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Navarro Cuéllar I, Espías Alonso S, Alijo Serrano F, Herrera Herrera I, Zamorano León JJ, Del Castillo Pardo de Vera JL, López López AM, Maza Muela C, Arenas de Frutos G, Ochandiano Caicoya S, Tousidonis Rial M, García Sevilla A, Antúnez-Conde R, Cebrián Carretero JL, García-Hidalgo Alonso MI, Salmerón Escobar JI, Burgueño García M, Navarro Vila C, Navarro Cuéllar C. Depth of Invasion: Influence of the Latest TNM Classification on the Prognosis of Clinical Early Stages of Oral Tongue Squamous Cell Carcinoma and Its Association with Other Histological Risk Factors. Cancers (Basel) 2023; 15:4882. [PMID: 37835576 PMCID: PMC10571553 DOI: 10.3390/cancers15194882] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 09/17/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The American Joint Committee on Cancer (AJCC), in its 8th edition, introduces modifications to the previous TNM classification, incorporating tumour depth of invasion (DOI). The aim of this research is to analyse the prognosis (in terms of disease-free survival and overall survival) of clinical early stage (I and II) squamous cell carcinomas of the oral tongue according to the DOI levels established by the AJCC in its latest TNM classification to assess changes to the T category and global staging system and to evaluate the association between DOI and other histological risk factors. METHODS A retrospective longitudinal observational study of a series of cases was designed. All patients were treated with upfront surgery at our institution between 2010 and 2019. The variables of interest were defined and classified into four groups: demographic, clinical, histological and evolutive control. Univariate and multivariate analyses were carried out and survival functions were calculated using the Kaplan-Meier method. Statistical significance was established for p values below 0.05. RESULTS Sixty-one patients were included. The average follow-up time was 47.42 months. Fifteen patients presented a loco-regional relapse (24.59%) and five developed distant disease (8.19%). Twelve patients died (19.67%). Statistically significant differences were observed, with respect to disease-free survival (p = 0.043), but not with respect to overall survival (p = 0.139). A total of 49.1% of the sample upstaged their T category and 29.5% underwent modifications of their global stage. The analysis of the relationship between DOI with other histological variables showed a significant association with the presence of pathological cervical nodes (p = 0.012), perineural invasion (p = 0.004) and tumour differentiation grade (p = 0.034). Multivariate analysis showed association between depth of invasion and perineural invasion. CONCLUSIONS Depth of invasion is a histological risk factor in early clinical stages of oral tongue squamous cell carcinoma. Depth of invasion impacts negatively on patient prognosis, is capable per se of modifying the T category and the global tumour staging, and is associated with the presence of cervical metastatic disease, perineural invasion and tumoural differentiation grade.
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Affiliation(s)
- Ignacio Navarro Cuéllar
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
| | | | | | - Isabel Herrera Herrera
- Radiology Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | - José Javier Zamorano León
- Public Health and Maternal & Child Health Department, School of Medicine, Universidad Complutense, 28040 Madrid, Spain;
| | | | - Ana María López López
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
| | - Cristina Maza Muela
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
| | - Gema Arenas de Frutos
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
| | - Santiago Ochandiano Caicoya
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
| | - Manuel Tousidonis Rial
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
| | - Alba García Sevilla
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
| | - Raúl Antúnez-Conde
- Oral and Maxillofacial Surgery Department, Hospital Universitario Ruber Juan Bravo, 28006 Madrid, Spain;
| | - José Luis Cebrián Carretero
- Oral and Maxillofacial Surgery Department, Hospital Universitario La Paz, 28046 Madrid, Spain; (J.L.C.C.); (M.B.G.)
| | | | - José Ignacio Salmerón Escobar
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
| | - Miguel Burgueño García
- Oral and Maxillofacial Surgery Department, Hospital Universitario La Paz, 28046 Madrid, Spain; (J.L.C.C.); (M.B.G.)
| | - Carlos Navarro Vila
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
| | - Carlos Navarro Cuéllar
- Oral and Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.N.C.); (A.M.L.L.); (C.M.M.); (G.A.d.F.); (S.O.C.); (M.T.R.); (A.G.S.); (J.I.S.E.); (C.N.V.); (C.N.C.)
