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Ritschl LM, Niu M, Sackerer V, Claßen C, Stimmer H, Fichter AM, Wolff KD, Grill FD. Effect of segmental versus marginal mandibular resection on local and lymph node recurrences in oral squamous cell carcinoma: is tumorous bone infiltration or location and resulting soft tissue recurrences a long-term problem? J Cancer Res Clin Oncol 2023; 149:11093-11103. [PMID: 37344607 PMCID: PMC10465630 DOI: 10.1007/s00432-023-04963-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 06/02/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Oral squamous cell carcinomas (OSCCs) adjacent to the mandible or with clinically suspected bone infiltration are surgically treated either with marginal or segmental resections. This retrospective study compared both resections regarding local recurrence and lymph node recurrence or secondary lymph node metastases. METHODS All consecutive primary OSCC cases between January 2007 and December 2015 that underwent mandibular marginal or segmental resection were included. Rates of local and lymph node recurrences or secondary metastases and possible risk factors such as tumor localization according to Urken's classification were recorded. RESULTS In total, 180 patients with 85 marginal (group I) and 95 segmental (group II) mandibular resections were analyzed. The local recurrence rates were comparable between the groups (28.2% vs. 27.4%; p = 0.897). Lymph node recurrences or secondary metastases were higher in group I (9.4% (n = 8) vs. 6.2% (n = 6); p = 0.001). Tumor localization appears to affect the outcomes. Significantly fewer local and lymph node recurrences/metastases were found for Urken's classification SB and S calculated by two-proportion z-test (p = 0.014 and 0.056, respectively). Local recurrences mostly emerged from soft tissues, which should be resected more radically than the bones. CONCLUSION While bone infiltration appears technically well controllable from an oncologic point of view, local recurrences and lymph node recurrences/metastases remain an issue. Regular clinical aftercare with imaging is crucial to detect recurrences.
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Affiliation(s)
- Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Minli Niu
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Valeriya Sackerer
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Carolina Claßen
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
- Department of Oral and Maxillofacial Surgery, School of Medicine, University of Saarland, Homburg, Saar, Germany
| | - Herbert Stimmer
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Andreas M Fichter
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany
| | - Florian D Grill
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany.
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Molteni G, Gazzini L, Sacchetto A, Nocini R, Comini LV, Arietti V, Locatello LG, Mannelli G. Mandibular reconstruction in head and neck cancer: which is the gold standard? Eur Arch Otorhinolaryngol 2023; 280:3953-3965. [PMID: 37269408 DOI: 10.1007/s00405-023-08050-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/30/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The aim of this study is to perform a systematic review to compare the outcomes of the different surgical options for mandibular reconstruction in head and neck cancer. MATERIAL AND METHODS 93 articles were selected. Four groups were identified: titanium plate without flaps, titanium plate covered by soft tissue flap, bone tissue flaps and double flaps. We compared patients' characteristics, site of mandibulectomy, type of reconstruction and complications. RESULTS 4697 patients were reported. The groups were not homogeneous regarding the type of defect and the treatment history. A significant difference in terms of post-operative complications was found between group 1 and group 2 (p < 0.00001), and between group 2 and group 3 (p < 0.00001). Total complications rate for group 4 was significantly higher when compared to group 3 (p < 0.00001), but no significant difference was found with group 2. CONCLUSION These results suggest that mandibular reconstruction using a microvascular bone flap is the best surgical option in patients without significant comorbidities.
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Affiliation(s)
- Gabriele Molteni
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Head and Neck Department, University Hospital of Verona, Verona, Italy
- Department of Surgery, Dentistry and Pediatrics, University of Verona, Verona, Italy
| | - Luca Gazzini
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Otorhinolaryngology-Head and Neck Surgery Department, San Maurizio Hospital, Bolzano, Italy
| | - Andrea Sacchetto
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria.
