Medical management determinants of the maxillofacial precancerous and benign diseases malignancy.

OBJECTIVE: Aim: To identify the medical management determinants of the maxillofacial precancerous and benign diseases malignancy. PATIENTS AND METHODS: Materials and Methods: 150 people with maxillofacial cancer and 100 people with precancerous and benign diseases of the same localization were interviewed. RESULTS: Results: There were revealed: a low percentage of detection during check-up (10.2-15.8%), more than a third of cases (35.8-37.4%) are diagnosed by chance; not all patients undergo histological verification of the diagnosis (25.7% in cancerous and 43.2% in precancerous and benign diseases); not all are under follow up observation (24.7-27.7%). The risk of precancerous and benign diseases malignancy is the highest at 40-59 years of age (OR=4.4; 95% CI: 1.9-10.5), andalso increases with the duration of the disease for more than 5 years (2.2; 1.2-4.10 ), in patients who didn't undergo histological verification (2.2; 1.3-3.8), don't follow doctors' recommendation on visits and treatment (2.4; 1.4-4.1), don't trust doctors and are dissatisfied with medical care (2.1; 1.3-3.6). The risk groups of the maxillofacial oncological, precancerous and benign diseases are men, who are 1.5 times more likely to suffer from them than women and are characterized by lower medical care activity. The risk factors of the maxillofacial precancerous and benign diseases malignancy are low financial (4.6; 1.7-12.4) and territorial (3.3; 1.1-10.3) accessibility of medical care, including dental care (2.8; 1.6-4.8). CONCLUSION: Conclusions: It is necessary to improve the prevention and medical care in order to advance the early detection of maxillofacial cancer, taking into account the established medical management determinants of malignancy.

Analgesic efficacy of the inferior alveolar nerve block for maxillofacial cancer surgery under general anaesthesia - A randomised controlled study.

Background and Aims: Mandibular resection during maxillofacial cancer surgery evokes a strong sympathetic response requiring high doses of opioids. We studied the effect of the inferior alveolar nerve block (IANB) for analgesia in maxillofacial cancer surgeries. Methods: This randomised controlled study was conducted over five months in a tertiary care cancer hospital following Institutional Ethics approval and trial registration. Fifty consenting adult patients belonging to the American Society of Anesthesiologists (ASA) physical status I and II requiring maxillofacial cancer surgery with unilateral mandibular resection were recruited. Twenty-five patients in the study arm received ipsilateral IANB; a mock injection was given to the control group. Fentanyl requirement and haemodynamic parameters during primary tumour excision were the primary and secondary endpoints. Student's t-test was applied to compare primary and secondary endpoints. Results: Forty-nine patients completed the study. Both arms were comparable with respect to age, gender distribution, ASA physical status and baseline heart rate (HR) and blood pressure (BP). The mean (standard deviation) intravenous fentanyl requirement during primary tumour excision in the IANB arm was 70(32) µg, significantly lower than 183(48) µg in the control arm, P < 0.001. The mean maximum HR during primary tumour excision was 82 and 99 per minute in the IANB and control arms, respectively (P < 0.001) whereas the maximum mean BP was 88 and 101 mm Hg, respectively (P < 0.001). Conclusion: IANB significantly reduced intraoperative fentanyl requirement and caused fewer haemodynamic changes during maxillofacial cancer surgery requiring unilateral mandibular excision.

Maximum surgical blood order schedule for flap reconstruction in oral and maxillofacial cancer patients.