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Díez-Montiel A, Antúnez-Conde R, Navarro Cuéllar C, Tousidonis Rial M, Salmerón JI, Bonsfills N, Pujol CA, Serrano FA, Ochandiano S. Embryonal Rhabdomyosarcoma of the Tongue in Adults. Life (Basel) 2023; 13:1255. [PMID: 37374040 DOI: 10.3390/life13061255] [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: 04/09/2023] [Revised: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in the first two decades of life. One third of cases appear in the head and neck, with 60% of these being embryonal type. RMS is extremely rare in adults, comprising only 1% of adult malignancies, and of those, only 3.3% are rhabdomyosarcomas. (2) Case report: A 46 y.o. male presented with a 1 cm exophytic pediculated painless lesion on the dorsum of his tongue, with progressive growth for 3 months. An excisional biopsy revealed an "embryonal rhabdomyosarcoma with fusocellular areas, with negative rearrangement for gen FOXO1A, negative MDM2 (only focal positivity), and positive INI-1". Subsequent contrast-enhanced MRI concluded the presence of a lesion with imprecise margins in the right half-tongue, 15 × 8 × 7 mm (longitudinal × transverse × craniocaudal), compatible with a sarcoma. The patient underwent a partial centrolingual glossectomy followed by reconstruction with a buccinator muscle local flap. After surgery, he received chemotherapy with eight cycles of VAC (vincristine, actinomycin, and cyclophosphamide) protocol. The patient is now disease free after 42 months, with good tongue function. (3) Discussion and conclusions: Embryonal RMS is an extremely rare sarcoma in adults, and the location in the tongue is even more exceptional (only two more similar cases are reported in the literature). The prognosis in adults is significantly poorer than in children. A complete margin-free resection with an adequate chemotherapy protocol is the treatment of choice in cases such as these.
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Affiliation(s)
- Alberto Díez-Montiel
- Department of Oral and Maxillofacial Surgery, Instituto de Investigación Sanitaria Gregorio Marañon (liSGM), Gregorio Marañon General University Hospital, 28007 Madrid, Spain
| | - Raúl Antúnez-Conde
- Department of Oral and Maxillofacial Surgery, Instituto de Investigación Sanitaria Gregorio Marañon (liSGM), Gregorio Marañon General University Hospital, 28007 Madrid, Spain
| | - Carlos Navarro Cuéllar
- Department of Oral and Maxillofacial Surgery, Instituto de Investigación Sanitaria Gregorio Marañon (liSGM), Gregorio Marañon General University Hospital, 28007 Madrid, Spain
| | - Manuel Tousidonis Rial
- Department of Oral and Maxillofacial Surgery, Instituto de Investigación Sanitaria Gregorio Marañon (liSGM), Gregorio Marañon General University Hospital, 28007 Madrid, Spain
| | - José Ignacio Salmerón
- Department of Oral and Maxillofacial Surgery, Instituto de Investigación Sanitaria Gregorio Marañon (liSGM), Gregorio Marañon General University Hospital, 28007 Madrid, Spain
| | - Nuria Bonsfills
- ICIRE Institute for Reconstructive and Aesthetic Surgery, 28009 Madrid, Spain
| | - Carolina Agra Pujol
- Department of Pathology, Gregorio Marañon General University Hospital, 28007 Madrid, Spain
| | | | - Santiago Ochandiano
- Department of Oral and Maxillofacial Surgery, Instituto de Investigación Sanitaria Gregorio Marañon (liSGM), Gregorio Marañon General University Hospital, 28007 Madrid, Spain
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Navarro Cuéllar C, Tousidonis Rial M, Antúnez-Conde R, Agea Martínez M, Navarro Cuéllar I, Salmerón Escobar JI, Navarro Vila C. Functional Outcomes with Facial Artery Musculo-Mucosal (FAMM) Flap and Dental Implants for Reconstruction of Floor of the Mouth and Tongue Defects in Oncologic Patients. J Clin Med 2021; 10:3625. [PMID: 34441924 PMCID: PMC8397211 DOI: 10.3390/jcm10163625] [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: 07/26/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 11/22/2022] Open
Abstract
Optimal functional outcomes in oncologic patients with squamous cell carcinoma (SCCA) of the tongue and floor of the mouth require good lingual mobility, adequate facial competence, the cheek suction effect and dental rehabilitation with osseointegrated implants. In this study, twenty-two oncologic patients who had been diagnosed with intraoral SCCA affecting the tongue and the floor of the mouth and who had undergone wide resection of the tumor and immediate reconstruction with an inferiorly pedicled FAMM flap and immediate osseointegrated implants were assessed. Lingual mobility, speech articulation, deglutition, implant success rate, mouth opening, and aesthetic results were evaluated. All patients were staged as T2 and the defect size ranged from 3.7 × 2.1 cm to 6.3 × 4.2 cm. A selective neck dissection was performed in all patients