- Department of Otolaryngology, Ospedale San Bortolo, AULSS 8 Berica, Vicenza, Italy.
| | - Riccardo Nocini
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Surgery, Dentistry and Pediatrics, University of Verona, Verona, Italy
| | - Lara Valentina Comini
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Otorhinolaryngology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Valerio Arietti
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Surgery, Dentistry and Pediatrics, University of Verona, Verona, Italy
| | - Luca Giovanni Locatello
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Otorhinolaryngology, Sant'Antonio Abate Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Tolmezzo, Italy
| | - Giuditta Mannelli
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Gheibollahi H, Mousavi S, Babaei A. Factors associated with survival and patient's quality of life after segmental mandibulectomy. Support Care Cancer 2023; 31:366. [PMID: 37253883 DOI: 10.1007/s00520-023-07831-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/23/2023] [Indexed: 06/01/2023]
Abstract
AIM This study aimed to explore the survival rate and quality of life (QoL) in patients who underwent segmental mandibulectomy and determine the associated factor with survival rate and QoL. MATERIAL AND METHODS In this cross-sectional study, all patients who underwent segmental mandibular resection in the referral center of Shiraz University of Medical Sciences, Iran, during 2015-2019 were included. Inclusion criteria were segmental mandibulectomy due to any pathology and age of more than 8 years old. Demographic, clinical data and patient survival were recorded. EORTC QLQ-HN43 was used to evaluate QoL. RESULTS Totally, 82 patients were studied. The overall 3-year survival rate was 69.5% (57 patients) (mean ± SD: 1.35 ± 1.03 years). According to univariate analysis, age (p-value = 0.001), hospital lengths of stay (p-value < 0.001), gender (p-value = 0.014, OR = 4.143), education (p-value = 0.015, OR = 0.291), pathology (p-value < 0.001, OR = 17.000), metastasis (p-value = 0.018, OR = 4.894), neck dissection (p-value < 0.001, OR = 52.381), frozen margin (p-value < 0.001 OR = 8.000), recurrence (p-value = 0.001, OR = 6.273), and status of chemoradiotherapy (p-value < 0.001) were significantly associated with survival rate. Logistic regression revealed that survival was associated with gender (p-value = 0.040, OR = 23.689), level of education (p-value = 0.019, OR = 0.019), and neck dissection (p-value = 0.019, OR = 175.781). According to univariate analysis, pathology (p-value = 0.003), neck dissection (p-value = 0.024), frozen margin (p-value = 0.004), and chemoradiotherapy (p-value = 0.026) were significantly associated with QoL. Linear regression revealed that QoL was associated with none of the measured factors. CONCLUSION In conclusion, gender, level of education, and neck dissection were related to 3-year patients' survival. None of the measured factors in this study were associated with QoL.
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Affiliation(s)
- Hamed Gheibollahi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sona Mousavi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Babol University of Medical Sciences, Babol, Iran
| | - Amirhossein Babaei
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
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Jenkins GW, Kennedy MP, Ellabban I, Adams JR, Sellstrom D. Functional outcomes following mandibulectomy and fibular free-flap reconstruction. Br J Oral Maxillofac Surg 2023; 61:158-164. [PMID: 36717338 DOI: 10.1016/j.bjoms.2022.11.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 01/04/2023]
Abstract
There remains a paucity of evidence with regards to functional outcomes following the reconstruction of segmental defects in the mandible. It is, however, well recognised that oral rehabilitation following head and neck surgery is a driver of improved quality of life outcomes. We present a prospective service review of functional outcomes of a consecutive cohort of patients following segmental mandibulectomy and virtual surgical planning (VSP) composite fibular free-flap reconstruction. Twenty-five patients, who were identified as having a complete dataset with a minimum of 12 months' follow up, ultimately met the inclusion criteria. Validated functional outcome measures were used primarily to assess speech, diet, and swallowing outcomes. The results demonstrate a decline in both speech and swallowing outcomes at three months postoperatively, with a decline of 37% in the Speech Handicap Index from the preoperative baseline, and a decline of 35% in the MD Anderson Dysphagia Inventory score over the same period. The MD Anderson Dysphagia Inventory score improved at 12 months, whereas the Speech Handicap Index did not. Fundamentally a collaborative approach is required between members of the multidisciplinary team (MDT) to enable optimal patient outcomes.
