Inferior alveolar nerve repositioning surgical techniques and outcomes - a systematic review

Inferior alveolar nerve (IAN) lateralization (IANL) or transposition (IANT) are both techniques allowing for dental implant placement in posterior atrophic mandibles. The aim of this study was to systematically review the implant survival rate and the complications associated with IAN reposition techniques with simultaneous implant placement in atrophic posterior mandibles. This systematic review was conducted following PRISMA guidelines (Preferred Reporting Items for Systematic review and Meta-Analysis). The review was designed to answer the following PICO question: Is IAN repositioning (I) a safe and efficient technique (O) to treat patient looking for fixed dental rehabilitation of an atrophic posterior mandible (P). Thirty-three articles were reviewed, including a total of 899 patients, and approximately 950 IAN repositioning procedures. Dental implant survival rate ranged between 86.95% and 100% with a mean dental survival rate of 90.16%. Among the 269 patients who underwent IANT, there were 93% immediate neurosensory disturbance, and 15% persistent neurosensory disturbance. Among the 350 patients who underwent IANL, there were 93% immediate neurosensory disturbance, and 6% persistent neurosensory disturbance. IANT and IANL are reliable techniques allowing safe dental implant placement in atrophic posterior mandible with high patient satisfaction. IANL seems to cause less persistent neurosensory disturbances compared to IANT. The level of evidence is poor due to the high number of bias present in the included studies. IAN neurosensory disturbance assessment should be better homogenized in order to increase comparability.

Surgical management of dysthyroid optic neuropathy: A systematic review

OBJECTIVE

There is currently no recommendation on the optimal surgical management for dysthyroid optic neuropathy (DON). The aim of this study is to systematically review the surgical management of DON and its outcome on visual acuity (VA).

DATA SOURCES

MEDLINE, Cochrane Library, and clinicaltrials.gov REVIEW METHODS: A systematic review of studies about the surgical management of DON was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles were included if preoperative and postoperative VA in logMAR (Logarithm of the Minimum Angle of Resolution) were available.

RESULTS

Fifteen articles were included in the study accounting for 669 orbits. The mean VA improvement was of 0.44 logMAR overall, 0.41 logMAR for 1-wall, 0.41 logMAR for 2-wall, and 0.55 logMAR for 3-wall decompressions. The mean reduction in exophthalmos was 4.9 mm overall, 4.3 mm for 1-wall, 4.54 mm for 2-wall, and 6.02 for 3-wall decompressions. The mean new onset diplopia (NOD) rate was 19.84% overall, 19,12% for 1-wall, 20.75% for 2-wall, and 19.83% for 3-wall decompressions.

CONCLUSION

The results are limited due to the high number of biases in the included studies. It seems that 3-wall decompression offers the best VA improvement and proptosis reduction although also the highest NOD and complications rate. Two-wall balanced decompression or 1-wall inferomedial decompression seems to be effective with less morbidity.

Oral carcinoma cuniculatum, a rare variant of squamous cell carcinoma

INTRODUCTION

Carcinoma cuniculatum (CC) is a rare variant of squamous cell carcinoma (SCC). Lack of awareness of this tumor and its difficult diagnosis delay management and complicate treatment. The aim of this study is to describe the clinical and histological features, predisposing factors, treatment and survival rate of oral carcinoma cuniculatum.

MATERIAL & METHOD

All patients with histologically confirmed CC of the oral cavity treated between January 2013 and August 2022 in a specialized center were retrospectively included. Patients were identified using the database ADICAP ("Association pour le Développement de l'Informatique en Cytologie et Anatomie Pathologique"). Once identified, the charts were reviewed.

RESULTS

Ten patients were included. CC lesions were mainly located in the mandibular or maxillary gingiva, while the 2 remaining lesions were located in the mobile tongue. The tumor showed local aggressiveness: mandibular or maxillary osteolysis was systematically found for gingival CC, while tongue lesions were classified cT3. Fifteen biopsies were performed in these 10 patients, histological diagnosis is difficult on a limited tissue sample. All patients underwent curative management with oncological excision surgery combined with neck lymph node dissection, and adjuvant radiotherapy (except one patient).

DISCUSSION

The main problem is the difficulty of diagnosis when biopsies are performed, which leads to a significant delay in diagnosis compared with SCC. In the event of clinico-histological discordance after biopsy, CC should be considered.