as part of their oncologic treatment, either electively or for node positive disease. Thirteen patients (59%) were diagnosed with node positive disease and underwent adjuvant radiotherapy. A total of 101 osseointegrated implants were placed for prosthetic rehabilitation and 8 implants were lost (7.9%), of which 7 received radiotherapy (87.5%). The implant success rate was 92.1%. Mouth opening was reported as normal in 19 patients (86.3%). Tongue tip elevation was reported as excellent in 19 patients (86.3%) and good in 3 patients (13.6%). Lingual protrusion was referred to as excellent in 15 patients (68.2%) and good in 6 patients (27.2%). Lateral excursion was reported as excellent in 14 patients (63.6%) and good in 7 patients (31.8%). In terms of speech articulation, 20 patients reported normal speech (90.9%). Regarding deglutition, 19 patients (86.3%) reported a regular diet while a soft diet was reported by 3 patients (13.7%). Aesthetic results were referred to as excellent in 17 patients (77.3%). FAMM flaps, immediate implants and fixed prostheses enable the functional rehabilitation of oncologic patients, optimizing aesthetics and functional outcomes even in patients undergoing irradiation, thus returning oncologic patients to an excellent quality of life.
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Affiliation(s)
- Carlos Navarro Cuéllar
- Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, C/Doctor Esquerdo 46, 28007 Madrid, Spain; (M.T.R.); (R.A.-C.); (M.A.M.); (I.N.C.); (J.I.S.E.); (C.N.V.)
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Navarro Cuéllar C, Martínez EB, Navarro Cuéllar I, López López AM, Rial MT, Pérez AS, Salmerón Escobar JI. Primary Maxillary Reconstruction With Fibula Flap and Dental Implants: A Comparative Study Between Virtual Surgical Planning and Standard Surgery in Class IIC Defects. J Oral Maxillofac Surg 2020; 79:237-248. [PMID: 32890473 DOI: 10.1016/j.joms.2020.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Oncological patients who undergo bilateral subtotal maxillectomies develop functional and esthetic sequelae that require immediate reconstruction. The purpose of this study is to evaluate the primary reconstruction of maxillary defects with fibula flap and dental implants assisted by virtual surgical planning (VSP) and to assess the postoperative outcomes compared with standard surgery. MATERIAL AND METHODS A retrospective study was designed between January 2016 and April 2020 with 12 oncologic patients who underwent subtotal bilateral maxillectomy. Six consecutive patients were treated by standard surgical procedure (SS) at the beginning of the study. In 2018, the VSP was implemented, and 6 consecutive patients were treated using this technique. All patients were rehabilitated with Ticare implants and implant prostheses. Anatomic position of the bone, bone apposition, change of vertical distance, and horizontal shift, the operative and ischemia time, the esthetic results, and the functional rehabilitation were evaluated and compared. RESULTS The position of the bone in anatomical position was 100% in the VSP group vs 66% in the SS group. The bone apposition was 100% in the VSP group vs 83.3%. The change of vertical distance and the horizontal shift were lower in the VSP group (P < .05). The ischemia time and operative time were shorter in the VSP group (P < .05). A good esthetic result was achieved in 83.3% in the VSP group vs 33.3% in the SS group; 81 dental implants and 1 zygomatic implant were placed. The success rate was 95% in the VSP group and 92.6% in the SS group. All patients were rehabilitated with implant prosthesis. CONCLUSIONS VSP improves the accuracy of midface reconstruction (class IIC defect) with a better anatomical position of the bone, a higher rate of bone contact, and a lower change in vertical distance compared with standard surgery. It significantly improves the esthetic result, reduces ischemia time, and operation time.
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Affiliation(s)
- Carlos Navarro Cuéllar
- Associate Professor, Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón Madrid, Spain.
| | - Elena Bullejos Martínez
- Assistant Professor, Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ignacio Navarro Cuéllar
- Assistant Professor, Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón Madrid, Spain
| | - Ana María López López
- Assistant Professor, Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Tousidonis Rial
- Assistant Professor, Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón Madrid, Spain
| | - Arturo Sánchez Pérez
- Assistant Professor, Facultad de Odontología, Universidad de Murcia, Murcia, Spain
| | - José Ignacio Salmerón Escobar
- Professor and Head, Maxillofacial Surgery Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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