6 and TNF-α levels on tumour recurrence in patients with OSCC in order to identify potential biomarkers for the early detection of disease recurrence. MATERIAL AND METHODS: The patients with newly diagnosed OSCC were treated and followed from the first visit from November 2006 until January 2008. Serum IL-6 and TNF-α concentrations were measured. The records of the patients were re-examined in July 2012 and data were recorded about cancer characteristics and tumour recurrence. Disease free survival was analyzed by Kaplan-Meier survival curves, log rank test and Cox proportional hazards regression. RESULTS: Serum IL-6 was shown as an independent risk factor for tumour recurrence. CONCLUSIONS: Pretreatment serum IL-6 concentration may be a useful biomarker for identification of OSCC patients with increased risk of the disease recurrence.

Simultaneous presentation of oral and skin anaplastic large T-cell lymphoma.

We present case of oral and skin anaplastic T-cell lymphoma in a 68-year-old woman. The patient presented with extensive ulcerations and necrotic tissue on the left mandibular gingiva. Orthopantomogram finding showed extensive necrolytic lesions of the adjacent mandible. Biopsy finding of oral lesions and subsequently of the skin confirmed the diagnosis of anaplastic T-cell lymphoma. The bridge on the teeth 35-37 was taken out. After three cycles of chemotherapy, oral lesions subsided, unlike skin lesions. Dentists should be aware that differential diagnosis when dealing with oral ulcerations might be the result of certain malignant hematologic diseases.

Jaw injuries of independence victims from the 1991 War in Croatia.

In the aetiology of maxillofacial injuries, car accidents, violence, sports injuries and lately war injuries are frequently mentioned. The purpose of this study was to exhibit and analyse types of jaw injuries on bodies exhumed from massive and individual graves located in regions temporarily occupied during the War in Croatia that lasted from 1991 to 1995. The sample was the post-mortal documentation of the orofacial region (set of teeth, photographs, radiographic images) of 1068 victims exhumed from massive grave sites in Croatia. The jaw traumatism was analysed on the whole sample as well as on individual graves, whilst the analysis of trauma frequency was performed separately. Descriptive statistics were computed and the value of P < .05 was accepted as statistically significant. Results of this study showed that out of 1068 examined corpses, 332 had midface and lower face fractures, which was 31.1% of the total number. Lower face fractures were more frequent with 28.1%. Age related frequency analysis showed a significant dependency. There were 34.6% of fractures in the under 30 age group, 34.2% in those aged 30-60, while 21.3% of fractures were noted in the over 60 age group. Female bodies had the lowest number of jaw fractures regardless of the osteoporotic changes. The results of this study suggest that younger and middle aged persons were molested more. Jaw fractures suggest ante-mortal molestation. In females, the more likely fracture causes were the falls of the bodies into the graves or body to body hits.

Evaluation of sentinel node biopsy in oral carcinomas.

It is still a matter of debate whether sentinel node biopsy might replace neck dissection in patients with clinically negative neck lymph nodes who suffer from oral squamous cell carcinoma. In 30 patients (26 male, 4 female, average age 59.4 years) with oral squamous cell carcinoma we performed ultrasound guided punction of the lymph nodes which were lymphoscintigraphically seen together with histopatological analysis of the dissected node. Sentinel lymph node was seen in 93% cases. By use of lymphoscintigraphy sentinel node was verified in 23 patients. Ultrasound guided punction showed presence of regional disease in 10% of cases, whereas sentinel biopsy revealed 23 of the converted necks. Histopathological findings were positive in 33% of our patients. The results of this study revealed that sentinel biopsy did not reveal 27% of the patients with positive neck histopathology. In conclusion, sentinel node biopsy should be performed in selective cases as in some localizations it is easier to perform neck dissection in comparison to the sentinel node biopsy.

Sclerosing polycystic adenosis of parotid gland: a unique report of two cases occurring in two sisters.

Sclerosing polycystic adenosis (SPA) of salivary glands is a tumorous lesion of salivary glands, with clinical presentation of a slow-growing mass characterized by a combination of histological features, some of which are reminiscent of mammary fibrocystic disease. SPA is mostly unifocal, but rarely may be multifocal and/or bilateral. Recurrences have been reported in up to 19% of cases. Although originally considered pseudoneoplastic, the occurrence of "dysplasia" and carcinoma in situ of ductal epithelium, and recent evidence of clonality suggest a possible neoplastic nature. Herein we describe, for the first time, two cases of SPA in two sisters (7 and 33 years old). The younger patient experienced multiple recurrences. This is the first report of familial occurrence of SPA, suggesting a possible genetic background.

Salivary and serum interleukin 1 beta, interleukin 6 and tumor necrosis factor alpha in patients with leukoplakia and oral cancer

Objectives: The aim of study was to compare salivary and serum concentrations of interleukin 1 beta (IL-1Beta), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-Alpha) in patients with oral leukoplakia, oral cancer and healthy controls. Study design: Eighty eight patients (28 with oral cancer, 29 leukoplakia, and 31 healthy controls) were included in this study. Cytokine concentrations were measured by commercial enzyme linked immunoassay. Results: Salivary IL-1Beta and IL-6 were significantly higher in oral cancer patients than in patients with leukoplakia and control group (p<0.05). No differences in concentrations of salivary TNF-Alpha between either of the groups were observed. Serum concentrations of IL-1Beta were below level of detection in all but two participants. No significant differences between the groups were observed in serum concentrations of IL-6. Serum TNF-Alpha was significantly higher in control subjects than in oral cancer patients. Conclusions: Patients with oral cancer have elevated levels of inflammatory cytokines in their saliva. Whether this elevation can be used for monitoring the malignant transformation of oral leukoplakia remains to be answered by further follow up studies (AU)

Salivary and serum interleukin 1 beta, interleukin 6 and tumor necrosis factor alpha in patients with leukoplakia and oral cancer.

