Ablation of advanced tongue cancer and mobile tongue reconstruction by using a sensitive anterolateral thigh and vastus lateralis muscle free flap.

BACKGROUND: Successful tongue reconstruction after total glossectomy for advanced tongue or base of tongue cancer should restore swallowing, speech function, and cosmesis. METHODS: The anterior lateral thigh flap sensitive myocutaneous (ALTF) with vastus lateralis muscle was used to reconstruct the oral defect in a patient undergoing total glossectomy with laryngeal preservation for T4 tongue cancer. RESULTS: Good functional outcomes, measured by independent feeding, speech and swallowing, were achieved. CONCLUSIONS: The anterolateral thigh myocutaneous flap for total tongue reconstruction creates a free neotongue tip with an adequate volume, producing acceptable swallowing function and cosmesis. The reconstruction with free flaps is a feasible method of restoring the functional outcomes in speech and deglutition among patients who undergo total glossectomy with laryngeal preservation.

Surgical management in a rare case of basaloid squamous cell carcinoma of the maxilla.

Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive version of squamous cell carcinoma (SCC) that preferentially occurs in the upper aerodigestive tract. Since the first description by Wain SL et al., in 1986, only 21 cases with BSCC in the nasal cavity or in the paranasal cavity have been reported in the English literature. We present a case of BSCC arising in a paranasal sinus, a 51-year-old male patient with four months history of right cheek swelling and unilateral nasal obstruction, who underwent an operation and postoperative radiotherapy. Clinical, pathological and surgical findings in this case are presented along with a brief discussion of literature.

Perineural invasion in head and neck cancers - a review.

RATIONALE: perineural invasion is an under-recognized way of metastatic spread via tumoral invasion of the nerves. It is encountered in malignancies located in the head and neck but also in cancers involving the pancreas, colon and rectum, prostate, biliary tract and stomach. For some tumors, it may be the only way of metastatic spread. It represents a marker for poor outcome, with increased risk for locoregional recurrence and reduced survival rates. The molecular mechanisms behind this process are not yet fully understood; research is done to identify new therapeutic targets in order to achieve disease control. OBJECTIVE: to make a rigorous analysis of this phenomenon and to highlight the best therapeutic approach. METHOD AND RESULTS: a review of the current literature in order to harmonize the international protocols to our local pathology. DISCUSSIONS: the surgical intervention is decisive to defeat the malignant process but must be associated with modern therapeutic methods, such as the image-guided radiation therapy and immunotherapy.

Orbital exenteration - a salvage procedure?

Orbital exenteration is a procedure performed usually for malignancies. The subsequent reconstructive efforts are directed towards rapid and stable healing but allowing detection of recurrent disease, obliteration of any communication between the orbit and surrounding cavities and above all a good quality of life. The surgical options must be tailored to each patient; we have to achieve first disease control and to compensate a 3D defect as best as we can. In the following, we present a series of three patients with aggressive tumors of the midface, admitted in our clinic in the last four years. For each case, orbital exenteration was performed in order to achieve tumor clearance. The results were good excepting one case (a relapse at three years interval) with a squamous cell carcinoma and perineural invasion.

A rare case of basaloid squamous cell carcinoma of the maxilla.

Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive variant of squamous cell carcinoma (SCC) that occurs preferentially in the upper aerodigestive tract. Since the first description by Wain SL et al., in 1986, only 21 cases with BSCC in the nasal cavity or in the paranasal cavity have been reported in the English literature. We present here a case of BSCC arising in a paranasal sinus. The case was a 51-year-old male patient with four months history of right cheek swelling and unilateral nasal obstruction, who received operation and postoperative radiotherapy. Clinical, surgical and pathological findings in this case, including immunohistochemistry is presented along with brief discussion of literature.

Correlations between the changes in patients' dental-facial morphology at the end of the orthodontic treatment and the psychological variables.

The purpose of this research was to assess the impact that the improvement of patients' dental-facial morphology has at the end of the orthodontic treatment upon the following psychological variables: self-esteem, current self-related thoughts as well as upon the variables of social self-esteem and performance. The number of patients included in the study was of 168 (82 children and 86 adolescents) who carried out the orthodontic treatment. At the end of the active treatment, we applied to all patients the assessment instruments for the level of self- esteem and self-related current thoughts: the Rosenberg's Self-Esteem Scale and the Heatherton & Polivy Current Thoughts Scale. As far as the patients in the study are concerned, the improvement of their facial aspect at the end of the treatment showed a significantly positive correlation with the variables of global self-esteem, self-related current thoughts, social self-esteem and performance, with the exception of the girls in children study group who showed no correlations between physical aspect and the performance variable.

Ultrastructural modifications at the level of marginal periodontium in the case of incorrect dental reconstruction.

Our study focused on the evolution of the marginal periodontium inflammatory process caused by an incorrect dental reconstruction. Our research studied a control group and a group of patients having traumatic and inflammatory lesions in different stages of evolution. A pronounced rarefaction of the junction desmosome structures as well as an inflammatory process pointed out by the presence of macrophages, neutrophils, Langerhans' cells, and mastocytes. The presence of altered fibroblasts and collagen fibers in the electron microscopic sections of vascular lesions represents microscopic signs of the inflammation and support the theory of local immunoglobulin synthesis.

[The reconstruction of the oral and maxillofacial defects with free vascularized flaps and microsurgical anastomoses]. / Plastia reconstructiva a defectelor oro-maxilo-faciale prin lambouri liber vascularizate si anastomozate microchirurgical.

The reconstruction of the oral and maxillofacial defects is difficult, because of the high specialisation of the tissues. In cancer resection, the post-operatory defects are quite important, because of the oncological principle of assuring free margins. The free flap is a modem and nowadays very used method in oral and maxillofacial reconstruction, after the removal of the malignant tumors with this localisation. These flaps are indicated for large defects, when the reconstruction with local or regional flaps is not possible. The wide variety of the raised tissues allows better results, making them the flaps of choice for large defects of the lip and cheek. The main advantages are related to the tri-dimensional extension of the free margins, assuring the quality of life and allowing early initiation of the radiotherapy in oncological patients.