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Affiliation(s)
- Glyndwr W Jenkins
- The James Cook University Hospital, Marton Road, Middlesbrough TS4 3bW, United Kingdom.
| | - Matthew P Kennedy
- Newcastle Upon Tyne Hospitals, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne NE7 7DN, United Kingdom
| | - Islam Ellabban
- The York Hospital, Wigginton Road, Clifton, York YO31 8HE, United Kingdom
| | - James R Adams
- Newcastle Upon Tyne Hospitals, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne NE7 7DN, United Kingdom
| | - Diane Sellstrom
- Newcastle Upon Tyne Hospitals, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne NE7 7DN, United Kingdom
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Mattei P, Thamphya B, Chamorey E, Scheller B, Château Y, Dassonville O, Poissonnet G, Culié D, Koulmann P, Hechema R, Sudaka A, Saada E, Benezery K, Demard F, Elaldi R, Bozec A. Therapeutic strategies, oncologic and swallowing outcomes and their predictive factors in patients with locally advanced hypopharyngeal cancer. Eur Arch Otorhinolaryngol. [DOI: 10.1007/s00405-021-07196-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/20/2021] [Indexed: 12/17/2022]
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Bozec A, Culié D, Poissonnet G, Demard F, Dassonville O. Current Therapeutic Strategies in Patients with Oropharyngeal Squamous Cell Carcinoma: Impact of the Tumor HPV Status. Cancers (Basel) 2021; 13:cancers13215456. [PMID: 34771619 PMCID: PMC8582410 DOI: 10.3390/cancers13215456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 01/19/2023] Open
Abstract
Simple Summary Contrary to other head and neck subsites, oropharyngeal squamous cell carcinoma (OPSCC) has shown a considerable increase in incidence over the past 20 years. This growing incidence is largely due to the increasing place of human papillomavirus (HPV)-related tumors. HPV-positive and HPV-negative OPSCC are two distinct entities with considerable differences in terms of treatment response and prognosis. However, there are no specific recommendations yet in the therapeutic management of OPSCC patients according to their tumor HPV-status. The aim of this review is therefore to discuss the therapeutic management of patients with OPSCC and the impact of HPV status on treatment selection. Abstract Since there is no published randomized study comparing surgical and non-surgical therapeutic strategies in patients with oropharyngeal squamous cell carcinoma (OPSCC), the therapeutic management of these patients remains highly controversial. While human papillomavirus (HPV)-positive and HPV-negative OPSCC are now recognized as two distinct diseases with different epidemiological, biological, and clinical characteristics, the impact of HPV status on the management of OPSCC patients is still unclear. In this review, we analyze the current therapeutic options in patients with OPSCC, highlighting the most recent advances in surgical and non-surgical therapies, and we discuss the impact of HPV status on the therapeutic strategy.
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Walia A, Lee JJ, Jackson RS, Hardi AC, Bollig CA, Graboyes EM, Zenga J, Puram SV, Pipkorn P. Management of Flap Failure After Head and Neck Reconstruction: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2021; 167:224-235. [PMID: 34491852 PMCID: PMC8972962 DOI: 10.1177/01945998211044683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To systematically review management of flap loss in head and neck construction with free tissue transfer as compared with locoregional flap or conservative management. DATA SOURCES Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were searched up to October 2019. REVIEW METHODS Candidate articles were independently reviewed by 2 authors. Articles were considered eligible if they included adequate reporting of flap management after flap loss and outcomes for survival of reconstruction, length of hospitalization, and perioperative complications. RESULTS A total of 429 patients had acute flap failure in the perioperative period. The overall success with a secondary free flap was 93% (95% CI, 0.89-0.97; n = 26 studies, I2 = 12.8%). There was no difference in hospitalization length after secondary reconstruction between free tissue transfer and locoregional flaps or conservative management (relative risk of hospitalization ≥2 weeks, 96%; 95% CI, 0.80-1.14; n = 3 studies, I2 = 0). The pooled relative risk of perioperative complications following free tissue transfer was 0.60 when compared with locoregional flap or conservative management (95% CI, 0.40-0.92; n = 5 studies, I2 = 0). CONCLUSION Salvage reconstruction with free tissue transfer has a high success rate. Second free flaps following flap failure had a similar length of hospitalization and lower overall complication rate than locoregional reconstruction or conservative management. A second free tissue transfer, when feasible, is likely a more reliable and effective procedure for salvage reconstruction.
