Objectives: Oral and oropharyngeal cancer remains among the top ten most common
malignancies in the United States and worldwide. Over the last several decades
the approach to treatment of oral cancer has changed very little with regards to
primary tumour extirpation while the approach to the "at risk" lymph nodes has
evolved significantly. Perhaps the most significant change in the surgical
treatment of cancer is the introduction of free flap for reconstruction post
resection. Despite these surgical advances, oral cancer ablation, still results
in the sacrifice of several functional and aesthetic organs. The aim of this
article was to provide a comprehensive review of the potential long-term
complications associated with surgical treatment of oral cancer and their
management.
Material and Methods: The available English language literature relevant to long-term surgical
complications associated with surgical treatment of oral cancer was reviewed.
The potential common as well as rarer complications that may be encountered and
their treatment are summarized.
Results: In total 50 literature sources were obtained and reviewed. The topics
covered in the first part of this review series include ablative surgery
complications, issues with speech, swallowing and chewing and neurologic
dysfunction.
Conclusions: The early complications associated with oncologic surgery for oral
cancer are similar to other surgical procedures. The potential long-term
complications however are quite challenging for the oncologic team and the
patient who survives oral cancer, primarily due to the highly specialized
regional tissues involved in the surgical field.
Objectives: Surgery remains the preferred treatment for the majority of oral
cancers. The aim of the present article was to provide a comprehensive review of
complications associated with surgical treatment of oral cancer including
hardware failure; complications associated with choice of reconstruction, donor
site morbidity as well as functional and aesthetic issues that impact on the
quality of life.
Material and Methods: The available English language literature relevant to complications
associated with surgical treatment of oral cancer was reviewed. Complications
associated with potential for disfigurement, choice of reconstruction, donor
site morbidity as well as functional and aesthetic issues that impact on the
quality of life are summarized.
Results: In total 35 literature sources were obtained and reviewed. The topics
covered in the second part of this review series include hardware failure, scars
and fistula formation; complications associated with choice of reconstruction,
donor site morbidity as well as functional and aesthetic issues.
Conclusions: Cancer resection should be planned around two very important concepts.
First and foremost is the eradication of disease. This should be the ultimate
goal of the ablative team and all potential complications that may be the result
of appropriately executed oncologic resection should be discussed in details
with the patient. Adequate reconstruction of the defects with restoration of
form and function is the second, but not of less importance, goal for the
successful care of the head and neck cancer patient.
Objectives: To observe the early adsorption of extracellular matrix and blood plasma
proteins to magnesium-incorporated titanium oxide surfaces, which has shown
superior bone response in animal models.
Material and Methods: Commercially pure titanium discs were blasted with titanium dioxide (TiO2)
particles (control), and for the test group, TiO2 blasted discs were further processed with a micro-arc oxidation method
(test). Surface morphology was investigated by scanning electron microscopy,
surface topography by optic interferometry, characterization by X-ray
photoelectron spectroscopy (XPS), and by X-ray diffraction (XRD) analysis. The
adsorption of 3 different proteins (fibronectin, albumin, and collagen type I)
was investigated by an immunoblotting technique.
Results: The test surface showed a porous structure, whereas the control surface
showed a typical TiO2 blasted structure. XPS data revealed
magnesium-incorporation to the anodic oxide film of the surface. There was no
difference in surface roughness between the control and test surfaces. For the
protein adsorption test, the amount of albumin was significantly higher on the
control surface whereas the amount of fibronectin was significantly higher on
the test surface. Although there was no significant difference, the test surface
had a tendency to adsorb more collagen type I.
Conclusions: The magnesium-incorporated anodized surface showed significantly higher
fibronectin adsorption and lower albumin adsorption than the blasted surface.
These results may be one of the reasons for the excellent bone response
previously observed in animal studies.
Objectives: The aim of the current study was to investigate whether there was a
relationship between a history of third molar removal and the prevalence of
orofacial pain in a sample of the general population.
Material and Methods: A survey was conducted in South East Cheshire, United Kingdom (81%
participation rate). Information was collected using postal questionnaires (n =
1510) and dental records (n = 809).
Results: Participants who reported third molar extractions were more likely to
report orofacial pain (RR = 1.29; 95% confidence interval [CI] 1.01 - 1.65).
Participants with a more recent history of extractions (< 8 years ago) as
recorded in dental records were more likely to report orofacial pain compared to
those who had all third molar present (RR = 1.91; 95% CI 1.10 - 3.32).
