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Russell J, Breik O, Borgna SC, Volker G, Pateman K, Batstone M. Implications of the composite free flap harvest site on quality of life after head and neck surgery: a prospective series. Int J Oral Maxillofac Surg 2024; 53:275-281. [PMID: 37858382 DOI: 10.1016/j.ijom.2023.09.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023]
Abstract
Quality of life (QOL) has become a primary determinant of the treatment outcome. There is a poor evidence base regarding the QOL implications of free flap harvest from the various different osseous composite donor sites. This prospective study assessed the impact of free flap harvest on QOL and compared QOL morbidity between fibula, scapula, and iliac crest (deep circumflex iliac artery; DCIA) donor sites in head and neck reconstructive surgery. This was a single-site prospective cohort clinical research study. Fifty-nine patients were recruited between 2017 and 2021; 30 underwent fibula flap reconstructive surgery, 17 scapula flap, and 12 DCIA flap. The patients were assessed using the University of Washington Quality of Life Questionnaire version 4 (UW-QOL v4) preoperatively and again at >12 months postoperatively. The results showed no significant change in the mean global QOL score postoperatively when compared to the preoperative baseline in any of the donor site groups. However, the mean postoperative scores for the appearance domain were significantly lower than the preoperative scores in all of the donor site groups. In addition, fibula flap patients had significantly reduced physical activity and recreation QOL domain scores postoperatively when compared to the preoperative scores.
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Affiliation(s)
- J Russell
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.
| | - O Breik
- Oral and Maxillofacial Surgery Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - S C Borgna
- Oral and Maxillofacial Surgery Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - G Volker
- Department of Physiotherapy, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - K Pateman
- Centre for Allied Health Research, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - M Batstone
- Oral and Maxillofacial Surgery Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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2
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Smith R, Higginson J, Breik O, Praveen P, Parmar S. Nutritional management of chyle leak after head and neck surgery: a systematic review and proposed protocol for management. Oral Maxillofac Surg 2024; 28:51-62. [PMID: 37014458 DOI: 10.1007/s10006-023-01152-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/26/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE Chyle leaks are a rare complication of neck surgery causing local damage, impairing healing and compromising free flaps. High output leaks can result in electrolyte imbalances and malnutrition. Nutritional management such as restricting the absorption of triglycerides is believed to reduce chyle, allowing spontaneous resolution of a leak. Dietary preparations and management can aid in reducing chyle production. There are no clear guidelines to aid nutritional decision-making in this complex scenario. METHODS A systematic review of the literature was carried out to identify studies evaluating nutritional management of chyle leaks in patients after neck dissections. RESULTS Ten studies were identified evaluating the role of nutritional therapy in the management of patients with chyle leaks after neck dissections. The level of evidence was low. Several studies identified that low volume leaks (defined as < 1000 mls per day) often resolved by dietary management and other conservative measures. High volume leaks rarely resolved with conservative measures alone. Parenteral nutrition had an established role in this context. CONCLUSIONS There is limited evidence to guide dietary restriction and introduction of oral diet in patients with chyle leak after major head and neck surgery. Based on available evidence, local guidelines for the nutritional management of patients identified with a chyle leak were produced and adopted by the Trust and the head and neck MDT. A national database for voluntary contribution of prospective data would help to generate better quality management protocols.
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Affiliation(s)
- Rebekah Smith
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - James Higginson
- Faculty of Medicine, Imperial College London, and the International Centre for Recurrent Head & Neck Cancer, Royal Marsden Hospital, London, UK
| | - Omar Breik
- Royal Brisbane and Womens Hospital, Brisbane, Australia
| | - Prav Praveen
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sat Parmar
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Balakittnen J, Ekanayake Weeramange C, Wallace DF, Duijf PHG, Cristino AS, Hartel G, Barrero RA, Taheri T, Kenny L, Vasani S, Batstone M, Breik O, Punyadeera C. A novel saliva-based miRNA profile to diagnose and predict oral cancer. Int J Oral Sci 2024; 16:14. [PMID: 38368395 PMCID: PMC10874410 DOI: 10.1038/s41368-023-00273-w] [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: 08/09/2023] [Revised: 11/13/2023] [Accepted: 12/25/2023] [Indexed: 02/19/2024] Open
Abstract
Oral cancer (OC) is the most common form of head and neck cancer. Despite the high incidence and unfavourable patient outcomes, currently, there are no biomarkers for the early detection of OC. This study aims to discover, develop, and validate a novel saliva-based microRNA signature for early diagnosis and prediction of OC risk in oral potentially malignant disorders (OPMD). The Cancer Genome Atlas (TCGA) miRNA sequencing data and small RNA sequencing data of saliva samples were used to discover differentially expressed miRNAs. Identified miRNAs were validated in saliva samples of OC (n = 50), OPMD (n = 52), and controls (n = 60) using quantitative real-time PCR. Eight differentially expressed miRNAs (miR-7-5p, miR-10b-5p, miR-182-5p, miR-215-5p, miR-431-5p, miR-486-3p, miR-3614-5p, and miR-4707-3p) were identified in the discovery phase and were validated. The efficiency of our eight-miRNA signature to discriminate OC and controls was: area under curve (AUC): 0.954, sensitivity: 86%, specificity: 90%, positive predictive value (PPV): 87.8% and negative predictive value (NPV): 88.5% whereas between OC and OPMD was: AUC: 0.911, sensitivity: 90%, specificity: 82.7%, PPV: 74.2% and NPV: 89.6%. We have developed a risk probability score to predict the presence or risk of OC in OPMD patients. We established a salivary miRNA signature that can aid in diagnosing and predicting OC, revolutionising the management of patients with OPMD. Together, our results shed new light on the management of OC by salivary miRNAs to the clinical utility of using miRNAs derived from saliva samples.
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Affiliation(s)
- Jaikrishna Balakittnen
- Saliva & Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery, Griffith University, Nathan, QLD, Australia
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, University of Jaffna, Jaffna, Sri Lanka
| | - Chameera Ekanayake Weeramange
- Saliva & Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery, Griffith University, Nathan, QLD, Australia
- Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia
| | - Daniel F Wallace
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Pascal H G Duijf
- Centre for Cancer Biology, Clinical and Health Sciences, University of South Australia & SA Pathology, Adelaide, SA, Australia
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Alexandre S Cristino
- Griffith Institute for Drug Discovery, Griffith University, Nathan, QLD, Australia
| | - Gunter Hartel
- QIMR Berghofer Medical Research Institute, Statistics Unit, Brisbane, QLD, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Roberto A Barrero
- eResearch, Research Infrastructure, Academic Division, Queensland University of Technology, Brisbane, QLD, Australia
| | - Touraj Taheri
- Department of Anatomical Pathology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Liz Kenny
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Royal Brisbane and Women's Hospital, Cancer Care Services, Herston, QLD, Australia
| | - Sarju Vasani
- Saliva & Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery, Griffith University, Nathan, QLD, Australia
- Royal Brisbane and Women's Hospital, Cancer Care Services, Herston, QLD, Australia
- Department of Otolaryngology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Martin Batstone
- Department of Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Omar Breik
- Royal Brisbane and Women's Hospital, Cancer Care Services, Herston, QLD, Australia
- Department of Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Chamindie Punyadeera
- Saliva & Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery, Griffith University, Nathan, QLD, Australia.
- Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia.