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Affiliation(s)
- Amit Walia
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Jake J Lee
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Angela C Hardi
- Bernard Becker Medical Library, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Craig A Bollig
- Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA.,Department of Genetics, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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Ma H, Shujaat S, Bila M, Nanhekhan L, Vranckx J, Politis C, Jacobs R. Survival analysis of segmental mandibulectomy with immediate vascularized fibula flap reconstruction in stage IV oral squamous cell carcinoma patients. J Stomatol Oral Maxillofac Surg 2020; 123:44-50. [PMID: 33321252 DOI: 10.1016/j.jormas.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/21/2020] [Accepted: 12/08/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aims to assess the survival rate of oral squamous cell carcinoma (OSCC) patients following immediate mandibular reconstruction with vascularized fibula flap (VFF) and to identify risk factors influencing the overall survival rate and postoperative outcomes. PATIENTS AND METHODS Patients suitable for the inclusion criterion diagnosed and treated between January 1996 till June 2019 for OSCC were retrospectively reviewed (n = 74). Potential risk factors and postoperative outcomes were recorded and analyzed. RESULTS The overall cumulative survival rate of patients was 0.52 at the end of 5th year. Overall, advanced pN stage (p = 0.0422), poor tumor differentiation (p < 0.0001), positive/close surgical margins (p = 0.0209), vascular invasion (p = 0.0395), perineural invasion (p = 0.0022) and tumor recurrence (p = 0.0232) were significantly related to a decreased cumulative survival. Tumor recurrence was significantly correlated with involvement of positive/close surgical margins, moderate (p = 0.0488), poor-differentiated tumors (p = 0.202), extracapsular spread (p = 0.0465), computer-assisted surgery (p = 0.0014) and early complications (p = 0.0224). Pain was significantly associated with the extracapsular spread (p = 0.0353) and early complications (p = 0.0127). CONCLUSION The five-year survival rate of advanced OSCC patients after segmental mandibulectomy with fibula free-flap reconstruction was 52.4%. Clinical/pathological risk factors such as the pN stage, tumor differentiation, surgical margins, vascular invasion, perineural invasion, tumor recurrence significantly influenced the overall cumulative survival rate.
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Affiliation(s)
- Hongyang Ma
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sohaib Shujaat
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Michel Bila
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Lloyd Nanhekhan
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jan Vranckx
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Bozec A, Majoufre C, De Boutray M, Gal J, Chamorey E, Roussel L, Philouze P, Testelin S, Coninckx M, Bach C, Schultz P, Garrel R, Louis M, Babin E, Cosmidis A, Céruse P, Baujat B, Culié D, Dassonville O, Poissonnet G, D'andrea G, Guerlain J, Vergez S, Dupret-bories A. Oral and oropharyngeal cancer surgery with free-flap reconstruction in the elderly: Factors associated with long-term quality of life, patient needs and concerns. A GETTEC cross-sectional study. Surg Oncol 2020; 35:81-8. [DOI: 10.1016/j.suronc.2020.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/21/2020] [Accepted: 08/17/2020] [Indexed: 11/19/2022]
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Højvig JH, Pedersen NJ, Charabi BW, Wessel I, Jensen LT, Nyberg J, Mayman-Holler N, Kehlet H, Bonde CT. Microvascular reconstruction in head and neck cancer - basis for the development of an enhanced recovery protocol. JPRAS Open 2020; 26:91-100. [PMID: 33225037 PMCID: PMC7666314 DOI: 10.1016/j.jpra.2020.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/30/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Microvascular reconstructions after head and neck cancer are among the most complicated procedures in plastic surgery. Postoperative complications are common, which often leads to prolonged hospital stay. Enhanced recovery after surgery (ERAS) is a peri- and postoperative care concept with the aim of achieving pain- and risk-free surgery. It has been previously established as superior to conventional care for a wide variety of procedures, including microsurgical procedures such as reconstructions of the breast. Several ERAS protocols for microvascular head and neck cancer reconstructions have been proposed, although most of these are based on extrapolated evidence from different surgical specialties. Results from the implementation of ERAS for these procedures are inconsistent. Methods The current study investigates our clinical experience of head and neck cancer reconstruction for the period of 2014-2016 with the aim of establishing a list of functional discharge criteria. By combining these with the current published knowledge on the subject, we developed an ERAS protocol. Results We performed 89 microvascular procedures in the study period, of which 58 were in the oral cavity/sinuses and 31 were laryngopharyngeal. Most cases were squamous cell carcinoma (89%). The average LOS was 20.3 days in both groups. Postoperative complications included infection (37%), 30-days re-operations (19%), and re-admissions (17%). Furthermore, we identified the following discharge criteria: adequate pain relief, ambulation, sufficient nutritional intake, normal infection-related blood parameter results and absence of fever, bowel function, and closure of tracheostomy. Conclusion Based on our retrospective analysis and identified discharge criteria, we present an approach to develop an ERAS protocol for microvascular reconstruction after head and neck cancer.
