Application of a chimeric ALT perforator flap with vastus lateralis muscle mass in the reconstruction of the defects after radical resection of a buccal carcinoma: A retrospective clinical study

BACKGROUND AND OBJECTIVES

Aggressive resection of buccal cancer simultaneously leaves both oral and lateral facial defects. It is unknown whether a perforator-based chimeric anterolateral thigh (ALT) flap, with a muscular component, is suitable for the reconstruction of these complicated defects.

METHODS

In this retrospective study, 48 patients with a buccal carcinoma (T2 N0-1 M0), who underwent extensive surgical resection, were enrolled. Twenty-seven cases underwent reconstruction using the classical ALT perforator flap (classical group), and 21 cases used the chimeric ALT perforator flap with vastus lateralis muscle mass (chimeric group). The incidence of wound infection, lower limb extremity function, facial appearance, survival curves, and quality of life were compared between groups.

RESULTS

The incidence of wound infection or effusion was lower in the chimeric group than in the classical group. The aesthetic result achieved in the chimeric group was better than in the classical group. Meanwhile, there was no significant difference in the function of the donor site between groups.

CONCLUSIONS

The chimeric ALT perforator flap, with a muscular component, can reconstruct both the oral and lateral face defects accurately. It sustains the profile of the lateral face and decreases the incidence of wound infection.

Prognostic role of platelet-to-lymphocyte ratio in oral cancer: A meta-analysis

BACKGROUND AND OBJECTIVE

Platelet-to-lymphocyte ratio (PLR) has been suggested to be associated with the progression of oral cancer with inconclusive results. The objective of the current study was to assess the prognostic role of oral cancer by meta-analysis.

METHOD

PubMed, EMbase(Ovid), CNKI, WanFang Data, VIP, and CBM databases were searched up to August 24, 2018. Studies investigating the association between PLR and progression of oral cancer were included. Meta-analysis was performed by using Revman 5.3 software. The protocol of the study was registered on PROSPERO (CRD42018106836).

RESULTS

A total of five studies were included in the meta-analysis. The results of the meta-analysis showed that higher PLR was associated with the poor progress of oral cancer (overall survival: OR = 2.06, 95 CI: 1.49-2.86, P < 0.0001; disease-specific survival: OR = 2.12, 95 CI: 1.59-2.82, P < 0.00001).

CONCLUSION

The current meta-analysis showed that higher PLR is a poor progression factor for oral cancer. However, larger sample, multi-center studies should be carried out in the future to validate the above conclusion.

Behavior of Buccal Mucosal Squamous Cell Carcinoma: A Retrospective Study of 53 Carcinomas of This Anatomical Region

The main aim of the present report is to study the pattern of distribution of cervical metastasis in buccal mucosa cancer and to discuss the various therapeutic options available. Fifty-three patients with squamous cell carcinoma of the buccal mucosa treated with tumorectomy and selective neck dissection were included in the study. We also studied the relationship between specific pathological features and overall survival. Level Ib was the most affected level, followed by level IIa. T stage, N stage, N involvement tumor thickness, extracapsular spread (ECS), and vascular invasion were associated with poorer outcomes regarding overall survival ( p  < 0.001). Carcinoma of the buccal mucosa should be treated aggressively from the early stages. A large tumorectomy of the primary tumor is required to reduce the number of local recurrences. Moreover, we recommend performing a supraomohyoid neck dissection even in cT1N0 if there is a suspicion that the tumor thickness may be greater than 0.4 cm. The high risk of local recurrence obliges protection of the neck from a future cervical recurrence even in T1 small tumors. This could reduce the risk of cervical involvement during the follow-up and improve overall survival rates.

Cervical metastases behavior of T1-2 squamous cell cancer of the oral mucosa

OBJECTIVES

The clinical management of the neck of patients with early-stage oral squamous cell cancer (OSCC) is still controversially discussed in the current literature. This study analyzes histo-clinical factors influencing the occurrence of cervical lymph node metastases (CM).

MATERIALS AND METHODS

In a retrospective mono-center study, patients with a primary T1-2 OSCC between 2000 and 2014 were analyzed regarding histo-clinical parameters possibly influencing the CM rate and the outcome.

RESULTS

Two hundred eighty-five patients (66 %) were male and 146 female (44 %), with a mean age of 60 ± 12 years at the time of diagnosis. Seventy-seven percent showed a positive risk profile (nicotine/alcohol) and 69 % underlying diseases. Forty-four percent of the patients were staged as T2 (30 % with CM). Advanced tumor size (T1 vs. T2) and grading (G1-2 vs. G3) were statistically significantly (p < 0.001) associated with the occurrence of CM. The localization within the oral cavity, age, gender, risk profile, or underlying diseases had no influence on CM occurrence. During the follow-up, tumor size (p = 0.001), CM (p < 0.001), and tumor relapse (p < 0.001) were significantly associated with a worse outcome.

CONCLUSIONS

Early-stage OSCC showed aggressive lymphatic metastatic behavior that depends on the size and the grading of the tumor.

CLINICAL RELEVANCE

A watch-and-wait policy as the primary management for cN0 may likely be inferior to a selective neck dissection for this patient group and should only be considered for very small tumors with a good differentiation.

Oral lichen planus and malignant transformation: a longitudinal cohort study

OBJECTIVE

Oral lichen planus (OLP) is associated with risk for developing oral squamous cell carcinoma (OSCC). We performed a 7-year prospective study to assess the incidence of malignant transformation of OLP among adults.

STUDY DESIGN

Three hundred twenty-seven OLP patients, 229 women (70.0%) and 98 men (30.0%), were observed during the follow-up period.

RESULTS

During a mean follow-up of 81.7 months, 8 of 327 patients developed an OSCC in OLP areas (0.36%/y), yielding the high overall standardized incidence ratio of 17.7 (95% confidence interval [CI] 8.8-35.3). The standardized incidence ratio for OSCC was significantly higher in women [27.0 (95% CI 11.2-64.8)] than in men [11.2 (95% CI 3.6-34.9)]. Six OSCCs were well differentiated (75%) and 2 moderately differentiated (25%). Three subjects (37.5%) developed recurrences within 2 years (mean 16.1 ± 3.5 months). Disease-free survival rate after 69.8 months was 97.3%.

CONCLUSIONS

OLP was associated with a significant increase in the risk for OSCC. Close surveillance may help to reduce the morbidity of OSCC arising from OLP at 24 months.