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Chang VKO, See L, Griffin A, Breik O, Batstone MD, Liu TPJ. Impact of dental state and surgical factors on postoperative neck infection in oral cancer patients. Br J Oral Maxillofac Surg 2024; 62:51-57. [PMID: 38044253 DOI: 10.1016/j.bjoms.2023.10.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/29/2023] [Accepted: 10/17/2023] [Indexed: 12/05/2023]
Abstract
Postoperative neck infection (PONI) is a known complication of neck dissection. In this study we explored the impact of dental status on the development of PONI, using orthopantomograms to assess edentulism, periodontal health, and caries status. Retrospective analysis was performed for all new oral cancer patients who had neck dissection between January 2008 and January 2020 in a tertiary head and neck centre. PONI risk factors assessed included patient characteristics, dental status, tumour, and surgical factors. Development of PONI was the primary outcome. Edentulous patients had lower risk of PONI (OR 0.06, p = 0.026) compared to those with 21 or more teeth. Periodontitis and dental caries were not statistically significant. Current smokers (OR 2.09, p = 0.044) and free flap reconstruction (OR 5.41, p < 0.001) were also significant predictors for development of PONI. This study highlights the presence of teeth as a potential source of infection post neck dissection and that orthopantomogram assessment may be inadequate to identify at risk patients. Future studies are required on direct clinical assessment of dentition to evaluate the impact of dental optimisation in prevention of PONI.
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Affiliation(s)
- Victor K O Chang
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia.
| | - Lydia See
- Metro North Oral Health Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Dentistry, University of Queensland, Brisbane, Queensland, Australia; Adjunct Research Fellow School of Dentistry, University of Western Australia, Perth, Australia
| | - Alison Griffin
- Statistics Unit, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Queensland, Australia
| | - Omar Breik
- Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Martin D Batstone
- Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Timothy P J Liu
- Metro North Oral Health Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Dentistry, University of Queensland, Brisbane, Queensland, Australia; Adjunct Research Fellow School of Dentistry, University of Western Australia, Perth, Australia
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5
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Ivanovski S, Breik O, Carluccio D, Alayan J, Staples R, Vaquette C. 3D printing for bone regeneration: challenges and opportunities for achieving predictability. Periodontol 2000 2023; 93:358-384. [PMID: 37823472 DOI: 10.1111/prd.12525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/09/2023] [Revised: 07/18/2023] [Accepted: 08/26/2023] [Indexed: 10/13/2023]
Abstract
3D printing offers attractive opportunities for large-volume bone regeneration in the oro-dental and craniofacial regions. This is enabled by the development of CAD-CAM technologies that support the design and manufacturing of anatomically accurate meshes and scaffolds. This review describes the main 3D-printing technologies utilized for the fabrication of these patient-matched devices, and reports on their pre-clinical and clinical performance including the occurrence of complications for vertical bone augmentation and craniofacial applications. Furthermore, the regulatory pathway for approval of these devices is discussed, highlighting the main hurdles and obstacles. Finally, the review elaborates on a variety of strategies for increasing bone regeneration capacity and explores the future of 4D bioprinting and biodegradable metal 3D printing.
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Affiliation(s)
- Saso Ivanovski
- School of Dentistry, Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), The University of Queensland, Queensland, Herston, Australia
| | - Omar Breik
- Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Danilo Carluccio
- Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Jamil Alayan
- School of Dentistry, Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), The University of Queensland, Queensland, Herston, Australia
| | - Ruben Staples
- School of Dentistry, Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), The University of Queensland, Queensland, Herston, Australia
| | - Cedryck Vaquette
- School of Dentistry, Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), The University of Queensland, Queensland, Herston, Australia
- Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
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6
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Young TK, Tuckett J, Johnson NR, Breik O. Rigid versus non-rigid fixation for bilateral mandibular angle fractures: a retrospective multicentre review. Plast Reconstr Surg 2023:00006534-990000000-02142. [PMID: 37772893 DOI: 10.1097/prs.0000000000011103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND Fractures involving the bilateral mandibular angle are an uncommon occurrence with limited evidence to inform the ideal fixation requirements for adequate treatment. The aim of this study was to evaluate the outcomes of managing bilateral mandibular angle fractures and determine if rigid fixation on one side improves outcomes compared to bilateral non-rigid fixation. METHODS Patients with isolated bilateral mandibular angle fractures surgically treated at the Royal Brisbane and Women's Hospital, Princess Alexandra Hospital, Gold Coast University Hospital and Townsville University Hospital between January 1, 2010 and December 31, 2022 were retrospectively identified. Data collected included patient demographics, mechanism of injury, fixation scheme, postoperative occlusion and the occurrence of postoperative complications and subsequent management. RESULTS Eighty-four patients met the inclusion criteria. Fifty-two patients had non-rigid fixation applied to both fractures, and thirty-two had rigid fixation placed on at least one side. All cases proceeded to union. There was no statistically significant difference between the groups for occlusal outcomes, wound dehiscence, infection or plate or screw loosening. CONCLUSION Our results suggest that bilateral non-rigid fixation can be used to treat bilateral mandibular angle fractures in the appropriate clinical context.
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Affiliation(s)
- Thomas K Young
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Joel Tuckett
- Maxillofacial Surgery Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Nigel R Johnson
- Maxillofacial Surgery Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- University of Queensland School of Dentistry
| | - Omar Breik
- Department of Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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7
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Higginson JA, Breik O, Thompson AH, Ashrafian H, Hardman JC, Takats Z, Paleri V, Dhanda J. Diagnostic accuracy of intraoperative margin assessment techniques in surgery for head and neck squamous cell carcinoma: A meta-analysis. Oral Oncol 2023; 142:106419. [PMID: 37178655 DOI: 10.1016/j.oraloncology.2023.106419] [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: 01/17/2023] [Revised: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Positive margins following head and neck squamous cell carcinoma (HNSCC) surgery lead to significant morbidity and mortality. Existing Intraoperative Margin Assessment (IMA) techniques are not widely used due to limitations in sampling technique, time constraints and resource requirements. We performed a meta-analysis of the diagnostic performance of existing IMA techniques in HNSCC, providing a benchmark against which emerging techniques may be judged. METHODS The study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Studies were included if they reported diagnostic metrics of techniques used during HNSCC surgery, compared with permanent histopathology. Screening, manuscript review and data extraction was performed by multiple independent observers. Pooled sensitivity and specificity were estimated using the bivariate random effects model. RESULTS From an initial 2344 references, 35 studies were included for meta-analysis. Sensitivity (Sens), specificity (Spec), diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve (AUROC) were calculated for each group (n, Sens, Spec, DOR, AUROC): frozen section = 13, 0.798, 0.991, 309.8, 0.976; tumour-targeted fluorescence (TTF) = 5, 0.957, 0.827, 66.4, 0.944; optical techniques = 10, 0.919, 0.855, 58.9, 0.925; touch imprint cytology = 3, 0.925, 0.988, 51.1, 0.919; topical staining = 4, 0.918, 0.759, 16.4, 0.833. CONCLUSIONS Frozen section and TTF had the best diagnostic performance. Frozen section is limited by sampling error. TTF shows promise but involves administration of a systemic agent. Neither is currently in widespread clinical use. Emerging techniques must demonstrate competitive diagnostic accuracy whilst allowing rapid, reliable, cost-effective results.
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Affiliation(s)
| | - Omar Breik
- School of Dentristy, University of Queensland, Australia
| | | | | | - John C Hardman
- International Centre for Recurrent Head and Neck Cancer, The Royal Marsden NHS Foundation Trust, UK
| | | | - Vinidh Paleri
- International Centre for Recurrent Head and Neck Cancer, The Royal Marsden NHS Foundation Trust, UK; Institute of Cancer Research, UK
| | - Jagtar Dhanda
- Department of Surgery, Brighton and Sussex Medical School, UK
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Brierly G, Celentano A, Breik O, Moslemivayeghan E, Patini R, McCullough M, Yap T. Tumour Necrosis Factor Alpha (TNF-α) and Oral Squamous Cell Carcinoma. Cancers (Basel) 2023; 15:cancers15061841. [PMID: 36980727 PMCID: PMC10046488 DOI: 10.3390/cancers15061841] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 02/24/2023] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Uncovering the inflammatory mechanisms underpinning initiation, progression, and promotion of oral squamous cell carcinoma (OSCC) development is fundamental to the rational pursuit of targeted therapeutics. Here we present a review of the current knowledge of the role of TNF-α in the aetiology, pathogenesis, and potential therapies with regards to OSCC. TNF-α is worthy of particular attention in OSCC, with its presence demonstrated to enhance cell proliferation and its downregulation demonstrated to inhibit proliferation and migration in other carcinomas in both in vitro and in vivo models and oral cancer patients. Increased TNF-α in the OSCC tumour microenvironment has been demonstrated to favour invasion through promotion of firstly the pro-inflammatory, pro-invasive phenotypes of OSCC cells and secondly its paracrine mechanism mediating recruitment and activation of inflammatory cells. Polymorphisms affecting the gene expression of TNF-α have been strongly associated with an increased risk for oral squamous cell carcinoma. A number of studies have considered TNF-α within biofluids, including saliva and serum, as a potential biomarker for the early detection of OSCC, as well as its staging, differentiation, and prognosis. The broad and multifaceted role that TNF-α plays in many inflammatory states presents an obvious confounder, particularly with demonstrated increased TNF-α levels in common oral disease states. Lastly, biologic agents targeting TNF-α are currently in clinical use for immune-mediated inflammatory rheumatological and gastrointestinal diseases. There is the potential that these biological agents might have an adjunctive role in OSCC prevention and treatment.