Contribution of FDG-PET in the diagnostic assessment of cervical lymph node metastasis in Oral Cavity Squamous Cell Carcinoma (OCSCC)

INTRODUCTION

The main objective of this study was to evaluate the contribution of FDG-PET in the diagnostic assessment of cervical lymph node metastasis in Oral Cavity Squamous Cell Carcinoma (OCSCC) and to advance a diagnostic threshold value for SUVmax in carcinomatous cervical lymph node.

METHODS

47 patients with OCSCC and suspicious cervical lymph node involvement (cN+) on FDG-PET were included in this retrospective study. The primary outcome was cervical lymph node SUVmax based on histological cervical metastatic disease (« gold standard »).

RESULTS

Among the 77 cervical lymph nodes considered suspicious on patients' FDG-PET, 50 were really metastatic on histological examination. The lymph node SUVmax with metastatic involvement on histological examination was 4.6 ± 3.9 [2.6 - 23.7] versus 3.6 ± 1.2 [2 - 7.3] without carcinomatous involvement (p = 0.004). The lymph node size was not statistically significant according to metastatic disease (p = 0.28).

DISCUSSION

A cervical lymph node SUVmax value of less than 2.6 on FDG-PET would suggest non-metastatic lymph node involvement. Supra Omohyoid Neck Dissection (SOHND) could therefore be performed in OCSCC when the SUVmax of the cervical lymph node is below this value in order to reduce the surgical morbidity of dissection of the lower internal jugular chain (Level IV).

Surgical treatment outcomes of solitary fibrous tumors in the head and neck: A retrospective study

The aim of this study was to better characterize head and neck solitary fibrous tumors (SFTs) and to evaluate surgical treatment. This retrospective study included patients who presented with head and neck SFTs. Clinical, radiological, and histological information and data regarding the treatments performed were collected. The risk of locoregional and distant metastases was calculated, and for orbital SFTs a specific classification was used. Overall, 34 patients were included. The majority of the SFTs were found in the oral cavity (n = 10), followed by the neck region (n = 8). The mean time to recurrence was 67.4 months. All patients underwent primary surgical resection. Recurrence was observed in five patients with a low risk of locoregional recurrence and distant metastasis. The treatment of choice is complete resection. Recurrence seems to be highly correlated with positive surgical margins. The safety margin should be increased when removing the lesion, and long-term follow-up should be performed.

Oral tongue squamous cell carcinomas in young patients according to their smoking status: a GETTEC study

BACKGROUND

Incidence of oral tongue squamous cell carcinoma (OTSCC) is increasing, especially in young adults, despite decreasing tobacco and alcohol consumption.

METHODS

This multicentric retrospective study of 185 young adults with OTSCC (median follow-up 43 months), investigated risk factors, tumour characteristics and oncological outcomes according to the smoking status.

RESULTS

Overall, 38% of patients were smokers (S). Non-smokers (NS) were significantly younger than S. Sex ratios were 1.1 for N and 1.8 for S. NS patients were less frequently cannabis or alcohol users than S, but were more likely to have a history of leukoplakia. Second primaries were observed in NS (4.4%) and in S (12.7%). Despite more frequent local relapse in NS (p = 0.018), there was no difference in diagnostic stage and overall survival between groups.

CONCLUSION

OTSCC affects differently young S and NS patients suggesting the existence of a specific clinical entity of OTSCC in non-smoking young adults.

Donor site sequelae and patient satisfaction after head and neck reconstruction with a radial forearm free flap

PURPOSE

Radial forearm free flap (RFFF) being a workhorse flap in head and neck reconstruction, we investigated its donor site delayed consequences.

METHODS

Multicentric case series evaluating 189 patients who underwent RFFF for carcinologic reasons at least 6 months before. Patients and surgeon's appreciation regarding the aesthetic and functional consequences of the flap harvest on their daily life were evaluated by questionnaires using likert scales. Medical data were collected from patients' charts retrospectively.

RESULTS

Thirty percent of patients had at least one sequelae. Experiencing a graft necrosis did not worsen long-term results. Cosmetic satisfaction was significantly worst for women, according to patients' and surgeons' opinion. For 81% and 92% patients, respectively, the flap harvest had no impact on daily life nor sport practice. Ratio between the benefits of reconstruction and the sequelae at the donor site was judged "excellent" for 77% patients.