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Affiliation(s)
- Jens H Højvig
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nicolas J Pedersen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Birgitte W Charabi
- Department of Otorhinolaryngology, Head and Neck surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lisa T Jensen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jan Nyberg
- Department of Oral and Maxillofacial surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nana Mayman-Holler
- Department of Anaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Kehlet
- Department of Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian T Bonde
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Gaur V, Doshi AG, Palka LR. Mandibular reconstruction using single piece zygomatic implant in conjunction with a reinforcing Fibular Graft Union: A case report. Int J Surg Case Rep 2020; 73:347-354. [PMID: 32745726 PMCID: PMC7398898 DOI: 10.1016/j.ijscr.2020.07.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 11/29/2022] Open
Abstract
Presenting to our knowledge, for the first time in literature, a case report on the long term follow-up of an implant retained fixed prosthesis on free fibular reconstruction with a single piece zygomatic implant and single piece bicortical implant via a flapless approach and immediate functional rehabilitation. The technique involved the concept of "Remote Bone Anchorage" in conjunction with the union of grafted free fibula flap with the native mandible. It was facilitated with a single piece zygomatic implant engaged in the mandible and splinted with single piece implants on the grafted fibula as needed for prosthetic functional reconstruction. The author has reported a unique concept of immediate functional rehabilitation in the fibular graft therefore providing additional splinting of the vascularized free fibula to the mandible by splinting them with single piece zygomatic cortical implant.
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Affiliation(s)
- Vivek Gaur
- Jaipur Dental College, Maharaj Vinayak Global University, Jaipur, India.
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Bozec A, Culié D, Poissonnet G, Dassonville O. Current role of primary surgical treatment in patients with head and neck squamous cell carcinoma. Curr Opin Oncol 2020; 31:138-145. [PMID: 30865132 DOI: 10.1097/cco.0000000000000531] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW The objective of this review article is to discuss the current role of surgery as the primary treatment modality in patients with head and neck squamous cell carcinoma (HNSCC). RECENT FINDINGS HNSCC represents one of the cancer locations where the primary treatment modality is the most under discussion. Indeed, the respective roles of primary surgical resection followed, as necessary, by adjuvant radiotherapy or definitive chemoradiotherapy remain controversial. The results of organ preservation trials and the drastic rise in the incidence of human papillomavirus-induced oropharyngeal tumors, which are known to be highly radiosensitive, have led to an increasing use of chemoradiation-based therapies in HNSCC patients. However, no chemoradiation-based protocol has shown better oncologic outcomes than radical primary surgery. Moreover, development of minimally invasive surgical techniques, such as transoral robotic surgery, and advances in head and neck microvascular reconstruction have considerably improved the clinical outcomes of the patients and have led to a reconsideration of the role of primary surgery in HNSCC patients. SUMMARY Surgery should be the primary treatment modality for most resectable oral cavity cancers and for T4a laryngeal/hypopharyngeal cancers. Primary surgery could also be the preferred modality of treatment for most early (T1-T2, N0) laryngeal and hypo/oropharyngeal carcinomas when this strategy offers an opportunity to reserve radiotherapy for a potential recurrence or second primary tumor. Primary surgery should also be considered in patients with locally advanced human papillomavirus-negative oropharyngeal carcinoma.
