Effectiveness of Sucralfate comparing to normal saline as an oral rinse in pain reduction and wound healing promotion in oral surgery

Objectives

To study the effectiveness of Sucralfate suspension oral rinse compared to normal saline alone for pain reduction and wound healing promotion in open oral surgical wounds. The primary outcome of this study was postoperative pain VAS score reduction. The secondary outcome was wound healing promotion based on wound grade and maximal wound length reduction.

Materials and methods

A total of 30 patients with secondary healing intraoral surgical wounds were enrolled in this study. Sucralfate suspension (1 g/5 mL) was prescribed to a randomized experimental group as an oral rinse every 6 h for 14 days in addition to standard postoperative care. Postoperative pain VAS score, wound grade, and wound length were collected and compared with baseline from initial to final visit during 2 weeks.

Results

The mean change of VAS score was significantly lower from baseline in the Sucralfate group on day 3 (-0.77 in control and -2.15 in Sucralfate, p < .05) and day 7 (-2.15 in control and -3.62 in Sucralfate, p < .05). Wound grade distribution over time was the same in both Sucralfate and control groups. The mean change in wound length was not significantly different between the two groups. No adverse reaction to Sucralfate was reported during the study participation.

Conclusions

Sucralfate suspension oral rinse can be recommended as an effective topical analgesic solution in postoperative secondary healing of intraoral wounds with no significant interference. The benefits of wound healing promotion have yet to be proven.

Level of evidence

1b.

Imaging nodal volume and survival in oral tongue cancer with cervical lymph node metastasis

OBJECTIVES

Oral tongue cancer is the most prevalent type of oral cavity cancer and presents the worst prognosis. With the use of TNM staging system, only the size of primary tumor and lymph node are considered. However, several studies have considered the primary tumor volume as a possible significant prognostic factor. Our study, therefore, aimed to explore the role of nodal volume from imaging as a prognostic implication.

METHODS

Medical records and imaging (either from Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) scan) of 70 patients diagnosed with oral tongue cancer with cervical lymph node metastasis between January 2011 and December 2016 were retrospectively reviewed. The pathological lymph node was identified, and nodal volume was measured using the Eclipse radiotherapy planning system and was further analysed for its prognostic implications, particularly on overall survival, disease-free survival, and distant metastasis-free survival.

RESULTS

From A Receiver Operating Characteristic (ROC) curve analysis, the optimal cut-off value of the nodal volume was 3.95 cm3, to predict the disease prognosis, in terms of overall survival and metastatic-free survival (p ≤ 0.001 and p = 0.005, respectively), but not the disease-free survival (p = 0.241). For the multivariable analysis, the nodal volume, but not TNM staging, was a significant prognostic factor for distant metastasis.

CONCLUSIONS

In patients with oral tongue cancer and cervical lymph node metastasis, the presence of an imaging nodal volume of ≥3.95 cm3 was a poor prognostic factor for distant metastasis. Therefore, the lymph node volume may have a potential role to adjunct with the current staging system to predict the disease prognosis.

LEVEL OF EVIDENCE

2b.

Low prevalence of p16-positive HPV-related head-neck cancers in Thailand: tertiary referral center experience

Background

There has been a sharp rise in the incidence of human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC) in many countries. Patients with HPV-positive OPSCC have a more favorable prognosis compared with HPV-negative OPSCC, leading to investigation and adoption of de-escalation treatment protocols. The baseline rate of HPV prevalence in certain populations is of epidemiologic significance. We aimed to evaluate the rate of high-risk HPV in a large cohort of Thai patients, including OPSCC, oral SCC (OSCC) and laryngeal SCC (LSCC).

Methods

In total, 504 patients with HN cancer (110 OPSCC, 260 OSCC and 134 LSCC) who had been treated in Chulalongkorn University between 2010 and 2016 formed the sample set. All histological slides were reviewed to validate the diagnosis and render the histological type as keratinizing (K), non-keratinizing (NK) or non-keratinizing with maturation (NK-M). Immunohistochemistry with p16 was performed in all cases and scored semiquantatively. Positive and equivocal cases were tested by the high-risk HPV DNA in situ hybridization (ISH). Validation with quantitative polymerase-chain reaction (qPCR) was performed in p16-positive OPSCC.

Results

The OPSCC were represented by NK (7.3%), NK-M (16.4%) and K (76.4%) types, with an HPV incidence of 100, 22.2 and 4.7%, respectively. The average HPV prevalence in OPSCC was 14.5%. The concordance with p16/ISH was 51.6%, while concordance of the NK morphology with positive HPV ISH was 100%. ISH-qPCR concordance in p16-positive OPSCC was 72.7%. Patients with HPV-positive OPSCC had significantly more tumors with a NK histologic type, tonsillar location, earlier clinical stage, less association with smoking, and, finally, better outcome and longer survival time. In non-OPSCC, p16-positive HPV-associated cancers were found in only 1.5% of OSCC (4/260) and LSCC (2/134).

Conclusion

A low rate of HPV-related OPSCC was found in Thai patients. The NK morphology was an excellent predictor of high-risk HPV infection in OPSCC. For OPSCC patients, HPV-positive ones had a significantly longer survival time than HPV-negative ones. There was a lack of p16-positive HPV-related OSCC and LSCC. Morphology and p16 status had a poor predictive value for detecting HPV in OSCC and LSCC.