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Affiliation(s)
- Gary Brierly
- Maxillofacial/Head and Neck Surgery, Royal Brisbane and Women's Hospital, Queensland Health, Brisbane, QLD 4072, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
| | - Antonio Celentano
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Carlton, VIC 3053, Australia
| | - Omar Breik
- Maxillofacial/Head and Neck Surgery, Royal Brisbane and Women's Hospital, Queensland Health, Brisbane, QLD 4072, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
| | - Elham Moslemivayeghan
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Carlton, VIC 3053, Australia
| | - Romeo Patini
- Department of Head, Neck and Sense Organs, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Michael McCullough
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Carlton, VIC 3053, Australia
| | - Tami Yap
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Carlton, VIC 3053, Australia
- Dermatology, Royal Melbourne Hospital, Melbourne Health, Parkville, VIC 3050, Australia
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Russell J, Volker G, McGarvey D, Sharpe C, Breik O, Borgna SC, Pateman K, Batstone M. An objective analysis of composite free flap donor site morbidity in head and neck surgery: Prospective series. Head Neck 2023; 45:398-408. [PMID: 36437486 PMCID: PMC10098479 DOI: 10.1002/hed.27254] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/25/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A poor evidence basis exists regarding the objective donor site morbidity associated with osseous free flap harvest. This study prospectively assessed the objective donor site morbidity associated with osseous free flap harvest for the fibula, scapula, and iliac crest (DCIA) donor sites. METHODS A single-site, prospective cohort clinical research study was conducted. Sixty-four patients were recruited between 2017 and 2021. Patients were assessed using a donor site specific assessment tool pre-operatively, and again >12 months post-operatively. RESULTS There was a significant reduction post-operatively in assessment tool scores compared to the pre-operative period for the fibula, scapula and DCIA. Females were more likely to report a greater reduction in Harris Hip Score post-operatively compared to males. CONCLUSIONS The fibula, scapula, and DCIA donor sites are associated with reduced objective function post-operatively compared to patient's pre-operative baseline. The implications are least pronounced for the fibula.
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Affiliation(s)
- Joshua Russell
- Faculty of MedicineThe University of QueenslandHerstonQueenslandAustralia
| | - Glen Volker
- Department of PhysiotherapyRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | - Declan McGarvey
- Department of PhysiotherapyRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | - Catherine Sharpe
- Department of PhysiotherapyRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | - Omar Breik
- Maxillofacial DepartmentRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | - Scott C. Borgna
- Maxillofacial DepartmentRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | - Kelsey Pateman
- The University of QueenslandSchool of DentistryHerstonQueenslandAustralia
| | - Martin Batstone
- Maxillofacial DepartmentRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
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Baghaie H, Shukla K, Stone J, Breik O, Munn Z. Effectiveness of prophylactic tranexamic acid versus placebo or no intervention for reducing blood loss in healthy patients undergoing orthognathic surgery: a systematic review protocol. JBI Evid Synth 2023; 21:430-440. [PMID: 36081370 DOI: 10.11124/jbies-22-00126] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to evaluate the effectiveness of perioperative prophylactic tranexamic acid for reducing blood loss in orthognathic surgery in healthy patients. INTRODUCTION Orthognathic surgery can cause significant hemorrhage, which requires postoperative blood transfusions. The most widely studied pharmaceutical adjunct for reducing blood loss is tranexamic acid, a synthetic amino acid that reversibly inhibits plasminogen activation. It is widely used and validated in other surgical procedures to limit blood loss; however, it is not a gold standard in orthognathic surgery. INCLUSION CRITERIA We will include clinical trials comparing tranexamic acid to appropriate controls. The primary outcomes are intraoperative blood loss, change in hematocrit/hemoglobin level, and need for blood transfusion. Secondary outcomes include operating time, length of hospital stay, and adverse reactions. Studies of patients with pre-existing coagulopathies and those undergoing only minor orthognathic surgery (eg, genioplasty) will be excluded. METHODS We will search 3 electronic databases (PubMed, Embase, and Cochrane Library) from database inception. Titles, abstracts, and full-text papers will be assessed against the inclusion criteria by 2 independent reviewers. Risk of bias will be assessed using the Cochrane Risk of Bias 2.0 tool. Data will be extracted by 2 independent reviewers. Meta-analysis will be conducted for all outcomes where appropriate, with weighted mean differences used for intraoperative blood loss, changes in hematocrit/hemoglobin levels, operation time, and length of stay; and risk ratio for transfusion rates and adverse outcomes. Certainty of the evidence will be presented using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42022314403.
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Affiliation(s)
- Hooman Baghaie
- School of Dentistry, The University of Queensland, Brisbane, QLD, Australia.,School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia.,JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Khilan Shukla
- School of Dentistry, The University of Queensland, Brisbane, QLD, Australia.,School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - Jennifer Stone
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Omar Breik
- Oral and Maxillofacial Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Zachary Munn
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Khadembaschi D, Jafri M, Praveen P, Parmar S, Breik O. Does neoadjuvant chemotherapy provide a survival benefit in maxillofacial osteosarcoma: A systematic review and pooled analysis. Oral Oncol 2022; 135:106133. [DOI: 10.1016/j.oraloncology.2022.106133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 11/06/2022]
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12
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Goh R, Beech N, Borgna S, Mansour M, Alexander T, Breik O. Meningoencephalitis following Le Fort I osteotomy: a case report. Int J Oral Maxillofac Surg 2022; 51:1600-1604. [DOI: 10.1016/j.ijom.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/23/2022] [Accepted: 07/18/2022] [Indexed: 10/14/2022]
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Chargi N, Breik O, Forouzanfar T, Martin T, Praveen P, Idle M, Parmar S, de Bree R. Association of low skeletal muscle mass and systemic inflammation with surgical complications and survival after microvascular flap reconstruction in patients with head and neck cancer. Head Neck 2022; 44:2077-2094. [PMID: 35652420 PMCID: PMC9540531 DOI: 10.1002/hed.27113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/17/2021] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background Skeletal muscle mass (SMM) and chronic inflammation are associated with postoperative complications and survival. Methods Patients with head and neck cancer (HNC) undergoing microvascular free flap reconstruction were included. SMM and neutrophil‐to‐lymphocyte ratio (NLR) were measured and their association with treatment outcomes analyzed. Results Five hundred and fifty‐four patients were included. Predictors for complications were elevated NLR in all flaps (OR 1.5), low SMM in radial forearm flap (OR 2.0), and elevated NLR combined with low SMM in fibula flap surgery (OR 4.3). Patients with solely elevated NLR were at risk for flap‐related complications (OR 3.0), severe complications (OR 2.2), and when combined with low SMM for increased length of hospital stays (LOS) (+3.9 days). In early‐stage HNC, low SMM (HR 2.3), and combined elevated NLR with low SMM (HR 2.6) were prognostics for decreased overall survival. Conclusions SMM and NLR are predictive for poor outcomes in patients with HNC undergoing microvascular reconstruction.