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Affiliation(s)
- Alexandre Bozec
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
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Goetze E, Moergel M, Gielisch M, Kämmerer PW. Safety of resection margins in CAD/CAM-guided primarily reconstructed oral squamous cell carcinoma-a retrospective case series. Oral Maxillofac Surg 2019; 23:459-464. [PMID: 31463557 DOI: 10.1007/s10006-019-00797-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES After resection of malignancies of the jaws, CAD/CAM procedures have become standard for primary bony reconstruction. Even so, these techniques may limit surgical resection safety. Therefore, the aim of the study was to examine osseous as well as soft tissue resection margins after CAD/CAM-guided tumor resections and reconstructions. METHODS A retrospective analysis of patients treated with oral squamous cell carcinoma (OSCC) from 2014 to 2019 was performed. Inclusion criteria were CAD/CAM-guided osseous resection and primary reconstruction. Evaluation was performed for histological confirmed resection margins (hard and soft tissue) as well as recurrence of the disease related to the resection status. RESULTS In 46 patients, bony resection margins were classified: tumor free (R0 41/46), microscopical invasion (R1 1/46), and close margin (R0 < 4 mm 4/46) respectively for soft tissue 29/46 tumor free (R0), 7/46 close margin (R0 < 4 mm), 5/46 R1, and 4/46 could not be further determined (Rx). Fourteen patients (14/46) showed recurrent disease (2/46 locoregional) without association with the bony resection margin status. Recurrence occurred predominantly (13/46) in high-staged tumor patients. R1/close margin/Rx resection of the soft tissue resulted in a significant earlier recurrence when compared with R0 resection. CONCLUSION CAD/CAM procedure allows safe tumor resection with the profit of a guided and accurate reconstruction. In contrast to positive soft tissue margins, positive bony resection margins did not increase recurrence parameters.
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Affiliation(s)
- Elisabeth Goetze
- Department of Oral, Maxillofacial and Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Maximillian Moergel
- Department of Oral, Maxillofacial and Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Matthias Gielisch
- Department of Oral, Maxillofacial and Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Peer W Kämmerer
- Department of Oral, Maxillofacial and Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany.
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Kansara S, Wang T, Koochakzadeh S, Liou NE, Graboyes EM, Skoner JM, Hornig JD, Sandulache VC, Day TA, Huang AT. Prognostic factors associated with achieving total oral diet following osteocutaneous microvascular free tissue transfer reconstruction of the oral cavity. Oral Oncol 2019; 98:1-7. [PMID: 31521884 DOI: 10.1016/j.oraloncology.2019.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/14/2019] [Accepted: 09/06/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Osteocutaneous microvascular free tissue transfer (OMFTT) is the current standard in reconstruction of large bony defects of the oral cavity. Although being able to swallow ranks as a top priority for patients undergoing OMFTT, factors associated with achieving an oral diet following surgery remain unclear. We sought to describe the rate of total oral diet achievement, and to identify possible pre-, intra-, and post-operative factors associated with achievement in patients undergoing OMFTT. METHODS Retrospective review between January 1, 2010 and March 31, 2018 at two tertiary academic centers. RESULTS 249 patients (67% male, mean age 58 years) met inclusion criteria, with a median follow up of 15 months. Overall, 142 (57%) of patients achieved a total PO diet post-operatively, with median time to achievement of 3.2 months. Multivariate analysis identified that lack of concurrent glossectomy (SHR 1.72 [1.09-2.70], p = 0.02), N0/1 disease (SHR 1.92 [1.16-3.13], p = 0.011), avoidance of post-operative fistula formation (SHR 1.96 [1.22-3.23], p = 0.005), pre-operative G-tube independence (SHR 3.33 [1.69-6.25], p < 0.001), and successful dental rehabilitation (SHR 2.08 [1.43-3.03], p < 0.001) are independently associated with total oral diet achievement. CONCLUSIONS Bony resections not requiring glossectomy, limited nodal disease burden, pre-operative gastrostomy-independence, avoidance of post-operative fistula, and dental rehabilitation are independently associated with achievement of total oral diet following OMFTT reconstruction of the oral cavity. Counseling patients on associated risk factors is important in guiding post-treatment expectations. Minimization of post-operative fistula, and maximization of dental rehabilitation may significantly improve total oral diet achievement in this patient population.