BACKGROUND: We established a MSBOS for flap reconstruction in oral and maxillofacial cancer patients. METHOD: We enrolled 2080 cases of oral and maxillofacial flap reconstruction from January 1, 2010 to December 31, 2021. Patient data were collected, including age, sex, BMI, preoperative Hb levels, ASA grade, T stage, flap type, tumor location, and bone flap. Scoring criteria were established based on a multivariate model of independent risk variables and their odds ratios. Two flap-type groups were divided into low-risk, intermediate-risk and high-risk groups by the scoring criteria, and analyzed using univariate and multivariate logistic regression. Perioperative transfusion analysis identified independent risk factors at various Hb levels. The cumulative percentage of patients requiring perioperative blood transfusion for each surgical procedure was calculated to establish the MSBOS. RESULTS: (1) Regression analysis showed that BMI, tumor T staging, ASA grade, preoperative Hb level (male: Hb < 130 g/L, female: Hb < 120 g/L), and bone flap were independent risk factors for perioperative blood transfusion. (2) Regression analysis showed that independent risk factors for perioperative transfusion included the following: BMI, tumor T3-T4 stage, ASA III, IV grade, and free flap/pediculated flap/bone flap in patients with different Hb levels; T3-T4 stage, ASA grade III-IV in mildly anemic patients; and ASA grade III-IV in moderately anemic patients. (3) A MSBOS was established for flap reconstruction in head and neck cancer patients. CONCLUSION: A MSBOS for head and neck cancer procedures was reduced by approximately 30% perioperative blood preparation while ensuring that clinical blood use standards were met. It help optimize blood inventory, and save blood resources.

Cáncer oromaxilofacial en niños: Parte I tumores malignos de tejido duro / Oromaxillofacial cancer in children: Part I hard tissue malignant tumors

Las enfermedades malignas de cabeza y cuello en la población pediátrica son poco frecuentes. Considerando todos los tumores de cabeza y cuello, tanto benignos como malignos, éstos están representados por una frecuencia entre un 2% a 5% de todos los tumores pediátricos. A nivel de los maxilares, los tumores malignos en niños está representado por un rango que varía entre un 7% a 51%. En Chile, se estiman menos de 500 casos nuevos por año y en el rango entre los 5 y 15 años constituyen la segunda causa de muerte, precedida por los accidentes, traumatismos y violencias. Es importante considerar, al estudiar este grupo de enfermedades, que existen diferencias con los tumores de adultos, tanto en su incidencia, biología, comportamiento, histología y manejo. Es por esta razón que nos parece necesario realizar una revisión de la literatura científica para obtener un perfil del cáncer bucomaxilofacial infantil, que aporte en el entendimiento y aplicación de programas adecuados en el contexto de la salud bucomaxilofacial. Adicionalmente, buscamos actualizar el conocimiento de estas patologías, caracterizándolas en relación a su epidemiología, etiopatogenia y tratamiento, de manera que contribuya a los cirujanos dentistas para realizar diagnósticos y la pronta derivación a un centro especializado de patología oral. Para un estudio preciso, esta revisión constará de tres partes: la primera es sobre "tumores malignos de tejido óseo", mencionando, entre ellos, al osteosarcoma, sarcoma de Ewing, linfomas tanto Hodgkin como No Hodgkin, fibrosarcoma e histiocitosis de células de Langerhans.

Malignant head and neck disease in the pediatric population are rare. Considering all head and neck tumors, both benign and malignant, they represent between 2% to 5% of all pediatric tumors. At the level of the jaws, malignant tumors in children present in a range that varies from 7% to 51%. In Chile, fewer than 500 new cases are reported each year and in the 5 to 15 year-range are estimated to constitute the second cause of death, preceded by accidents, injuries and violence. When studying this group of diseases it is important to consider the differences with adult tumors, both in incidence, biology, behavior, histology and management. Therefore we believe it necessary to conduct a review of scientific literature to obtain a profile of child oral maxillofacial cancer, contributing to the understanding and implementation of appropriate programs in the context of maxillofacial health. In addition, we seek to update knowledge of these pathologies, characterizing their epidemiology, pathogenesis and treatment, so as to contribute to dental surgeons for diagnosis and early referrals to specialized centers for oral pathology. For a detailed study, this review will consist of three parts: the first is on "malignant bone tumors", included among these are: osteosarcoma, Ewing's sarcoma, Hodgkin's lymphoma, non-Hodgkin's lymphoma, Langerhans cell histiocytosis and fibrosarcoma.