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Affiliation(s)
- Najiba Chargi
- Department of Head and Neck Surgical Oncology, Division of Imaging and Oncology Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Omar Breik
- Department of Oral and Maxillofacial Surgery, University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology VU University Medical Center/Academic Centre for Dentistry Amsterdam, ACTA University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands
| | - Timothy Martin
- Department of Oral and Maxillofacial Surgery, University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Prav Praveen
- Department of Oral and Maxillofacial Surgery, University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Matthew Idle
- Department of Oral and Maxillofacial Surgery, University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Satyesh Parmar
- Department of Oral and Maxillofacial Surgery, University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, Division of Imaging and Oncology Center, University Medical Center Utrecht, Utrecht, the Netherlands
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Archer N, Zebic L, Turton N, Higginson J, Idle M, Praveen P, Martin T, Parmar S, Breik O. An evaluation of the clinical utility of C-reactive protein and antibiotic use in patients undergoing major head and neck reconstructive surgery with outcome assessment. Oral Maxillofac Surg 2021; 26:455-461. [PMID: 34599697 PMCID: PMC8486958 DOI: 10.1007/s10006-021-01001-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 09/02/2021] [Indexed: 12/01/2022]
Abstract
Purpose This ambispective observational study aims to evaluate the local utility of peri-operative CRP testing and prophylactic antibiotics in relation to post-operative complications in patients who have undergone major head and neck oncological reconstructive surgery. Results A total of 79 patients were identified for inclusion; CRP testing was undertaken within the first 3 days postoperatively in 78/79 cases. Results demonstrated no benefit of extended prophylactic antibiotic use in reducing post-operative infection. Forty-two post-operative complications arose. In the prospective arm, CRP did not influence the decision to commence antibiotic therapy for any of the surgical site infections. Age, diabetes, smoking, or high body mass index (BMI) did not appear to affect the incidence of postoperative infection (p > 0.05). There is no evidence that more than 24 h of antibiotic prophylaxis is indicated for patients undergoing head and neck reconstructive surgery. Conclusion Everyone who is involved in peri-operative patient care should be educated regarding the appropriate use of CRP testing, with the implementation of protocols required to standardize CRP testing and prophylactic antibiotic prescription.
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Affiliation(s)
- Natalie Archer
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, B15 2GW UK
| | - Lara Zebic
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, B15 2GW UK
| | - Natalie Turton
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, B15 2GW UK
| | - James Higginson
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, B15 2GW UK
| | - Matthew Idle
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, B15 2GW UK
| | - Prav Praveen
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, B15 2GW UK
| | - Timothy Martin
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, B15 2GW UK
| | - Sat Parmar
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, B15 2GW UK
| | - Omar Breik
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham, B15 2GW UK
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Vasiliadou I, Breik O, Baker H, Leslie I, Sim VR, Hegarty G, Michaelidou A, Nathan K, Hartley A, Good J, Sanghera P, Fong C, Urbano TG, Lei M, Petkar I, Ferreira MR, Nutting C, Wong KH, Newbold K, Harrington K, Bhide S, Kong A. Safety and Treatment Outcomes of Nivolumab for the Treatment of Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: Retrospective Multicenter Cohort Study. Cancers (Basel) 2021; 13:cancers13061413. [PMID: 33808781 PMCID: PMC8003537 DOI: 10.3390/cancers13061413] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 02/08/2021] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 01/19/2023] Open
Abstract
Nivolumab is an anti-PD-1 monoclonal antibody currently used as immunotherapy for patients with recurrent/metastatic head and neck squamous cell carcinoma (HNSCC) with evidence of disease progression after platinum-based chemotherapy. This study evaluates real-world safety and treatment outcomes of non-trial nivolumab use. A retrospective multicenter cohort study of patients with recurrent/metastatic HNSCC treated with nivolumab between January 2017 and March 2020 was performed. Overall, 123 patients were included. The median age was 64 years, the majority of patients were male (80.5%) and had a smoking history (69.9%). Primary outcomes included overall response rate (ORR) of 19.3%, median progression-free survival (PFS) of 3.9 months, 1-year PFS rate of 16.8%, a median overall survival (OS) of 6.5 months and 1-year OS rate of 28.6%. These results are comparable to the CHECKMATE-141 study. Of 27 patients who had PD-L1 status tested, positive PD-L1 status did not significantly affect PFS (p = 0.86) or OS (p = 0.84). Nivolumab was well tolerated with only 15.1% experiencing immune-related toxicities (IRT) and only 6.7% of patients stopping due to toxicity. The occurrence of IRT appeared to significantly affect PFS (p = 0.01) but not OS (p = 0.07). Nivolumab in recurrent/metastatic HNSCC is well tolerated and may be more efficacious in patients who develop IRT.
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Affiliation(s)
- Ifigenia Vasiliadou
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
| | - Omar Breik
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
- Department of Oral and Maxillofacial Surgery, Royal Brisbane and Women’s Hospital, QLD 4029 Brisbane, Australia
| | - Holly Baker
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Isla Leslie
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (I.L.); (C.N.); (K.H.W.); (K.N.); (K.H.); (S.B.)
| | - Van Ren Sim
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
| | - Gemma Hegarty
- Kent Oncology Centre, Maidstone and Tunbridge Wells NHS Trust, Kent ME16 9QQ, UK; (G.H.); (A.M.); (K.N.)
| | - Andriana Michaelidou
- Kent Oncology Centre, Maidstone and Tunbridge Wells NHS Trust, Kent ME16 9QQ, UK; (G.H.); (A.M.); (K.N.)
| | - Kannon Nathan
- Kent Oncology Centre, Maidstone and Tunbridge Wells NHS Trust, Kent ME16 9QQ, UK; (G.H.); (A.M.); (K.N.)
| | - Andrew Hartley
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
| | - James Good
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
| | - Paul Sanghera
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
| | - Charles Fong
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
| | - Teresa Guerrero Urbano
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
| | - Mary Lei
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
| | - Imran Petkar
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
| | - Miguel Reis Ferreira
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
| | - Chris Nutting
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (I.L.); (C.N.); (K.H.W.); (K.N.); (K.H.); (S.B.)
| | - Kee Howe Wong
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (I.L.); (C.N.); (K.H.W.); (K.N.); (K.H.); (S.B.)
| | - Kate Newbold
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (I.L.); (C.N.); (K.H.W.); (K.N.); (K.H.); (S.B.)
| | - Kevin Harrington
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (I.L.); (C.N.); (K.H.W.); (K.N.); (K.H.); (S.B.)
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW7 3RP, UK
| | - Shree Bhide
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (I.L.); (C.N.); (K.H.W.); (K.N.); (K.H.); (S.B.)
| | - Anthony Kong
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Comprehensive Cancer Centre, King’s College London, Guy’s Campus, London SE1 1UL, UK
- Correspondence:
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Breik O, Higginson J, Al-Ajami AK, Mohamed A, Martin T, Amel-Kashipaz R. Clear Cell Odontogenic Carcinoma: First Report of Novel EWSR1-CREM Fusion Gene in Case of Long-Term Misdiagnosis. Head Neck Pathol 2021; 15:1391-1398. [PMID: 33616852 PMCID: PMC8633255 DOI: 10.1007/s12105-021-01302-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/05/2021] [Indexed: 01/11/2023]
Abstract
Clear Cell odontogenic Carcinomas (CCOC) are rare, aggressive malignant odontogenic tumours which are often misdiagnosed as benign odontogenic tumours due to the non-specific histologic appearance, and benign early clinical presentation. However, due to their propensity to metastasize, the best outcomes are experienced with they are diagnosed early and treated aggressively. In this paper, we present a case of a CCOC misdiagnosed as a clear cell calcifying epithelial odontogenic tumour which was only found to be a CCOC after cervical node metastasis. The original diagnosis was questioned and confirmed to be a CCOC by identification of the chromosomal translocation EWSR1 on fluorescence in situ hybridization. This has recently been described in CCOC and a wide variety of other mesenchymal and epithelial neoplasms. Previous reports have demonstrated EWSR1-ATF1 and EWSR1-CREB1 fusions in CCOC. Next generation sequencing of this case demonstrated the EWSR1-CREM fusion gene which has not been previously reported for CCOC. CREM fusion proteins have only recently been found in several tumour types including the closely associated hyalinizing clear cell carcinoma of salivary glands. This is discussed in this paper, and the role of the discovery of the CREM fusion protein in CCOC adds to your understating of the role of CREM in oncogenesis, and the possible link between CCOCs and hyalinizing clear cell carcinomas.
