ABSTRACT
OBJECTIVE: The main aim of this article was to review the clinical and biological factors that have been shown to influence the response of the head and neck squamous cell carcinoma (HNSCC) to primary radiotherapy and briefly discuss how some of these factors could be exploited to improve outcome. DESIGN: Medline based search covering 1982-2006 to identify the HNSCC literature where the effect of clinical and biological factors on locoregional control and overall survival were investigated. RESULTS: Clinical factors are routinely used in management decisions. Nevertheless, identically staged tumours receiving the same treatment may have different outcomes. Biological factors such as hypoxia, proliferation and radio-sensitivity play an important role in radiation response. However, these are not currently used in practise because tests that are clinically reliable and feasible are not available. CONCLUSION: High-quality translational research will allow us to develop biological tests that can be used in routine clinical practise to tailor individual treatment, with the ability to improve patient outcome further by modifying the underlying tumour biology.
Subject(s)
Biomarkers, Tumor/metabolism , Carcinoma, Squamous Cell/radiotherapy , Cell Proliferation/radiation effects , Head and Neck Neoplasms/radiotherapy , Biomarkers, Tumor/radiation effects , Carcinoma, Squamous Cell/metabolism , Carcinoma, Squamous Cell/pathology , Cell Hypoxia/radiation effects , Dose-Response Relationship, Radiation , Head and Neck Neoplasms/metabolism , Head and Neck Neoplasms/pathology , HumansABSTRACT
Sixty-eight patients were evaluated 6 months to 6 years after treatment for oral cancer using standardized questionnaires to explore the influence of age, sex, site and stage of tumour, and primary treatment on their functional status measured by the University of Washington Quality of Life Questionnaire (UW-QoL), and the association between functional status and psychological outcome measured by the Hospital Anxiety and Depression Scale (HADS), style of coping measured by the Mental Adjustment to Cancer Questionnaire (MAC-Q), and social support measured by the Short-Form Social Support Questionnaire (SSQ-6). Young patients, women, patients with advanced tumours, those with oropharyngeal tumours and those who had been treated with both surgery and radiotherapy reported worse function. The worse the functional domain, the more likely it was to be associated with anxiety, depression and ineffective coping style, and better functional scores were weakly associated with fighting spirit, level of social support and satisfaction with that support. We have identified patients at need and highlighted their problems. Dealing with these problems may ultimately improve the perception of function after treatment of oral cancer.
Subject(s)
Activities of Daily Living , Adaptation, Psychological , Attitude to Health , Head and Neck Neoplasms/psychology , Mouth Neoplasms/psychology , Social Support , Adult , Age Factors , Aged , Aged, 80 and over , Anxiety/classification , Anxiety/psychology , Combined Modality Therapy , Depression/classification , Depression/psychology , Female , Follow-Up Studies , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/therapy , Humans , Male , Middle Aged , Mouth Neoplasms/pathology , Mouth Neoplasms/therapy , Neoplasm Staging , Oropharyngeal Neoplasms/psychology , Personal Satisfaction , Quality of Life , Sex Factors , Social Adjustment , Statistics, Nonparametric , Surveys and QuestionnairesABSTRACT
Twenty-three patients undergoing oral reconstructive surgery with radial forearm free flaps had a vascular assessment of the forearm preoperatively. Segmental upper limb pressures were measured and colour flow duplex visualization of forearm vessels and blood flow done. In 18 the blood pressure and flow were within normal limits, but five (22%) showed either unilateral or bilateral arteriopathy or aberrant vascular anatomy. Identification of pre-existing vascular disease helps to rationalize the selection of donor vessels, reduces the risk of ischaemic damage to the hand after disruption of the radial artery and may be of benefit in reducing the incidence of failure of free flaps.
Subject(s)
Forearm/blood supply , Mandibular Neoplasms/surgery , Mouth Neoplasms/surgery , Surgical Flaps , Adult , Aged , Blood Flow Velocity , Blood Pressure Determination , Carcinoma, Squamous Cell/rehabilitation , Carcinoma, Squamous Cell/surgery , Female , Forearm/surgery , Hand/blood supply , Humans , Male , Mandibular Neoplasms/rehabilitation , Middle Aged , Mouth Floor/surgery , Mouth Neoplasms/rehabilitation , Preoperative Care , Radial Artery/pathology , Ulnar Artery/abnormalities , Ulnar Artery/pathology , Ultrasonography, Doppler, Color , Ultrasonography, Doppler, DuplexABSTRACT
A case of posterior fracture-dislocation of the mandibular condyle which resulted in conductive deafness and cholesteatoma is presented. Initial management by condylectomy improved auditory canal patency but failed to prevent the development of cholesteatoma, necessitating mastoid surgery. Although major complications following fractures of the condyle are not common the need to consider the possibility of damage to the ear in such fractures is emphasised.
