RESUMO
INTRODUCTION: Surgical management of skin cancer is an important part of modern maxillofacial surgery. The common tumours treated are squamous cell carcinoma, malignant melanoma and some benign lesions, but the largest group of tumours are the basal cell carcinomas. Although only locally aggressive, if they are not completely removed, recurrence may occur and be troublesome, especially in the head and neck. Even in this region, incomplete excision is uncommon, less than 20 %, but management of positive margins remains controversial. This review evaluates the effectiveness of a further surgical intervention after a positive margin. MATERIALS AND METHODS: A retrospective audit was undertaken to determine the rate of positive margins within the unit and subsequently the percentage of residual tumour found in any secondary excisions. RESULTS: The results show that in a sample of 247 patients, 11 % had positive peripheral margins. A second excision only showed that 36 % had any evidence of residual tumour. DISCUSSION: The study raises the question of the value of further surgery. Finally, the authors suggest a more focused approach to the finding of a positive margin before the patient is offered more treatment.
Assuntos
Carcinoma Basocelular/cirurgia , Neoplasias Faciais/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasia Residual/cirurgia , Neoplasias Cutâneas/cirurgia , Carcinoma Basocelular/patologia , Comportamento Cooperativo , Neoplasias Faciais/patologia , Seguimentos , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Comunicação Interdisciplinar , Neoplasia Residual/patologia , Prognóstico , Reoperação , Estudos Retrospectivos , Pele/patologia , Neoplasias Cutâneas/patologiaRESUMO
Donor site morbidity is important in deciding the site for harvest of cancellous bone for alveolar bone grafts. Many studies have supported the view that tibia is safe with few complications in the short term. We know of no studies on the long-term complications to the donor site after tibial bone grafting in children with alveolar clefts. The casenotes of 40 children who had had tibial bone grafts for alveolar clefts were studied retrospectively, and parents or patients were contacted by telephone and a standardised questionnaire was used to assess any long term complications at the donor site. We found none. We found no evidence of long-term complications at the donor site in children who had had proximal tibial bone grafting for secondary repair of alveolar clefts. We conclude that the proximal tibia is a safe site from which to obtain cancellous bone graft for alveolar clefts in children. This study is preliminary, and highlights the need for a randomised trial.