CONCLUSIONS

Although objectively important, RFFF morbidity has little impact in head and neck cancer patient's life.

Significant decrease of facial cellulitis admissions during COVID-19 lockdown in France: A multicentric comparative study

During the 2020 coronavirus pandemic, a lockdown was imposed in France during the first wave. An apparent decrease in incidence of cellulitis of odontogenic origin was noticed then. This study aimed to compare the incidence of cellulitis during this extraordinary period with the same period in 2018 and 2019, based on retrospective multicentric data. All maxillofacial surgery departments in French public hospitals were contacted. Responders were asked to include all patients admitted for the surgical drainage of a head and neck abscess of odontogenic origin during the first 2020 lockdown period, and in a similar time frame in 2018 and 2019 (control group), based on screening the French diagnostic and therapeutic classification of medical acts. We report a 44% significant nationwide decrease in the incidence of admissions for cellulitis. There were 187 patients in 2020 for 334 and 333 patients in 2018/2019 respectively. The reasons to explain this finding are hypothetical (organizational reasons leading to earlier management, patients' fear to seek for medical management, usual excess in surgical indications or concomitant decrease of non-steroidal anti-inflammatory drugs delivery). Whatever the explanation, it would be of great interest to find it out in order to improve the prevention of cellulitis.

Current status of surgical planning and transfer methods in orthognathic surgery

Since the advent of orthognathic surgery major efforts have been made to render these surgical procedures more reliable, accurate, reproducible, and shorter. Such improvements imply the enhancement of surgical planning (SP) techniques and optimization of SP transfer tools. Most widespread current SP methods are based on physical examination/anthropometric measurements combined with cephalometric analysis. Most surgeons currently use handmade acrylic surgical splints or sometimes freehand surgery as transfer tool. The emergence of virtual surgical planning (VSP) procedures gave birth to several modern transfer tools, such as computer-assisted design and manufactured (CAD/CAM) splints, CAD/CAM splints with extra-oral bone support, customized miniplates, and surgical navigation. This article classifies and describes these emerging transfer tools, therewith underlining their advantages and drawbacks.

Supraomohyoid neck dissection in cancer of the oral cavity

BACKGROUND

In oral cavity cancer, supraomohyoid neck dissection (SOHND) is becoming more popular for patients with N0 and N1 disease in the neck. The aim of this study was to assess the value of this surgical procedure.

METHODS

The study included 237 previously untreated patients with oral cavity cancer. The neck treatment consisted of SOHND or functional neck dissection (FND). One hundred sixty patients underwent postoperative radiation therapy. Survival probabilities, neck recurrences, and distant metastases were analyzed according to the surgical procedure.

RESULTS

For patients having undergone SOHND, the 5-year survival probabilities were 70.2% and 76.5% in N0 and N1 necks, respectively. The neck recurrence rate in SOHND was 2%.

CONCLUSIONS

SOHND is an effective method of treatment for the clinically negative neck in patients with squamous cell carcinoma of the oral cavity. It also proves efficient, in conjunction with postoperative radiotherapy, for control of neck metastases in selected patients.

[Treatment of fibrous dysplasia of the cranio-facial bones. Report of 25 cases]

