Staging and grading as prognostic factors in maxillary squamous cell carcinoma.

PURPOSE: This retrospective study was performed to present our long-term results in the treatment of maxillary squamous cell carcinoma and evaluate especially the influence of T staging and grading on patients' survival. PATIENTS AND METHODS: We performed a retrospective analysis of 93 consecutive patients with alveolar, gingival, or palatal maxillary SCC treated at our clinic with surgical resection and/or radiation therapy. Data were obtained from chart review and patients' records and were analyzed statistically using the log-rank test and Kaplan-Meier survival curves. The male:female ratio was 2:1 and the mean age was 63 years (range 35 to 94 yrs). Most patients showed a T4 stage (66%) and the most frequent staging was T4N0M0 (42%). The most common histopathological grading was G2 (57%), followed by G3 (22%) and G1 (21%). The 5-year overall survival rate was 71%, and the recurrence rate was 37%. Advanced T stage (T4) and grading did not significantly influence the cumulative survival rates. CONCLUSIONS: T-stage and grading do not have a significant impact on patients' long-term survival. The most crucial factor for recurrence prevention and therefore survival are free resection margins.

Antibiotic susceptibility and resistance of the odontogenic microbiological spectrum and its clinical impact on severe deep space head and neck infections.

OBJECTIVE: The purpose of this retrospective study was to identify the major pathogens responsible for deep space head and neck infections and their current resistance to routinely used antibiotics in a university hospital setting. STUDY DESIGN: A total of 206 patients suffering from odontogenic deep space infections were treated at our department by means of surgical intervention and intravenous administration of antibiotics. RESULTS: The predominant bacteria were viridans group streptococci (VGS), staphylococci, Prevotella, Peptostreptococcus, and Bacteroides. In the aerobic spectrum, resistance against clindamycin was found in 18%, against macrolides in 14%, and against penicillin G in 7%. The anaerobes were resistant to clindamycin in 11%, to metronidazole in 6%, and to penicillin G in 8%. CONCLUSION: The high resistance rate for clindamycin and macrolides was especially striking and may necessitate an adaptation of our antibiotic regime in the future.

Closure of oroantral communications with Bichat's buccal fat pad.

PURPOSE: The aim of the present study was to evaluate the use of the pedicled buccal fat pad for the closure of oroantral communications (OACs) and to describe our experience with this surgical procedure. PATIENTS AND METHODS: A retrospective review of 161 patients treated at the University Hospital for Cranio-Maxillofacial and Oral Surgery in Vienna, Austria, from 2000 to 2005, with the diagnosis of an OAC was performed. All defects were closed by application of a buccal fat pad. Data were obtained from chart review, a compiled database, and clinical follow-up and included the location of the defect, the cause of the OAC, the modality of anesthesia, intraoperative complications, any complications during the process of wound healing, and any late adverse effects. RESULTS: The buccal fat pad for closure of an OAC was successfully used in 161 patients at our department. In 12 patients (7.5%), the closure of the OAC was insufficient, and a second operation was necessary. Excluding all severe and complicating cases such as tumor-related defects or previously treated cases, the overall success rate for closure of the OAC was nearly 98%. No late complications occurred, and all patients were free of pain or any limitations after the 6-month follow-up period. CONCLUSIONS: According to the recommendations and anatomic limitations reported in published studies and discussed in the present report, the application of the buccal fat pad is a safe and reliable procedure for closing an OAC.

Surgical treatment of squamous cell carcinoma of the maxilla and nasal sinuses.