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Affiliation(s)
- Sagar Kansara
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Tao Wang
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, United States
| | - Sina Koochakzadeh
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Nelson E Liou
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Evan M Graboyes
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Judith M Skoner
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Joshua D Hornig
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Vlad C Sandulache
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Terry A Day
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Andrew T Huang
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States.
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Alotaibi A, Aljabab A, Althubaiti G. Predictors of Oral Function and Facial Aesthetics Post Maxillofacial Reconstruction with Free Fibula Flap. Plast Reconstr Surg Glob Open 2018; 6:e1787. [PMID: 30881773 PMCID: PMC6414127 DOI: 10.1097/gox.0000000000001787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/26/2018] [Indexed: 11/25/2022]
Abstract
Background: For maxillofacial reconstruction, free flaps have largely replaced pedicled flaps. In a Saudi Arabian sample, we (1) assessed patients’ postoperative oral function and facial aesthetics (OFFA), specifically pertaining to diet, speech intelligibility, oral opening, maxilla-mandibular occlusion, and facial aesthetics (all rated 0–2) following fibular free flap surgery; and (2) identified preoperative predictors of a novel 10-point OFFA rating scale combining these 5 parameters. Methods: We conducted a retrospective review of the medical records of all patients who underwent free fibula flap surgery for nontraumatic maxillofacial reconstruction from 2010 to 2017 and were followed postoperatively for at least 6 months or until death. Results: In 20 patients (10 female; mean age, 33.8; range, 7–56), the results were excellent, 19 of 20 patients ultimately resuming a normal diet, one a soft diet; good oral opening in 18; and normal speech, normal occlusion, and an aesthetically good result, each in 17 patients. Half the patients had a perfect (10/10) OFFA score at final assessment, whereas 2 scored 9/10, one 8/10, and two 6/10. On univariate analysis, patient age > 45, tumor of higher malignancy potential, comorbid illness, and adjuvant radiotherapy predicted a worse OFFA score, whereas a multivariate model combining comorbid illness (P = 0.002) and preoperative radiotherapy (P = 0.010) predicted a lower OFFA score, accounting for 57% of the variance (R2 = 0.57). Conclusion: In Saudi Arabia, fibular free flaps yielded overall very good to excellent results in 19 of 20 patients undergoing nontraumatic maxillofacial reconstruction.
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Affiliation(s)
- Ahmed Alotaibi
- Departments of Plastic and Oromaxillofacial Surgery, King Fahd Medical City, Riyadh, Saudi Arabia
| | - Abdulsalam Aljabab
- Departments of Plastic and Oromaxillofacial Surgery, King Fahd Medical City, Riyadh, Saudi Arabia
| | - Ghazi Althubaiti
- Departments of Plastic and Oromaxillofacial Surgery, King Fahd Medical City, Riyadh, Saudi Arabia
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Haase C, Lethaus B, Knüchel-Clarke R, Hölzle F, Cassataro A, Braunschweig T. Development of a Rapid Analysis Method for Bone Resection Margins for Oral Squamous Cell Carcinoma by Immunoblotting. Head Neck Pathol 2018; 12:210-220. [PMID: 28929330 PMCID: PMC5953878 DOI: 10.1007/s12105-017-0856-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/12/2017] [Indexed: 12/12/2022]
Abstract
The purpose of this proof-of-principle study was to develop a rapid and approachable method to analyse bone resection margins in patients with oral squamous cell carcinoma (OSCC) in an intraoperative setting, similar to assessing frozen sections of soft tissue. Bone excision and risk of remaining tumour cells could be minimised, thus improving reconstruction measures and facilitating convalescence. Frozen, sawed wafers of porcine bone artificially combined with porcine skin (simulating OSCC properties) were used to develop and evaluate a new molecular method: protein transfer from non-decalcified, sawed wafers onto a membrane stained by immunofluorescence (Tissue-ProtTrans). Tissue-ProtTrans was based on the detection of keratin 5/6 as a marker of tumour cells. The results were compared to standard immunohistochemistry (IHC) and H&E results of the same wafers after decalcification. Tissue-ProtTrans resulted in a total assay time of 3.5 h using the Trans-Blot® Turbo™ Transfer System (Bio-Rad) for protein transfer. Amersham Protran® Premium Nitrocellulose Membranes 0.2 µm (GE Healthcare) were stained with a primary antibody to keratin 5/6 (Dako Agilent) and a secondary antibody labelled with IRDye® 800CW (LI-COR). Visualisation was performed with an infrared laser scanner (Odyssey). Upon comparison, five independent experiments on porcine specimens processed with the Tissue-ProtTrans showed similar results to standard IHC and H&E analysis. In comparison to standard IHC results (requiring several days due to decalcification) Tissue-ProtTrans provided similar results, but was much faster (3.5 h). This highly promising method has good potential for further time reduction and will be suitable for intraoperative assessment.