Subject(s)
Cholesteatoma, Middle Ear/etiology , Hearing Loss, Conductive/etiology , Joint Dislocations/complications , Mandibular Condyle/injuries , Mandibular Fractures/complications , Adult , Cholesteatoma, Middle Ear/surgery , Ear Canal/pathology , Ear Ossicles/surgery , Humans , Joint Dislocations/surgery , Male , Mandibular Condyle/surgery , Mandibular Fractures/surgery , Mastoid/surgeryABSTRACT
A technique for resection of a palatal tumour via a Le Fort 1 maxillary access osteotomy is described. Access via the osteotomy allows intra-operative examination of the superior aspect of the palate and resection of the tumour without gross destruction of the nasal mucosa. The nasal mucosa provides a bed for a full-thickness skin graft to effect closure of the palatal defect.
Subject(s)
Maxilla/surgery , Osteotomy/methods , Palatal Neoplasms/surgery , Palate/surgery , Skin Transplantation , Humans , Mouth Mucosa/surgery , Nasal Mucosa/pathology , Nasal Mucosa/surgery , Salivary Gland Neoplasms/surgery , Salivary Glands, Minor/surgeryABSTRACT
One hundred and twenty-four fine needle cutting biopsies of lesions of the head and neck have been carried out over the last 7 years. While the overall accuracy of diagnosis was 79%, the accuracy of the 43 biopsies carried out during the last 2 years was 93%. These results compare very favourably with published results of the accuracy of fine needle aspiration cytology.
Subject(s)
Biopsy, Needle/methods , Head and Neck Neoplasms/pathology , Biopsy, Needle/instrumentation , Carcinoma, Squamous Cell/pathology , Diagnosis, Differential , Equipment Design , Humans , Neck/pathology , Needles , Parotitis/pathology , Sialadenitis/pathology , Submandibular Gland Diseases/pathology , SyringesABSTRACT
Fifty-three British senior registrars in oral and maxillofacial surgery (OMS) were sent a questionnaire designed to determine their views on some of the main aspects of training in the specialty. Thirty-seven returns were received (70%), 36 completed. This paper reports and discusses the results of the survey.
Subject(s)
Attitude of Health Personnel , Medical Staff, Hospital , Surgery, Oral/education , Education, Dental , Education, Dental, Graduate , Education, Medical , Education, Medical, Graduate , Education, Medical, Undergraduate , Humans , Internship and Residency , Personal Satisfaction , Scotland , Time FactorsABSTRACT
A case report of synovial chondromatosis of the temporomandibular joint is presented in which the limitations of clinical findings, needle biopsy, standard radiography and computer assisted tomography were exposed and the importance of clinico-pathology consultation reaffirmed.
Subject(s)
Chondromatosis, Synovial/pathology , Temporomandibular Joint Disorders/pathology , Adult , Diagnosis, Differential , Female , Humans , Joint Loose Bodies/pathologyABSTRACT
A rare case of symptomless central neurilemmoma of the mandible is reported. Post-operative recovery was uneventful and, in particular, post-surgical paraesthesia was followed by a return to normal sensation.
Subject(s)
Mandibular Neoplasms/pathology , Neurilemmoma/pathology , Aged , Diagnosis, Differential , Humans , Male , Mandibular Neoplasms/diagnosis , Neurilemmoma/diagnosis , ParesthesiaABSTRACT
A case of dental infection with spread to the mediastinum causing pericarditis and cardiac tamponade is described. The clinical course of the disease, the investigations undertaken and the treatment given are outlined.
Subject(s)
Focal Infection, Dental/complications , Mediastinitis/etiology , Pericarditis/etiology , Abscess/complications , Adult , Face , Humans , Male , Neck , Shock, Septic/etiologyABSTRACT
A case is reported of a 7 year-old girl who suffered a central luxation of the mandibular condyle into the middle cranial fossa. The management and previously reported cases are discussed.