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Affiliation(s)
- Omar Breik
- Head and Neck Surgeon, Oral and Maxillofacial Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - James Higginson
- Oral and Maxillofacial Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Abdulla K. Al-Ajami
- Oral and Maxillofacial Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Abubakar Mohamed
- Biomedical Science, Molecular Pathology, Queen Elizabeth Hospital, Birmingham, UK
| | - Tim Martin
- Head and Neck Surgeon, Oral and Maxillofacial Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK
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Abstract
Electronic cigarettes (E-cigarettes) have become increasingly popular around the world. Currently, dental professionals' knowledge and attitudes are varied with many clinicians unclear regarding the impact of E-cigarette products on the oral and general health of their patients. With developing social and health-related challenges, advice of dental and medical associations and other regulatory bodies on E-cigarette use is changing. Growing evidence demonstrating the risks of E-cigarette usage has prompted a review of legislation in the United Kingdom (UK), United States of America (USA), Australia and Canada to include the sale and availability of E-cigarettes, particularly those containing nicotine. Further consideration within the scientific and public health community is being given to assessing demographic usage patterns particularly uptake by non-smokers and adolescents, efficacy as a cessation tool, the impact of vapour on bystanders and direct injuries via explosions as well as emerging lung injuries. This article aims to provide a summary of the most up to date evidence relating to E-cigarette use, the latest position of dental associations and the oral health implications of E-cigarettes compared to conventional smoking. The article also aims to collate this information in order to provide dental clinicians with guidance on how to advise patients, specifically in answering common questions posed regarding E-cigarette use.
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Affiliation(s)
- K Briggs
- General Dentist, Private Practice, Brisbane, Australia
| | - C Bell
- Associate Specialist Oral and Maxillofacial Surgery, Bristol University Hospitals Trust, Bristol, United Kingdom
| | - O Breik
- Oral and Maxillofacial Surgeon, Royal Brisbane and Women's Hospital, Brisbane, Australia
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18
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Breik O, Idle M, Martin T, Praveen P, Parmar S. Three-Dimensional Computer-Assisted Surgical Planning and Manufacturing in Complex Maxillary Reconstruction. Atlas Oral Maxillofac Surg Clin North Am 2020; 28:151-164. [PMID: 32741512 DOI: 10.1016/j.cxom.2020.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Omar Breik
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK.
| | - Matthew Idle
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Timothy Martin
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Prav Praveen
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Satyesh Parmar
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK
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19
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Breik O, Kumar A, Birchall J, Mortimore S, Laugharne D, Jones K. Follow up imaging of oral, oropharyngeal and hypopharyngeal cancer patients: Comparison of PET-CT and MRI post treatment. J Craniomaxillofac Surg 2020; 48:672-679. [PMID: 32513432 DOI: 10.1016/j.jcms.2020.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/18/2019] [Revised: 04/18/2020] [Accepted: 04/26/2020] [Indexed: 01/09/2023] Open
Abstract
There is currently no consensus as to the ideal timing, frequency and modality of imaging for follow up of head and neck cancer patients. The aim of this study was to analyze the diagnostic accuracy of PET-CT versus MRI, and imaging at 3 versus 6 months for follow up of head and neck cancer patients treated with curative intent with no clinical signs of treatment failure. MATERIALS AND METHODS A retrospective study was performed for all head and neck cancers treated with curative intent at the Royal Derby Hospital. Data collected included demographic information, site of primary cancer, staging, treatment provided, type of follow up imaging performed and results of follow up imaging. Inclusion in the study was for oral, oropharyngeal and hypopharyngeal cancers treated with curative intent, asymptomatic patients, those who have had follow up imaging within 6 months of treatment, and those followed up for at least 2.5 years since treatment. RESULTS A total of 140 patients were included in the study. 25% of patients had evidence of recurrent/metastatic disease on imaging, 60% of which were identified within 6 months post treatment. The majority (60%) of failures were due to distant metastases. The sensitivity and specificity of both MRI and PET-CT was higher at 6 months post-treatment compared to 3 months post-treatment. Overall the sensitivity and specificity for PET-CT and MRI within 3-6 months post treatment were 94.7% and 83.5% and 60% and 85.7% respectively for identifying treatment failure. CONCLUSION Follow up Imaging at 6 months post treatment is more likely to accurately identify treatment failures with fewer false positives than imaging at 3 months. PET-CT is preferable to MRI for identifying post treatment locoregional and distant treatment failure.
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Affiliation(s)
- Omar Breik
- Head and Neck Oncology Fellow, Department of Oral and Maxillofacial Surgery, Head and Neck Unit, Royal Derby Hospital, UK
| | - Anand Kumar
- Maxillofacial/Head and Neck Surgeon, Department of Oral and Maxillofacial Surgery, Head and Neck Unit, Royal Derby Hospital, UK.
| | - James Birchall
- Nuclear Medicine Physician and Radiologist, Nuclear Medicine Department, Royal Derby Hospital, UK
| | - Sean Mortimore
- ENT/Head and Neck Surgeon, Department of Otorhinolaryngology, Head and Neck Unit, Royal Derby Hospital, UK
| | - David Laugharne
- Maxillofacial/Head and Neck Surgeon, Department of Oral and Maxillofacial Surgery, Head and Neck Unit, Royal Derby Hospital, UK
| | - Keith Jones
- Maxillofacial/Head and Neck Surgeon, Department of Oral and Maxillofacial Surgery, Head and Neck Unit, Royal Derby Hospital, UK
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20
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Breik O, Goodrum H, Koria H, Edmondson S, Praveen P, Parmar S. Rehabilitation post maxillary and mandibular reconstruction: Current status and future approaches. Oral Oncol 2020; 105:104663. [DOI: 10.1016/j.oraloncology.2020.104663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
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Tocaciu S, Breik O. The need for more robust research on the role of pentoxifylline and tocopherol in the management of osteoradionecrosis of the jaws. Int J Oral Maxillofac Surg 2020; 49:544-545. [DOI: 10.1016/j.ijom.2019.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/29/2019] [Indexed: 10/25/2022]
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22
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Breik O, Selbong U, Laugharne D, Jones K. Dealing with vascular anomalies during radial forearm free flap harvest: report of two cases and review of the literature. Int J Oral Maxillofac Surg 2019; 48:1509-1515. [PMID: 31239082 DOI: 10.1016/j.ijom.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/18/2018] [Revised: 04/23/2019] [Accepted: 06/05/2019] [Indexed: 11/18/2022]
Abstract
Radial forearm free flap reconstruction for head and neck cancer is very common, and it is widely considered a workhorse flap. Although this flap has a relatively reliable anatomy, surgeons need to be aware of possible anatomical variations and how to deal with them. This paper presents the cases of two patients who underwent oral reconstruction, in whom anomalies of the radial artery were identified while raising a radial forearm free flap. Case 1 demonstrates the dominant branch of the radial artery joining the common interosseous artery approximately 9 cm from the first wrist crease. Case 2 demonstrates abnormal distal branching of the radial artery approximately 4 cm from the first wrist crease. Reconstruction with the flap was successful in both cases. A literature review of reported anomalies of the radial artery is presented, and how to deal with such vascular anomalies is discussed.