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Affiliation(s)
- Claudia Haase
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Bernd Lethaus
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | | | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Angela Cassataro
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Till Braunschweig
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany.
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Rendenbach C, Schoellchen M, Bueschel J, Gauer T, Sedlacik J, Kutzner D, Vallittu PK, Heiland M, Smeets R, Fiehler J, Siemonsen S. Evaluation and reduction of magnetic resonance imaging artefacts induced by distinct plates for osseous fixation: an in vitro study @ 3 T. Dentomaxillofac Radiol 2018; 47:20170361. [PMID: 29718688 DOI: 10.1259/dmfr.20170361] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES: To analyze MRI artefacts induced at 3 T by bioresorbable, titanium (TI) and glass fibre reinforced composite (GFRC) plates for osseous reconstruction. METHODS: Fixation plates including bioresorbable polymers (Inion CPS, Inion Oy, Tampere, Finland; Rapidsorb, DePuy Synthes, Umkirch, Germany; Resorb X, Gebrueder KLS Martin GmbH, Tuttlingen, Germany), GFRC (Skulle Implants Oy, Turku, Finland) and TI plates of varying thickness and design (DePuy Synthes, Umkirch, Germany) were embedded in agarose gel and a 3 T MRI was performed using a standard protocol for head and neck imaging including T1W and T2W sequences. Additionally, different artefact reduction techniques (slice encoding for metal artefact reduction & ultrashort echo time) were used and their impact on the extent of artefacts evaluated for each material. RESULTS: All TI plates induced significantly more artefacts than resorbable plates in T1W and T2W sequences. GFRCs induced the least artefacts in both sequences. The total extent of artefacts increased with plate thickness and height. Plate thickness had no influence on the percentage of overestimation in all three dimensions. TI-induced artefacts were significantly reduced by both artefact reduction techniques. CONCLUSIONS: Polylactide, GFRC and magnesium plates produce less susceptibility artefacts in MRI compared to TI, while the dimensions of TI plates directly influence artefact extension. Slice encoding for metal artefact reduction and ultrashort echo time significantly reduce metal artefacts at the expense of scan time or image resolution.
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Affiliation(s)
- Carsten Rendenbach
- 1 Department of Oral and Maxillofacial Surgery, Charité - Universitaetsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany.,2 Berlin Institute of Health (BIH) , Berlin , Germany
| | - Max Schoellchen
- 3 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Julie Bueschel
- 3 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Tobias Gauer
- 4 Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Jan Sedlacik
- 5 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Daniel Kutzner
- 5 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Pekka K Vallittu
- 6 Department of Biomaterials Science, Institute of Dentistry, University of Turku, and City of Turku, Welfare Division , Turku , Finland
| | - Max Heiland
- 1 Department of Oral and Maxillofacial Surgery, Charité - Universitaetsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
| | - Ralf Smeets
- 3 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Jens Fiehler
- 5 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Susanne Siemonsen
- 5 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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