OBJECTIVES: The aim of study was to compare salivary and serum concentrations of interleukin 1 beta (IL-1ß), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) in patients with oral leukoplakia, oral cancer and healthy controls. STUDY DESIGN: Eighty eight patients (28 with oral cancer, 29 leukoplakia, and 31 healthy controls) were included in this study. Cytokine concentrations were measured by commercial enzyme linked immunoassay. RESULTS: Salivary IL-1ß and IL-6 were significantly higher in oral cancer patients than in patients with leukoplakia and control group (p<0.05). No differences in concentrations of salivary TNF-α between either of the groups were observed. Serum concentrations of IL-1ß were below level of detection in all but two participants. No significant differences between the groups were observed in serum concentrations of IL-6. Serum TNF-α was significantly higher in control subjects than in oral cancer patients. CONCLUSIONS: Patients with oral cancer have elevated levels of inflammatory cytokines in their saliva. Whether this elevation can be used for monitoring the malignant transformation of oral leukoplakia remains to be answered by further follow up studies.

The prevalence of human papillomavirus 16 and Epstein-Barr virus in patients with oral squamous cell carcinoma.

It has been suggested that certain viruses such as human papillomaviruses (HPV) and Epstein-Barr virus (EBV) might have a role in oral squamous cell carcinoma (OSCC). However, results of the published studies are controversial and are dependent on the geographic distribution and methods of sampling and sample analysis. The aim of this study was to determine the prevalence of HPV 16 and EBV in OSCC patients. In 24 patients with OSCC (mean age 59.6 +/- 8.8) and 30 controls (mean age 49.1 +/- 8.3), 5 mL of blood was collected to determine the prevalence of EBV by serologic methods. In addition, swabs were obtained to analyze the presence of HPV 16 and EBV by use of polymerase chain reaction. Statistical analysis was performed by use of Mann-Whitney test, chi2-test and Spearman correlation test. The results of this study showed that there were no significant differences between OSCC patients and control subjects according to the presence of EBV or HPV 16. Therefore, it can be concluded that the role of the aforementioned viruses is less likely in our population of OSCC patients.

Salivary analytes in patients with oral squamous cell carcinoma.

Literature data indicates that measurement of certain salivary constituents might serve as a useful diagnostic/prognostic tool in the patients with oral squamous cell carcinoma (OSCC). In 24 patients with OSCC (60 +/- 2.5 yrs) and in 24 controls (24 +/- 3.7 yrs) we have determined levels of salivary magnesium, calcium, copper, chloride, phosphate, potassium, sodium, total proteins and amylase. Sodium, potassium and chloride were determined by indirect potentiometry whereas copper, magnesium and phosphate were determined by atomic absorption spectrophotometry. Total proteins were determined by pyrogalol colorimetric method. Amylase levels were determined by continued colorimetric method. Statistical analysis was performed by use of chi2 test and Spearman's correlation test. The results of this study indicate that the concentrations of sodium and chloride were significantly elevated in patients with OSCC when compared to the controls. However, level of total protein was significantly decreased when compared to the healthy controls. Furthermore, there was a negative correlation between alcohol consumption and total protein concentration in patients with oral carcinoma. We might conclude that in patients with OSCC increased salivary sodium and chloride might reflect their overall dehydration status due to alcohol consumption rather than consequence of OSCC itself.

Latissimus dorsi-scapula free flap for reconstruction of defects following radical maxillectomy with orbital exenteration.

A total of 21 patients with latissimus dorsi-scapula free flap reconstruction immediately following radical maxillectomy together with orbital exenteration are presented. Orbital exenteration was performed in all patients due to tumour invasion at the time of diagnosis. There was no total flap failure. Two tissue components subdivided into separate flap units with individual vascular pedicles linked by a single vascular source provide an ideal reconstructive solution for massive defects of the mid-face and orbit. Separate arcs of rotation of each flap unit permit greater mobility necessary for complex three-dimensional reconstruction. A vertically positioned angle of the scapula enables simultaneous reconstruction of the malar eminence and alveolar ridge whereas spontaneous intraoral epithelialisation of the latissimus dorsi muscle requires no additional procedure. For these reasons, in our opinion, combined latissimus dorsi-scapula free flap should be considered the first choice in reconstruction of defects following total maxillectomy with orbital exenteration.

The pectoralis major flap in head and neck reconstruction: first 500 patients.

AIM: The aim of this study was to evaluate almost 20 years of using the pectoralis major flap in head and neck reconstruction at the Department of Maxillofacial Surgery, Zagreb. PATIENTS: In the period from 1981 to 1999, a total of 506 pectoralis major flaps were used for head and neck reconstruction in 500 patients. In all cases the flap was used after surgical resection of an advanced malignant tumour of the head and neck. RESULTS: The tumours were intraoral in 387 cases (77%), pharyngeal in 78 cases (15%) and on the skin in 10 cases (5%). The defect was located in the mucosal lining in 407 (81%), skin in 43 (8%), both intra- and extraoral in 53 (10%) patients. Bone defects occurred in 65 patients. In 31 patients (6%), the pectoralis major flap was used in combination with other flaps (deltopectoral, tongue, trapezius and free flaps). Complications occurred with 168 flaps (33%), but total flap necrosis was only seen in 10 patients (2%). Surgical treatment of complications was necessary in 87 patients (17%). CONCLUSION: Despite the increasing use of microvascular reconstruction, the pectoralis major myocutaneous flap continues to be the most universal major flap in head and neck reconstruction.