PURPOSE: In the treatment of oral squamous cell carcinoma of the maxilla and paranasal sinuses, radical surgery and reconstruction with free flaps is accepted among many clinics. Nevertheless, the treatment protocols vary considerably. This study was performed to present our experience in the treatment of maxillary squamous cell carcinoma with surgical means alone, and to try to identify crucial prognostic factors for the patients' survival. PATIENTS AND METHODS: Thirty-six patients with primary resectable squamous cell carcinoma were included in the study. The mean age was 63 years (43-87 years) and 50% presented in advanced tumor stage (T4). Five patients (14%) already had cervical metastases. All patients were treated by radical surgery alone, and the resulting defects were closed by means of local or free flaps or the use of an obturator, respectively. RESULTS: The overall 5-year survival rate was 64%; the recurrence rate was 33%. Only patients who presented in T3 or T4 stages or had no free resection margins died during the follow-up period. Sixty-nine percent of the patients who died passed away within the first 12 months of follow-up. The 5 patients with cervical metastases received therapeutic neck dissection and showed no regional recurrence. In cases of R1 resection, adjuvant radiotherapy was applied. CONCLUSIONS: The sole surgical treatment of squamous cell carcinomas of the maxillary region led to good results, and can therefore be seen as a valuable strategy. Free resection margins and early detection of the tumor are the most important factors for success.

Maxillomandibular fixation using intraoral cortical bone screws and specially designed metal hooks (Ottenhaken) in the conservative treatment of mandibular fractures.

PURPOSE: The present work evaluated the success of maxillomandibular fixation (MMF) by intraoral cortical bone screws and specially designed metal hooks (Ottenhaken) in nondislocated or slightly dislocated mandibular fractures. PATIENTS AND METHODS: A total of 44 patients who sustained various types of mandibular fractures were treated at the University Hospital for Craniomaxillofacial and Oral Surgery, Vienna Medical School by MMF with Ottenhaken only. The patients were evaluated by preoperative and postoperative radiography, and clinical testing was performed by thermal testing with a cold spray and by assessing the degree of tooth mobility adjacent to the inserted screws. To determine the success of the treatment, various parameters, including screw or hook fracture, screw loosening, local infection of the punctured mucosa, and iatrogenic tooth damage, were considered. RESULTS: The screws and hooks were successfully inserted and MMF was engaged with tight elastics in all cases. The most frequent complication was rupturing of the elastics, necessitating replacement. In 5 patients, local infection of the mucosa around the screw led to severe pain that was treated successfully with analgesics. The screws could be left in place in all 5 cases. Hook fracture and screw loosening each occurred in 1 patient. No iatrogenic injuries of the dental roots were noted. After screw removal, all wounds healed uneventfully. CONCLUSION: The use of intraoral cortical bone screws and specially designed metal hooks (Ottenhaken) for MMF is a useful, valid alternative to arch bars that carries only rare, mild complications.

Postoperative prophylactic antibiotic treatment in third molar surgery--a necessity?

PURPOSE: We evaluated the need for prophylactic postoperative oral antibiotic treatment in the removal of asymptomatic third molars. MATERIALS AND METHODS: In a prospective study of more than 30 months, a total of 528 impacted lower third molars were surgically removed in 288 patients. All patients were referred to our department by a dentist or a general practitioner. No patient showed any sign of pain, inflammation, or swelling at the time of removal. Three groups were established. In the first group, antibiotic treatment with amoxicillin/clavulanic acid as an oral medication was carried out for 5 days postoperatively. In the second group, we used clindamycin. In the third group, the patients received no antibiotic treatment. Clinical and radiologic factors were recorded for each case, and the rationale for assigning the patients to the groups was strictly random. The surgical technique was the same in all cases, and the follow-up period was 4 weeks. Parameters that were evaluated were pain, differences in mouth opening, infection, the occurrence of dry socket, and adverse postoperative side effects. RESULTS: We could not find any significant difference between the 3 groups regarding the evaluated parameters, but in 69.6% of the patients with dry socket, the teeth were partially erupted, which showed a significant difference. CONCLUSIONS: The results of our study show that specific postoperative oral prophylactic antibiotic treatment after the removal of lower third molars does not contribute to a better wound healing, less pain, or increased mouth opening and could not prevent the cases of inflammatory problems after surgery, respectively, and therefore is not recommended for routine use.