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Affiliation(s)
- O Breik
- Head and Neck Unit, Royal Derby Hospital, Derby, UK.
| | - U Selbong
- Head and Neck Unit, Royal Derby Hospital, Derby, UK
| | - D Laugharne
- Head and Neck Unit, Royal Derby Hospital, Derby, UK
| | - K Jones
- Head and Neck Unit, Royal Derby Hospital, Derby, UK
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23
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DeAngelis A, Breik O, Angel C, Goh C, Iseli T, Nastri A, McCullough M, Wiesenfeld D. Can radiological examination of mandibular bone invasion accurately predict the need for mandibular resection in oral squamous cell carcinoma? Int J Oral Maxillofac Surg 2019; 48:576-583. [DOI: 10.1016/j.ijom.2018.12.007] [Citation(s) in RCA: 9] [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: 04/20/2018] [Revised: 10/18/2018] [Accepted: 12/11/2018] [Indexed: 11/29/2022]
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Breik O, Tocaciu S, Briggs K, Tasfia Saief S, Richardson S. Is there a role for pentoxifylline and tocopherol in the management of advanced osteoradionecrosis of the jaws with pathological fractures? Case reports and review of the literature. Int J Oral Maxillofac Surg 2019; 48:1022-1027. [PMID: 30981534 DOI: 10.1016/j.ijom.2019.03.894] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 11/14/2018] [Revised: 01/19/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
Osteoradionecrosis (ORN) is an infrequent but serious complication of radiotherapy, especially in the head and neck region. It is a slowly progressive condition, with management in the early stages focused on symptom control, and surgery usually reserved for advanced ORN. However, established ORN is difficult to treat. The role of hyperbaric oxygen therapy has recently been contested. The use of pentoxifylline in the management of ORN was first described by Delanian in 2004, but its benefits have not been replicated in other studies. In cases of advanced ORN with pathological fractures, many centres still advocate surgical resection and reconstruction. However, in this group of patients who often have multiple medical comorbidities, many of whom have previously undergone significant surgery, a resective plan is not always ideal. This paper presents two successful cases of bony union after the use of pentoxifylline and tocopherol to manage grade III ORN of the mandible. Both patients had pathological fractures and orocutaneous fistulas and were deemed unsuitable for surgery. The possible reasons for the success of pentoxifylline and tocopherol are discussed, and a review of the current literature evidence of similar cases is presented. Pentoxifylline and tocopherol should be considered for the management of advanced ORN where surgical management is not appropriate.
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Affiliation(s)
- O Breik
- Oral and Maxillofacial Unit, Monash Health, Victoria, Australia; Queen Elizabeth Hospital, Birmingham, UK
| | - S Tocaciu
- Oral and Maxillofacial Unit, Monash Health, Victoria, Australia.
| | - K Briggs
- Oral and Maxillofacial Unit, Monash Health, Victoria, Australia
| | - S Tasfia Saief
- Oral and Maxillofacial Unit, Monash Health, Victoria, Australia
| | - S Richardson
- Oral and Maxillofacial Unit, Monash Health, Victoria, Australia
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25
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Briggs KA, Breik O, Ito K, Goss AN. Arthrocentesis in the management of internal derangement of the temporomandibular joint. Aust Dent J 2018; 64:90-95. [DOI: 10.1111/adj.12665] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2018] [Indexed: 12/30/2022]
Affiliation(s)
- KA Briggs
- Oral & Maxillofacial Surgery Unit; Gloucester Royal Hospital; Gloucester UK
- Oral & Maxillofacial Surgery Unit; The University of Adelaide; Adelaide South Australia Australia
| | - O Breik
- Oral & Maxillofacial Surgery Unit; The University of Adelaide; Adelaide South Australia Australia
- Oral & Maxillofacial Surgery Unit; Royal Derby Hospital; Derby UK
| | - K Ito
- Nihon University School of Dentistry at Matsudo; Chiba Japan
| | - AN Goss
- The University of Adelaide; Adelaide South Australia Australia
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Breik O, Lababidi E, Savage J, Engelbrecht H, Kumar R, Crossley CW. Assessing an oral surgery specific protocol for patients on direct oral anticoagulants. Br J Oral Maxillofac Surg 2018. [DOI: 10.1016/j.bjoms.2018.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kanatsios S, Breik O, Dimitroulis G. Biomet stock temporomandibular joint prosthesis: Long-term outcomes of the use of titanium condyles secured with four or five condylar fixation screws. J Craniomaxillofac Surg 2018; 46:1697-1702. [DOI: 10.1016/j.jcms.2018.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/12/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022] Open
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DeAngelis A, Breik O, Koo K, Iseli T, Nastri A, Fua T, Rischin D, McCullough M, Wiesenfeld D. Non-smoking, non-drinking elderly females, a 5 year follow-up of a clinically distinct cohort of oral squamous cell carcinoma patients. Oral Oncol 2018; 86:113-120. [PMID: 30409291 DOI: 10.1016/j.oraloncology.2018.09.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 08/07/2018] [Revised: 09/02/2018] [Accepted: 09/05/2018] [Indexed: 02/01/2023]
Abstract
To examine differences in survival and clinical outcomes of elderly patients without traditional risk factors presenting with oral squamous cell carcinoma. Retrospective review of 287 consecutive patients divided into 2 treatment period cohorts treated for oral SCC between the 1st Jan 2007 and 31st Dec 2012. Patients were classified as either smoker-drinkers (SD) or non-smoking, non-drinking (NSND). Only patients with oral sub-site primaries according to ICD-10 were included. Carcinomas of the lip, tonsil, base of tongue and oro-pharyngeal subsites were excluded. Of the study population (N = 287), 24.4% were NSND and 9.75% were NSND elderly (older than 70 years) females. >50% of tumours arose from the oral tongue in NSND patients (p = 0.022) and there was a higher rate of recurrent and persistent disease (42.9% vs 27.6%, p = 0.005). Disease specific survival at 5 years was significantly reduced when NSND elderly females were compared to all other patients (p < 0.001) as well as age matched controls (p = 0.006). This effect was verified independently in each cohort.The results of this study suggest that NSND elderly females are a distinct patient population with poorer disease specific survival outcomes.
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Affiliation(s)
- Adrian DeAngelis
- Oral & Maxillofacial Surgery, Royal Melbourne Hospital, Australia.
| | - Omar Breik
- Oral & Maxillofacial Surgery, Royal Melbourne Hospital, Australia
| | - Kendrick Koo
- Otorhinolaryngology Head & Neck Surgery, Royal Melbourne Hospital, Australia
| | - Tim Iseli
- Otorhinolaryngology Head & Neck Surgery, Royal Melbourne Hospital, Australia
| | - Alf Nastri
- Oral & Maxillofacial Surgery, Royal Melbourne Hospital, Australia; University of Melbourne, Australia
| | - Tsien Fua
- Dept of Radiation Oncology, Peter MacCallum Cancer Centre, Australia.
| | - Danny Rischin
- Dept of Medical Oncology, Peter MacCallum Cancer Centre, Australia; Sir Peter MacCallum Dept of Oncology, University of Melbourne, Australia.
| | - Michael McCullough
- Melbourne Dental School, University of Melbourne, Australia; Royal Melbourne Hospital, Australia.
| | - David Wiesenfeld
- Victorian Comprehensive Cancer Centre, Australia; Dept of Surgery, University of Melbourne, Australia.