Fibrous dysplasia accounts for approximately 2% of bone tumors. The ribs, proximal femurs and cranio-facial bones represent the majority of bone lesions. Surgery is the mainstay of treatment but the technique is controversial: conservative surgery or removal of dysplastic lesions followed by implantation of autogenous bone graft. The aim of this study was to assess the indications of each method. The medical records of 25 patients with fibrous dysplasia of the cranio-facial bones treated between January 1, 1980 and December 31, 1994 at the Department of Maxillofacial Surgery, Centre Hospitalier Universitaire de Bordeaux, France, were reviewed. Fourteen (56%) patients were women and 11 (44%) men. The median age at the time of diagnosis was 23 years (ranging from 8 to 56 years). The mean follow-up was 8 years. Two patients were unavailable for follow-up after treatment. The primary sites of the tumors were the mandible (n = 19 [76%]), maxilla (n = 1 [4%]) and skull (n = 5 [20%]). For mandibular lesions, the primary treatment always included a correction of deformations and asymmetry, which was the only treatment in 14 cases. Two patients required subsequent surgery to reduce further bone enlargement (1 and 2 years later in the first case and 11 years later in the second) without further problems. In 3 cases a segmental mandibulectomy followed by implantation of autogenous bone graft was required, and no further recurrence was observed. Therefore, the success rate of conservative surgery was 74% initially, and up to 86% after subsequent surgery. Skull lesions, although often very extensive, were remarkably stable and asymptomatic. They were successfully treated 4 times by conservative surgery, mainly for cosmetic reasons. One patient, with an ethmoidal tumor producing a mass effect along the course of the optic nerve, underwent a combined cranio-facial resection. As for the only maxillary tumor, three curettages were performed throughout an 11-year period and there was no evidence of further recurrence 4 years after the last intervention. In all cases, conservative surgery may be recommended as primary treatment of fibrous of the craniofacial bones, providing essential structures like the optic nerve are not at risk. Cosmetic results and local control proved excellent, and a further removal of the tumor remained feasible in the event of a recurrence. Success or failure did not correlate with tumor size, which justifies the use of this technique.

[Gunshot injuries of the face. Analysis of 165 cases and reevaluation of the primary treatment]

Our large experience of shotgun injuries to the face emphasizes the need for a reappraisal of primary treatment for this poorly documented topic. The medical records of 165 patients, treated at our institution between january 1st, 1982 and december, 31st 1996 for such an injury, were reviewed. Almost all cases were exclusively self-inflicted lesions. The guns were mainly twelve-gauge and occasionally 16 or 20-gauge. Close range wounds in an heterogeneous area--soft-tissue, mandible, muscles of the tongue and floor of the mouth, oral and nasal cavities, maxilla and paranasal sinuses--caused massive damage. A topographic classification based on the soft-tissue and bone loss is reported. After initial management (including securing the airway and control of bleeding), conservative debridement of all devitalized tissues and stabilization of the fractures were performed. As soon as possible, bone and soft tissue reconstruction was undertaken using local or distant flaps. However, immediate definitive reconstructive procedures were scarcely [corrected] used and only in particular cases. We believe that a carefully planned reconstruction schedule is required to achieve satisfactory appearance and function.

[Surgical treatment of pleomorphic adenoma of the parotid gland. Apropos of 192 cases]

Tumors of the salivary glands are exceptional, representing approximately 2% of head and neck tumors. The parotid gland is most often involved, at a frequency reaching 80%. Histology examination generally shows a pleomorphous adenoma. The choice of a surgical technique best adapted to curative treatment depends on the type of tumor and is widely debated. Our management strategy is based on simultaneous histology examination and superficial parotidectomy. Several pre and intra-operative factors determine the need for resection. We verified our strategy with a retrospective study.

[Spinal accessory nerve and lymphatic neck dissection]

Radical neck dissection was the golden standard of treatment for cervical nodes in head and neck tumors. From the seventies, the preservation of the spinal accessory nerve has become increasingly popular in order to improve the functional result of the neck dissections. The aim of this study was to assess the degree of functional disability associated with each type of neck dissection and the value of anatomical references for dissection of the spinal accessory nerve. One hundred twenty seven patients were evaluated 1 month and 1 year after radical, functional or supraomohyoid neck dissection with a questionnaire and a physical examination. Anatomical measurements of the spinal accessory nerve were performed in 20 patients. We found considerable or severe shoulder dysfunction in 7%, 34% and 51% respectively of patients in whom supraomohyoid, functional and radical neck dissections were performed. Furthermore 49% of patients having undergone a radical neck dissection had little or no symptoms. Sacrifice of the spinal accessory nerve in radical neck dissection may lead to shoulder dysfunction. A functional disability may also be associated, although in a less extent, with any neck dissection in which the spinal accessory nerve is dissected and placed in traction. There is a large variation in the degree of functional disability and pain in patients with similar neck dissections. The course of the spinal accessory nerve in the neck makes it particularly vulnerable to injury during the dissection near the sternocleidomastoid muscle and in the posterior cervical triangle.