Conclusions: This research suggests that self-reported third molar removal is linked
to self-reported orofacial pain, however evidence from one study is not
sufficient to give an unequivocal answer.
Objectives: The purpose of this study is to analyze the
morphological change of cell nuclei and the change of proliferating activity of
oral malignancy and epithelial dysplasia between before and after photodynamic
therapy in order to predict recurrence.
Material and Methods: We experienced 14 cases of oral squamous cell
carcinoma, one case of verrucous carcinoma and seven cases of epithelial
dysplasia treated by photodynamic therapy (PDT). The mean nuclear area (NA) and
coefficient of variation of the nuclear area (NACV) of 100 nuclei per slide were
calculated using computer-assisted image analysis in hematoxylin and eosin
stained biopsy specimens before and after PDT. Additionally, proliferating cell
nuclear antigen (PCNA) immunohistochemistry was carried out in each specimen.
Results: The mean NA after PDT was significantly lower than that
before PDT in the nonrecurrent group. However, there was no significant
difference in mean NA before and after PDT in the recurrent group. There were no
significance differences in NACV before and after PDT in either the nonrecurrent
or recurrent group. Furthermore, the PCNA labelling indices of the specimens
after PDT was significantly lower than that before PDT in both the nonrecurrent
and the recurrent group.
Conclusions: Mean nuclear area in the biopsy specimen after
photodynamic therapy is likely to be a predictive marker for the recurrence of
oral squamous cell carcinoma or epithelial dysplasia subjected to photodynamic
therapy, while coefficient of variation of the nuclear area and proliferating
cell nuclear antigen labelling indices are less helpful in predicting the
recurrence of such lesions.
Luiz Antonio Guimarães Cabral, Luis Felipe das Chagas e Silva de
Carvalho, José Antônio Pereira Salgado, Adriana Aigotti
Haberbeck Brandão, Janete Dias Almeida
Background: Squamous cell carcinoma is a malignant epithelial neoplasm characterized
by variable clinical manifestations. When located in the gingiva, this neoplasm
may mimic common inflammatory lesions. The aim of this study was to report a
case of atypical squamous cell carcinoma, in which the patient had no risk
factors for the development of this neoplasm.
Methods: A 61 year old Caucasian female was seen with a 3 month history of a
rapidly growing, painful nodule in the gingiva adjacent to tooth #11. Clinical
examination revealed a proliferative lesion in the vestibular marginal gingiva
of teeth #11 and #12, presenting with purulent exudation. Thus, in view of the
clinical symptoms and differential diagnosis of an infectious granulomatous
process and malignant neoplasm, an incisional biopsy was obtained from the
lesion.
Results: The diagnosis of squamous cell carcinoma was made and fourteen days
after incisional biopsy, healing was found to be unsatisfactory. The patient was
referred for treatment consisting of surgical excision of the tumour. A
removable partial denture was fabricated for rehabilitation, one month after
surgery of the maxilla; the patient was submitted to dissection of the regional
lymph nodes and radiotherapy for an additional 3 months. Three years after the
end of treatment, the patient continues to be followed-up and does not show any
sign of recurrence.
Conclusions: Gingival squamous cell carcinoma is a condition which chance of cure is
higher when carcinomatous lesions are diagnosed and treated early. In this
instance dentists play an important role in early detection of gingival squamous
cell carcinoma.
Background: The keratocystic odontogenic tumour is classified as a developmental
cyst derived from the enamel organ or from the dental lamina. The treatment of
keratocystic odontogenic tumour of the jaw remains controversial. The aim of
this study was to report the outcome of our conservative treatment protocol for
keratocystic odontogenic tumour.
Methods: Three patients with different complaints referred to Oral and
Maxillofacial Surgery Clinic, Faculty of Dentistry, Selçuk University. Initial
biopsy was carried out in all patients and keratocystic odontogenic tumours was
diagnosed subsequent to histopathological examination. The patients with
keratocystic odontogenic tumours were treated by enucleation followed by open
packing. This conservative treatment protocol was selected because of existing
young aged patients. The average follow-up duration of the cases was 2 years.
Results: Out of 3 cases, 2 lesions were present in mandible and 1 lesion in
maxilla. There was no evidence of recurrence during follow-up. All the cases
were monitored continuously with panoramic radiographs, computed tomography and
clinical evaluations.
Conclusions: This conservative treatment protocol for keratocystic odontogenic
tumours, based on enucleation followed by open packing would be a possible
choice with a view of offering low recurrence rate and low morbidity rate
particularly in young patients.