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Subramaniam S, Breik O, Cadd B, Peart G, Wiesenfeld D, Heggie A, Gibbons S, Nastri A. Long-term outcomes of craniofacial implants for the restoration of facial defects. Int J Oral Maxillofac Surg 2018; 47:773-782. [DOI: 10.1016/j.ijom.2018.01.013] [Citation(s) in RCA: 11] [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: 02/13/2017] [Revised: 01/14/2018] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
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Lababidi E, Breik O, Savage J, Engelbrecht H, Kumar R, Crossley CW. Assessing an oral surgery specific protocol for patients on direct oral anticoagulants: a retrospective controlled cohort study. Int J Oral Maxillofac Surg 2018; 47:940-946. [PMID: 29653869 DOI: 10.1016/j.ijom.2018.03.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/30/2018] [Accepted: 03/14/2018] [Indexed: 11/29/2022]
Abstract
Chronic therapy with the new direct oral anticoagulants (DOACs) poses new challenges for dental practitioners assessing the risk versus benefit of cessation versus non-cessation of anticoagulant therapy for dentoalveolar procedures. A retrospective controlled cohort study was designed to evaluate a non-cessation protocol for patients taking DOACs in the setting of dental extractions. A records review covering the period 1 January 2016 to 31 December 2016 identified 43 patients on DOAC therapy; 53 dentoalveolar procedures were performed under local anaesthesia, of which 15 included varying degrees of peri-procedural cessation. A control group of 50 patients on uninterrupted warfarin therapy undergoing 59 dentoalveolar procedures was identified. The incidence, severity, and timing of bleeding events were recorded for each group. Four (10.5%) minor bleeding events were recorded in the non-cessation DOAC group and nine (15.3%) minor bleeding events in the warfarin group. No bleeding events were recorded in the DOAC cessation group. Comparison of the incidence of bleeding events between the non-cessation DOAC group and the warfarin group showed no statistically significant difference (odds ratio 0.65, P=0.56). Within the limitations of this study, dental extractions in the context of continuing DOAC therapy can be performed safely provided extra local haemostatic measures are applied.
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Affiliation(s)
- E Lababidi
- Oral and Maxillofacial Surgery Unit, Royal Dental Hospital of Melbourne, Melbourne, Victoria, Australia.
| | - O Breik
- Oral and Maxillofacial Surgery Unit, Royal Dental Hospital of Melbourne, Melbourne, Victoria, Australia
| | - J Savage
- Oral and Maxillofacial Surgery Unit, Royal Dental Hospital of Melbourne, Melbourne, Victoria, Australia
| | - H Engelbrecht
- Oral and Maxillofacial Surgery Unit, Royal Dental Hospital of Melbourne, Melbourne, Victoria, Australia
| | - R Kumar
- Oral and Maxillofacial Surgery Unit, Royal Dental Hospital of Melbourne, Melbourne, Victoria, Australia
| | - C W Crossley
- Oral and Maxillofacial Surgery Unit, Royal Dental Hospital of Melbourne, Melbourne, Victoria, Australia
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Saha A, Breik O, Simpson I, Kumar R. Large Paediatric Central Osteoma with Osteoblastoma-Like Features in the Mandible. Head Neck Pathol 2018; 13:264-269. [PMID: 29508129 PMCID: PMC6514206 DOI: 10.1007/s12105-018-0900-z] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
Abstract
The diagnosis of osteomas in the paediatric population can pose a challenge to pathologists in excluding malignant bony tumours. We present the case of a 10-year old male presenting with a large left mandibular radiopaque lesion. This paper discusses the case of a central osteoma with osteoblastoma-like features, literature review, differential diagnosis of radiopaque lesions of the maxilla and mandible as well as a detailed discussion of the pathology of the lesion. Although similar lesions have been described in the sino-orbital region, this is believed to be the first report of this pathological entity in the mandible.
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Affiliation(s)
- Anik Saha
- 0000 0004 0379 3501grid.414366.2Eastern Health, Melbourne, VIC Australia
| | - Omar Breik
- 0000 0000 9295 3933grid.419789.aRegistrar, Oral and Maxillofacial Surgery, Monash Health, Melbourne, VIC Australia
| | - Ian Simpson
- 0000 0000 9295 3933grid.419789.aConsultant Anatomical Pathologist, Monash Health, Melbourne, VIC Australia
| | - Ricky Kumar
- 0000 0000 9295 3933grid.419789.aConsultant Oral and Maxillofacial Surgeon, Monash Health, Melbourne, VIC Australia
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Kaderbhai J, Breik O, Heggie AA, Penington AJ. High-flow paediatric mandibular arteriovenous malformations: case reports and a review of current management. Int J Oral Maxillofac Surg 2017; 46:1650-1655. [PMID: 28705626 DOI: 10.1016/j.ijom.2017.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 02/07/2017] [Revised: 05/02/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
Abstract
High-flow vascular malformations in the paediatric population are potentially life-threatening and are challenging to treat. This paper describes the management of three cases of mandibular arteriovenous malformations and reviews the contemporary management options for these serious lesions.
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Affiliation(s)
- J Kaderbhai
- Oral and Maxillofacial Unit, Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital of Melbourne, Australia
| | - O Breik
- Oral and Maxillofacial Unit, Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital of Melbourne, Australia
| | - A A Heggie
- Oral and Maxillofacial Unit, Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital of Melbourne, Australia.
| | - A J Penington
- Oral and Maxillofacial Unit, Department of Plastic and Maxillofacial Surgery, The Royal Children's Hospital of Melbourne, Australia
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DeAngelis A, Breik O, Koo K, Nastri A, McCullough M, Wiesenfeld D. Non-smoking, non-drinking elderly females, a five-year follow-up of a clinically distinct cohort of oral squamous cell carcinoma patients. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Breik O, Tivey D, Umapathysivam K, Anderson P. Does the Rate of Distraction or Type of Distractor Affect the Outcome of Mandibular Distraction in Children With Micrognathia? J Oral Maxillofac Surg 2016; 74:1441-53. [DOI: 10.1016/j.joms.2016.01.049] [Citation(s) in RCA: 14] [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: 12/18/2015] [Revised: 01/26/2016] [Accepted: 01/26/2016] [Indexed: 11/26/2022]
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Breik O, Mahindu A, Moore MH, Molloy CJ, Santoreneos S, David DJ. Apert syndrome: Surgical outcomes and perspectives. J Craniomaxillofac Surg 2016; 44:1238-45. [PMID: 27378001 DOI: 10.1016/j.jcms.2016.06.001] [Citation(s) in RCA: 13] [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: 12/23/2015] [Revised: 05/06/2016] [Accepted: 06/03/2016] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Apert syndrome is a rare congenital malformation with severe craniofacial anomalies. The aim of this study was to review the outcomes of craniofacial and neurosurgical interventions in Apert syndrome patients treated at a single institution. MATERIALS AND METHODS A retrospective review of all patient records with a diagnosis of Apert syndrome assessed and managed in the Australian Craniofacial Unit (ACFU) from 1985 to 2013 was conducted. RESULTS A total of 94 patients were identified, and 130 transcranial procedures were performed. Of the patients, 83 underwent a fronto-orbital advancement (FOA) as their primary procedure, and 18 patients also underwent a posterior vault procedure. Twenty patients underwent a fronto-facial monobloc advancement. Overall, 70% of patients underwent at least 2 transcranial procedures. Shunts were inserted in 2 patients preoperatively and in 5 patients postoperatively for cerebrospinal fluid (CSF) leaks or acute hydrocephalus. Re-do FOAs were performed in 8 patients. Patients who underwent an FOA at the age of more than 18 months had no recurrence of raised intracranial pressure (ICP). Of 18 patients who also underwent a posterior vault procedure, 1 patient had recurrence of raised ICP. Midfacial surgery was performed early if there was evidence of obstructive sleep apnoea (OSA), but delayed midfacial surgery was preferred. Complications were reported in 18% of procedures. The most common complications were CSF leaks and acute hydrocephalus. CONCLUSION Shunting is rarely required in Apert syndrome patients, confirming a predominantly nonprogressive ventriculomegaly. FOA appears to be a more stable procedure when performed at an age of more than 18 months. Undergoing a posterior vault procedure may reduce the risk of recurrent raised ICP and lead to fewer transcranial procedures needed in childhood. Midfacial surgery should be delayed until adolescence where there is no evidence of OSA, psychological disturbance, or complications of exorbitism. Complications are rare when these patients are treated by an experienced craniofacial team.