[Posterior marginal mandibulectomy for cancer of the oral cavity and oropharynx. Experience with 14 clinical cases]

Marginal mandibulectomies are now widely performed in the anterior aspect of the mandible providing that the preoperative clinical and radiologic evaluation shows no bone invasion. These marginal resections can be extended to the posterior area. Molar, retromolar and ascending ramus resections can be performed. This removes the upper bone segment preserving the dental canal whenever possible. From 1990, 14 patients were treated with this technique for carcinoma of the retromolar triangle (9 cases) and oropharynx (5 cases). 11 different flaps were used to cover the soft tissue defect and 3 direct sutures were performed. Eleven patients underwent postoperative radiotherapy with a mean dose of 58 Gray. Median follow-up was 32 months. Functional and cosmetic results were very satisfactory due to preservation of mandibular continuity. We found no osteomyelitis, postoperative fracture or radionecrosis. This technique avoids a segmental resection in some well-defined cases and the disability produced as a result of this treatment. There is therefore, no need for complex reconstruction and the operating time is shortened in fragile patients.

Prognostic value of histologic findings in neck dissections for squamous cell carcinoma

BACKGROUND

Cervical node involvement is the most significant prognostic factor in head and neck squamous cell carcinoma. When histologic findings show node invasion, the number of positive nodes and the presence of extracapsular spread are commonly accepted as prognostic factors.

OBJECTIVE

To confirm the findings of recent reports that there is no significant difference in outcome associated with extracapsular spread.

SETTING

Referral center.

DESIGN

Retrospective study.

PATIENTS

Three hundred thirty-seven patients under-going 487 neck dissections for carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx from January 1, 1985, to December 31, 1992. For N3 node involvement, a radical neck dissection was performed; other patients underwent supraomohyoid or functional neck dissection. Two hundred forty-two patients underwent postoperative radiotherapy (mean dose, 59 Gy).

OUTCOME MEASURES

Survival capabilities calculated by the Kaplan-Meier method and significance calculated by the log rank test.

RESULTS

Overall 5-year survival was 50.8%. The study of prognostic factors showed no significance for extracapsular spread (P = 45). Conversely, the number of positive nodes had a significant value (P < .001).

CONCLUSIONS

Extracapsular node spread per se might be considered as no longer having a definitive prognostic value. These results, consistent with those of previous reports, may be due to wider use of combined treatment modalities.

[Infrahyoid musculocutaneous flaps: anatomical bases and indications in cervicofacial oncologic surgery]

The infrahyoïd myocutaneous flap has been described by Wang in 1986. Its use seems still limited, although its obvious interest in head and neck reconstructive surgery, especially in oropharyngeal area. Authors expound anatomic bases of this flap, and a 62 case's experience confirming its potential.

[Analysis of reconstruction procedures for defects of the mouth floor. Report of 96 cases]

The aim of this study was to assess the reconstruction of floor of the mouth defects after cancer surgery. The medical records of 140 patients treated between January 1st, 1987 and December 31st, 1995 were reviewed. Ninety-six patients had primary reconstruction: there were 82 cutaneous or osteomyocutaneous flaps and 14 microsurgical transfers. Among these patients 15 had titanium mandibular reconstruction plates. The reconstruction procedures and postoperative follow-up were evaluated. Healing by first intention is appropriate for superficial soft tissue defects. The nasolabial flap is used only for small mucosal defects. A forearm flap should be the first choice treatment for large soft tissue defects owing to its plasticity and reliable vessels. Segmental mandibular resections often imply mandibular reconstruction. Titanium plates may be used alone or with a cutaneous flap. Tolerance of plates after radiotherapy is very good and they are an effective method of reconstruction for fragile patients.

[Mandibular reconstruction in oncology: discussion of indications]

The aim of the study was to assess the results of segmental mandibular resections and the validity of mandibular reconstructions. The medical records of 95 patients treated between January 1, 1987 and December 31, 1992 were reviewed. There were 82 (86%) carcinomas, 9 ameloblastomas and 4 sarcomas. Among the 82 patients treated for carcinoma, the overall 2- and 5-year survival rates were 70% and 33% respectively. The functional results evaluated one year after surgery showed no significant difference according to the reconstruction procedure: myocutaneous flap, osteomyocutaneous flap, titanium mandibular reconstruction plate or microsurgical transfer. The most important factor in functional rehabilitation is the amount of soft tissue resected. In head and neck oncology, aggressive surgical reconstruction of the mandible must only be used in patients with good general status and fair survival probability.