The role of magnetic resonance imaging and computed tomography in oral squamous cell carcinoma patients' preoperative staging.

Introduction: The aim of the study was to evaluate the accuracy of MRI and CT with regard to the detection of lymph node metastases based on the data of specific patients with OSCC who received bilateral neck dissection. Materials and methods: In a retrospective analysis from 01/2014 to 12/2020 patients who underwent primary tumor resection and bilateral neck dissection were evaluated. Results: 174 preoperative MRI (78.74%, N=137) and CT (21.26%, N=37) were correlated with the histopathological findings. CT had a sensitivity of 67% and specificity of 68% (p=0.76). MRI showed an overall sensitivity of 66% and a specificity of 68% (p=0.76). In 52.87% of all cases no differences between cN and pN were found. MRI is the method to overestimate lymph node involvement compared to CT (overestimation in 27% vs. 21.62%). Conclusion: The current data indicate that MR and CT show poor efficacy in the detection of cervical metastases. Accordingly, attention must be paid to alternatives to correct local staging modalities. The application of structured bilateral neck dissection needs to be questioned.

Hyperspectral Imaging Allows Evaluation of Free Flaps in Craniomaxillofacial Reconstruction.

INTRODUCTION: Treatment of extended defects after tumor resection in oral, maxillofacial, and facial surgery (craniomaxillofacial) is usually performed by free microvascular flaps. Evaluation of flap survival is crucial, especially in the first hours after insertion and connection. For flap evaluation various invasive and noninvasive methods have been developed. This retrospective clinical study examined the ability of a hyperspectral imaging (HSI) camera (Tivita, Diaspective Vision, Germany) to assess postoperative flap properties in comparison to established clinical parameters. MATERIALS AND METHODS: Thirteen patients with tumor resection and free flap reconstruction were included for camera analysis and another 10 patients as control group. For this purpose, at defined time intervals and under standardized conditions, recordings of transplants 3 to 100 hours postoperatively were performed. Images were used to examine oxygenation (StO 2 %), tissue hemoglobin index, tissue water index, near infrared range perfusion index of free flaps quantitatively and qualitatively. RESULTS: HSI provides values differing between patients observed with no intraindividual significant difference. After 24 hours a mean reduction of 16.77% for StO 2 %, 9.16% for tissue hemoglobin index and 8.46% was observed, going in line with no loss of flap was noted in the observation period. CONCLUSION: HSI is suitable as a noninvasive measure for the evaluation of free flaps in craniomaxillofacial surgery in case of stable imaging conditions with respect to light, surrounding and position of the camera. However, clinical measurements are still the method of choice.

Extent of Neck Dissection and Cervical Lymph Node Involvement in Oral Squamous Cell Carcinoma.

Introduction: Tumor resection combined with neck dissection (ND) or radiotherapy are established methods for the treatment of patients with oral squamous cell carcinoma (OSCC). However, the extent of ND can lead to postoperative complications. Therefore, for the first time, this study aims to identify lymph node involvement in OSCC performed in a bilateral systematic approach based on oncologic board meetings relying on presurgical magnetic resonance imaging (MRI) and computed tomography (CT). Materials and Methods: In a retrospective single-center study, patients with primary OSCC resection and systematic ND performed in 4 different manners (MRND III bilateral, MRND III left and SND right, MRND III right, SND left, and SND bilateral) were examined. Lymph node involvement allocated to levels was evaluated depending on primary localization and T-stage. Results: A total of 177 consecutive patients (mean age 63.64; 92 female, male 85) were enrolled in this study. A total of 38.98% showed cervical lymph node involvement, and metastases were found in levels 1-4. The distribution of positive lymph node metastases (n=190 LNs) was 39.47% in level 1, 38.95% in level 2, 10.53% in level 3, and 11.05% in level 4. Discussion: In a cohort of OSCC patients with systematic bilateral ND, levels 1 and 2 had positive lymph node involvement, and no lymph node involvement was seen at level 5. Without any clinical or imaging suspicion, ND expanding 5-level MRND should be avoided regardless of the primary tumor localization, T-stage and intraoperative proof of cervical metastases.

Image Fusion Improves Interdisciplinary Communication in the Treatment of Head and Neck Cancer.

INTRODUCTION: The diagnosis and therapy of oral squamous cell carcinoma (Osee) in Germany is according to guidelines and relies on interdisciplinary board meetings. Standard examination techniques are computed tomography (CT) and magnet resonance imaging (MRI). These technologies are used as objective tools for serial presentation in an oncologic board meeting. The presentation of multiple series at different time points can be time consuming and might not often depict a patients case clearly for all involved disciplinaries. A conclusive image fusion could improve the communication. Thus, this study aims to introduce a novel idea of image fusion into the field of craniomaxillofacial surgery in order to ease understanding and improve therapy in complex Osee patients' cases. MATERIALS AND METHODS: Three key data sets of a patient with OSCC at the right tongue have been merged by image fusion of 3 MRi of head and neck with 3 CT thorax and abdomen using Syngo via (Siemens). Fused images were used as at a glance picture for presenting and discussion a patients case. Focus was on presenting a case of a primary manifestation of OSCC with the potential of a local relapse and distant metastases in an interdisciplinary oncol-ogic board meeting. RESULTS: Image fusion enabled to visualize the primary tumor, local relapse as well as distant pulmonary metastasis and within the suprarenal gland, which have been occurred in a linear time line of 13 months. DISCUSSION: Image fusion of different modalities that is CT and MRi, which were gathered at different time points, presents a new approach within the field of craniomaxillofacial surgery and helped to understand cancer localization and relapse at 1 glance. This new approach will enable a compact data set of patients oncological history as a more decisive tool for all involved disciplinaries. CONCLUSIONS: Image fusion might have the potential to become a standard approach in order to ease multiple therapists to make therapy decisions in oncologic board meetings on basis of current three-dimensional ready CT imaging and MRI.