Oral cancer incidence based on annual cancer statistics in Korea

INTRODUCTION: The objective of this research was to determine the incidence of oral cancer in Korea. MATERIALS AND METHODS: The classifications of oral and maxillofacial cancer (OMFC) that we used are based on possible locations of OMFC: lip, tongue, mouth, salivary glands, tonsil, oropharynx, nasopharynx, hypopharynx, pharynx unspecified, and nose, sinuses. RESULTS: 1) There were 2,848 OMFC cases, accounting for 1.6% of all cancers. The male to female ratio was 2.72:1. 2) The estimated crude rates (CRs) were 5.7 overall, 8.4 for males, and 3.1 for females. The age-standardized incidence rates (ASRs) were 4.6 overall, 7.3 for males and 2.3 for females. 3) The incidence of mouth cancer was highest. The mouth and salivary glands were the most frequent sites for cancer among males and females, respectively. 4) Patients who were 40 years or older accounted for 91% of OMFC cases, with the highest proportion of cases in the 60-69 year-old age group for both sexes. 5) Tongue cancer was the most prevalent OMFC overall. Nasopharyngeal cancer was highest among males, and salivary gland cancer was highest among females. 6) From 2004 to 2008, the relative 5-year survival rate of OMFC patients was 57.5%. There was a trend of increasing survival among OMFC patients during the study period. The survival rate for females (69.3%) was much higher than that for males (53.1%). CONCLUSION: Social and personal efforts should be required to increase the survival rates of OMFC patients and Korean national cancer management policy should establish new measures for economic and social management and support.

THE CLINICAL UTILITY OF POSITRON EMISSION TOMOGRAPHY FOR INITIAL DIAGNOSIS AND FOLLOW UP CHECK IN ORAL AND MAXILLOFACIAL CANCER PATIENTS

BACKGROUND: Positron Emission Tomography(PET) with [18F]-fluorodeoxyglucose (FDG) is a new imaging technique that has the advantage of imaging metabolic changes linked to malignancy. PET-FDG can provide a functional image of the regional biochemistry which may be more sensitive and accurate for detecting the presence of tumor in early stage. Recently, the clinical use of PET scan has been studied in many cancers but, there is a few clinical reports in oral and maxillofacial cancers. We have evaluated the ability of PET-FDG for initial diagnosis and detection of early subclinical recurrent malignancies in follow up check. PATIENTS AND METHODS: PET-FDG studies were performed in 33 patients from october, 1997 to september, 1998. 14 patients underwent PET-FDG evaluation for initial diagnosis and 19 patients for follow up check. RESULTS: Evaluated for initial diagnosis, PET-FDG was found to have an overall accuracy of 79%, sensitivity of 90%, specificity of 60%, positive predictive rate of 80% and negative predictive rate of 75%. Evaluated for follow up check, PET-FDG demonstrated accuracy of 84%, sensitivity of 91%, specificity of 75%, positive predictive rate of 83% and negative predictive rate of 86%. CONCLUSION: These data indicate that PET-FDG scan appears to be effective in initial diagnosis and detection of early recurrent oral and maxillofacial malignancies. The informations gained with PET-FDG can be included for essential treatment planning because of possibility of detection for early subclinical malignancies and distant metastases.

THE UTILITY OF POSITRON EMISSION TOMOGRAPHY IN ORAL AND MAXILLOFACIAL CANCER

Positron emission tomography(PET) is a diagnostic method that creates high resolution, 3-Dimentional tomographic images of the distribution of positron emitting radionuclides in human body. Computed tomography(CT) and magnetic resonance imaging(MRI) are routinely used to delineate the presence and extent of primary and metastatic oral and maxillofacial malignancy. Because the CT and MRI criteria for malignancy depend upon morphology, these imaging techniques have limitations in their ability to identify malignant tissue when fascial planes are distorted or destroyed. PET has the advantage of imaging metabolic changes that appear to be linked to malignancy. Recently, PET has shown promise in the early detection of primary and metastatic oral and maxillofacial canter and has been used to evaluate the tumor response to chemotherapy and radiotherapy. We report cases of diagnosis of oral and maxillofacial cancers and review the literatures to determine whether PET is effective in identifying oral and maxillofacial tumors.