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Affiliation(s)
- Omar Breik
- Australian Craniofacial Unit, Women's and Children's Hospital, 72 King William Rd, North Adelaide, South Australia 5006, Australia.
| | - Antony Mahindu
- Department of Neurosurgery, Women's and Children's Hospital, 72 King William Rd, North Adelaide, South Australia 5006, Australia
| | - Mark H Moore
- Australian Craniofacial Unit, Women's and Children's Hospital, 72 King William Rd, North Adelaide, South Australia 5006, Australia
| | - Cindy J Molloy
- Department of Neurosurgery, Women's and Children's Hospital, 72 King William Rd, North Adelaide, South Australia 5006, Australia
| | - Stephen Santoreneos
- Department of Neurosurgery, Women's and Children's Hospital, 72 King William Rd, North Adelaide, South Australia 5006, Australia
| | - David J David
- Australian Craniofacial Unit, Women's and Children's Hospital, 72 King William Rd, North Adelaide, South Australia 5006, Australia
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Breik O, Tivey D, Umapathysivam K, Anderson P. Mandibular distraction osteogenesis for the management of upper airway obstruction in children with micrognathia: a systematic review. Int J Oral Maxillofac Surg 2016; 45:769-82. [DOI: 10.1016/j.ijom.2016.01.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 01/08/2016] [Accepted: 01/18/2016] [Indexed: 11/17/2022]
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Breik O, Sim F, Wong T, Nastri A, Iseli TA, Wiesenfeld D. Survival Outcomes of Mucosal Melanoma in the Head and Neck: Case Series and Review of Current Treatment Guidelines. J Oral Maxillofac Surg 2016; 74:1859-71. [PMID: 27063590 DOI: 10.1016/j.joms.2016.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/10/2016] [Accepted: 03/10/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE Malignant mucosal melanoma of the head and neck (MMHN) is an aggressive and rare neoplasm with poor long-term outcomes. The aim of this study is to evaluate the outcomes of patients treated by a single-institution head and neck multidisciplinary team. MATERIALS AND METHODS In this retrospective case series, all MMHN cases treated at the Royal Melbourne Hospital from 1990-2015 were retrospectively reviewed. Patient demographic characteristics (eg, age), treatment offered, pathology, and outcomes were collected, tabulated, and correlated with outcomes. Survival outcomes were calculated by the Kaplan-Meier method. Comparison was made between oral and sinonasal melanomas. RESULTS A total of 16 cases were identified. Two were excluded because of inaccessible data. Of the 14 remaining cases, 8 were sinonasal melanomas and 6 were oral cavity melanomas. Sinonasal tumor patients presented with epistaxis or visual impairment. Oral melanoma patients presented with pigmented lesions or ulceration. Follow-up ranged from 4 months to 11 years. In 2 patients, locoregional recurrences developed that were successfully re-excised. Six patients died of distant metastases despite clear surgical margins. Two patients with sinonasal melanomas died of extensive local disease with intracranial invasion. One patient died 4 years after diagnosis without disease. There were no failures in the neck. The 2- and 5-year overall survival rates were 63.3% and 31.7%, respectively, by the Kaplan-Meier method. The difference in survival between oral and sinonasal melanomas was not statistically significant. CONCLUSIONS Despite clear surgical margins, MMHN has a poor prognosis and most deaths are due to distant metastases. Systemic therapies such as those used in cutaneous melanoma treatment might be used in the future for MMHN.
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Affiliation(s)
- Omar Breik
- Registrar, Department of Oral and Maxillofacial Surgery, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
| | - Felix Sim
- Head and Neck Fellow, Head and Neck Tumour Stream, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Tim Wong
- Consultant Oral and Maxillofacial Surgeon, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alf Nastri
- Head of Unit, Department of Oral and Maxillofacial Surgery, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Tim A Iseli
- Head of Unit, Department of Otorhinolaryngology, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Wiesenfeld
- Head, Head and Neck Tumour Stream, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Breik O, Cheng A, Sambrook PJ, Goss AN. Protocol in managing oral surgical patients taking dabigatran. Aust Dent J 2014; 59:296-301; quiz 401. [DOI: 10.1111/adj.12199] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2013] [Indexed: 11/27/2022]
Affiliation(s)
- O Breik
- Oral and Maxillofacial Surgery Unit; Royal Adelaide Hospital; Adelaide South Australia
| | - A Cheng
- Oral and Maxillofacial Surgery Unit; Royal Adelaide Hospital; Adelaide South Australia
| | - PJ Sambrook
- Oral and Maxillofacial Surgery Unit; Royal Adelaide Hospital; Adelaide South Australia
| | - AN Goss
- The University of Adelaide and Emeritus Consultant; Oral and Maxillofacial Surgery Unit; Royal Adelaide Hospital; Adelaide South Australia
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Breik O, Tivey D, Umapathysivam K, Anderson P. Mandibular distraction osteogenesis in the management of airway obstruction in children: a systematic review protocol. ACTA ACUST UNITED AC 2013. [DOI: 10.11124/jbisrir-2013-975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
The new thrombin inhibitors have provided an exciting opportunity for effective thromboprophylaxis without some of the disadvantages of the current anticoagulants. These drugs are orally administered, have predictable pharmacokinetics and dose-response, do not require monitoring and have an acceptable safety profile when used appropriately. However, inappropriate prescribing of these drugs may lead to catastrophic consequences. Clinicians need to be aware of some of the drawbacks associated with the use of dabigatran and, in particular, its reduced clearance in the setting of renal failure and the lack of an effective reversing agent when bleeding does occur. In this review, the evidence for efficacy and safety of dabigatran is discussed. We also aim to provide practical clinical advice on the pre- and post-operative management of the elective and emergency surgical patient on dabigatran and provide guidelines for the management of acute haemorrhage in the context of dabigatran therapy.
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Affiliation(s)
- Omar Breik
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Abstract
BACKGROUND The cause of mandibular third molar impaction is said to be due to inadequate space between the distal of the second mandibular molar and the anterior border of the ascending ramus of the mandible. The amount of space is determined primarily by facial growth. This study aimed to assess whether different patterns of facial growth lead to a different incidence of mandibular third molar impaction. It was hypothesized that those with predominantly horizontal (brachyfacial) would have lower incidence of mandibular third molar impaction compared with those with a predominantly vertical growth pattern (dolichofacial). METHODS Ninety-eight dental records were sourced from the records of orthodontic patients in the Royal Dental Hospital of Melbourne and all lateral cephalometric radiographs and orthopantomograms were assessed. The degree of impaction was determined by the Pell and Gregory system, and the facial type categorized by the facial axis angle. RESULTS The overall rate of mandibular third molar impaction was 58.76 per cent. Those with a facial axis angle >93 (brachyfacials) demonstrated an almost two times lower incidence of mandibular third molar impaction as compared to subjects with a facial axis angle <87 (dolichofacials). CONCLUSIONS Within the limitations of the study, it was concluded that the greater horizontal facial growth pattern of brachyfacial subjects over dolichofacial subjects provides increased space for full eruption of the mandibular third molars.
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Affiliation(s)
- O Breik
- Royal Dental Hospital of Melbourne, Victoria
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Affiliation(s)
- Omar Breik
- Faculty of Medicine, Dentistry and Health Sciences, School of Dental Science, University of Melbourne, Melbourne, Australia.
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Breik O, Hay KD. Migrating foreign body in the tongue. N Z Dent J 2008; 104:62-64. [PMID: 18672832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We present an unusual case where a foreign body entered and migrated through the tongue. In its path, it created a multitude of different symptoms including ecchymoses, small lumps, submental swelling and neuralgic-type pain. The foreign body had migrated from the left postero-lateral surface of the tongue, anteriorly along the lateral then dorsal surfaces of the tongue, until it self-exfoliated on the right anterior floor of the mouth. A brief literature review is also presented.
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Affiliation(s)
- Omar Breik
- Auckland Oral Health Regional Service, Greenlane Clinical Centre, Auckland, New Zealand
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