Combined trauma in craniomaxillofacial and orthopedic-traumatological patients: the need for proper interdisciplinary care in trauma units.

AIM: The primary aim of this study was to analyze frequency and characteristics of combined facial and peripheral trauma with consecutive hospitalization and treatment. MATERIALS AND METHODS: The study included all patients with concomitant orthopedic-traumatolgical (OT) and craniomaxillofacial (CMF) injuries admitted to our level I trauma center in 2018. The data were collected by analysis of the institution's database and radiological reviews and included age, sex, injury type, weekday and time of presentation. All patients were examined and treated by a team of surgeons specialized in OT and CMF directly after presentation. RESULTS: A total number of 1040 combined OT and CMF patients were identified. Mean age was 33.0 ± 26.2 years. 67.3% (n = 700) were male patients. Primary presentation happened most frequently on Sundays (n = 199) and between 7 and 8 pm (n = 74). 193 OT fractures were documented, where cervical spine injuries were most frequent (n = 30). 365 facial and skull fractures were recorded. 10.8% of the 204 patients with fractures of the viscerocranium presented with at least one fracture of the extremity, 7.8% (16/204) with cervical spine fractures, 33.3% (68/204) with signs of closed brain trauma and 9.8% (20/204) with intracranial hemorrhage. DISCUSSION: The study shows a high frequency of combined facial with OT-injuries and brain damage in a predominantly young and male cohort. Attendance by interdisciplinary teams of both CMF and OT surgeons specialized in cervical spine trauma surgery is highly advisable for adequate treatment. CONCLUSION: Diagnostics and treatment should be performed by a highly specialized OT and CMF team, with a consulting neurosurgeon in a level-1 trauma center to avoid missed diagnoses and keep mortality low.

Patterns of Craniomaxillofacial Trauma After E-Scooter Accidents in Germany.

INTRODUCTION: E-Scooters are trending as an individual transport vehicle with electric drive in Germany. But there is less data about the frequency, demographic details and possible injuries and therapy needs in context with E-scooter accidents. Therefore, the primary aim of this study was to analyze the frequency and the characteristics of facial trauma as well as the consecutive hospitalization and management after injuries with E-scooters in a German clinic specialized in craniomaxillofacial surgery. MATERIALS AND METHODS: Retrospective data analysis of the hospital information system of patients admitted to central emergency unit driving e-scooters and injuries between June and December 2019. RESULTS: A total of 28 consecutive patients were admitted to the emergency care unit of a level one trauma center from June to December 2019. 85% had a minimum of two or more facial injuries. Most common were soft tissue injuries with 64% (n = 18), fractures with 54% (n = 15) and teeth injuries with 39% (n = 11). 82% percent of injuries were related with consumption of alcohol. DISCUSSION: The data show a variety of different injuries from teeth injury, wounds and facial fractures in varying degrees in a predominantly young and male cohort (mean age 33.57, 68% male) often associated with alcohol. As accidents happen especially at nighttime and on weekends personnel capacities should be provided. Still bicycle accidents and following injuries stay a major problem.

Three-Dimensional Magnetic Resonance Imaging Volumetry of Radial Forearm Flap Reconstructions After Craniomaxillofacial Tumor Resection.

BACKGROUND: Oral cancer is a common and life threatening disease that requires interdisciplinary treatment and often necessitates complex facial reconstruction. Standard care includes tumor resection, while reconstruction is routinely performed with free radial forearm flaps. As esthetic results are crucial for quality of life, flap size, flap volume, and flap composition have to be considered. To date no standardized measurement of flap volume and shrinkage has been established for routine use. The purpose of this study was therefore to evaluate the transplant volume of radial forearm flaps in craniomaxillofacial reconstruction using magnetic resonance imaging (MRI) volumetry. MATERIAL AND METHODS: Ten postoperative MR sequences of 5 patients were included. All patients had received transplantation of radial forearm flaps after tumor resection and radiation therapy. Evaluated parameters were: sex, age, type of flap, flap volume. Two different observers (1 surgeon and 1 radiologist) segmented transplant volume at three different time points in a postoperative MRI independently and in consensus, using both axial and coronal slices. A nonfat saturated T1 spin echo sequence was used. Mean transplant volume was calculated. RESULTS: A total of 90 volumetric measurements were included. Overall Tvolm was 24.83 cm from axial sections and 27.25 cm from coronal sections. Measurements for axial and coronal orientations differed significantly. Results showed excellent intra- and inter-rater correlation, coefficient for rater A and rater B were 0.91 (axial) and 0.96 (coronal). CONCLUSION: MRI volumetry is a noninvasive reproducible method to quantify volume of free radial forearm flaps in situ but should follow specific considerations for best results.