[Pathological fractures of the mandible caused by cancer of the oral cavity]

The pathological fracture of the mandible is a rare and undesirable consequence of cancerous bone invasion. This study investigates the retrospective incidence of this phenomenon in diagnosed cases of squamous cell carcinoma of the mandibular region, and reviews the methods of treatment used. A total of 194 patients with squamous cell carcinoma of the mandibular region were observed. Only six cases of pathological fractures were found. The treatment was conditioned by the need to eliminate the tumor, and was carried out in different methods according to the individual cases. This study underlines the importance of both knowing various techniques and collaborating with other specialists in treating the fracture.

Limits of laryngeal mask airway in patients after cervical or oral radiotherapy

PURPOSE

To test the efficacy of the LMA in patients with previous oral or cervical radiotherapy, without upper airway obstruction.

METHODS

In nine patients after oral or cervical radiotherapy, efficiency of ventilation was assessed after induction of general anaesthesia and LMA insertion. Fibreoptic examination through the tube was performed to check the position of LMA.

RESULTS

In patients who had had oral radiotherapy, all five had limited mouth opening and in two, LMA insertion was difficult but permitted good ventilation. In the four patients who had had cervical radiotherapy, LMA insertion was easy but, in two, the lungs were difficult to ventilate and, in two, the lungs could not be ventilated and orotracheal intubation was required.

CONCLUSION

In patients with limitation of mouth opening after oral radiotherapy, LMA may represent an alternative to tracheal intubation. In patient with cervical sclerosis after radiotherapy; the use of LMA should be avoided.

Airway complications in patients with infection caused by HIV

Numerous problems may be identified in the airways of patients with HIV infection. In many cases, these airway conditions represent exaggerations of infections seen in the immunocompetent host. However, in other instances, they represent manifestations of unique problems, infectious and/or neoplastic, that are a consequence of the profound immunosuppression seen in the patient with infection due to HIV.

Evaluation of argyrophilic nucleolar organizer regions (AgNORs) in oral carcinomas in relation to human papillomavirus infection and cytokinetics

The numbers of argyrophilic nucleolar organizer regions (AgNORs) were quantified in oral carcinomas (n = 39) with or without human papillomavirus (HPV) infection. The AgNOR counts of the HPV-positive samples (7.15 +/- 2.13) were not significantly (P = 0.09) higher than those of the HPV-negative ones (6.16 +/- 1.89). Furthermore, the lesions infected with multiple HPV types had greater counts than those with HPV type 16/18 infection alone. Significant differences were observed between the mean counts of the poorly (10.50 +/- 0.54), moderately (7.31 +/- 1.07) and well- (5.12 +/- 0.85) differentiated carcinomas. The mean AgNOR numbers in the oral carcinomas at TNM stages III/IV were found to be significantly (P < 0.01) higher than the numbers in corresponding stage II lesions. Cytokinetics of the lesions assessed by the bromodeoxyuridine (Brdu) labelling index (LI%) showed a linear correlation (r = 0.91; P < 0.0001) with their respective mean AgNOR counts.

Clinical trial of recombinant granulocyte colony-stimulating factor for chemotherapy-induced neutropenia patients with oral cancer

PURPOSE

This study was undertaken to evaluate the efficacy and toxicity of recombinant human granulocyte colony-stimulating factor (rhG-CSF) in reducing neutropenia in patients with oral cancer undergoing intensive chemotherapy.

MATERIALS AND METHODS

Patients with chemotherapy-induced neutropenia (< 1 x 10(9)/L) were divided into two groups: control group (n = 13) and rhG-CSF administration group (n = 16). rhG-CSF was administered subcutaneously at a dose of 75 micrograms/day on consecutive days. Peripheral blood cell counts and oral complications were investigated in each group.

RESULTS

The duration of neutropenia and absolute neutrophil nadir counts were significantly improved by administration of G-CSF. No consistent effect on thrombocytopenia was noted. Administration of rhG-CSF also reduced the duration and degree of oral complications associated with chemotherapy-induced neutropenia. Intolerable side effects associated with administration of rhG-CSF were not observed.

CONCLUSION

It was concluded that rhG-CSF is effective in shortening the duration of neutropenia after chemotherapy at a dose of 75 micrograms/day.

Assessment of malnutrition parameters in head and neck cancer and their relation to postoperative complications

BACKGROUND

Malnutrition is reported frequently in head and neck cancer patients. The impact of malnutrition on surgical outcome is not clearly understood. The purpose of this study was to define the usefulness of six different parameters in scoring malnutrition and to determine the nutritional parameter primarily related to postoperative complications.

METHODS

Sixty-four patients undergoing major surgery for advanced head and neck cancer were studied prospectively, and six different parameters were used to define malnutrition. Logistic regression was used to relate nutritional parameters to postoperative complications.

RESULTS

The parameters applied all identified different aspects of the nutritional status, as malnutrition varied between 20% and 67%. Logistic regression analysis identified a weight loss of more than 10% to be the most prominent predictive parameter for the occurrence of major postoperative complications.

CONCLUSIONS

Patients with weight loss more than 10% during the six months before surgery are at a great risk for the occurrence of major postoperative complications.

Assessment of malnutrition parameters in head and neck cancer and their relation to postoperative complications

BACKGROUND

Malnutrition is reported frequently in head and neck cancer patients. The impact of malnutrition on surgical outcome is not clearly understood. The purpose of this study was to define the usefulness of six different parameters in scoring malnutrition and to determine the nutritional parameter primarily related to postoperative complications.

METHODS

Sixty-four patients undergoing major surgery for advanced head and neck cancer were studied prospectively, and six different parameters were used to define malnutrition. Logistic regression was used to relate nutritional parameters to postoperative complications.

RESULTS

The parameters applied all identified different aspects of the nutritional status, as malnutrition varied between 20% and 67%. Logistic regression analysis identified a weight loss of more than 10% to be the most prominent predictive parameter for the occurrence of major postoperative complications.

CONCLUSIONS

Patients with weight loss more than 10% during the six months before surgery are at a great risk for the occurrence of major postoperative complications.

GB virus infection in patients with oral cancer and oral lichen planus

We studied the incidence of GBV-C infection in patients with oral cancer or oral lichen planus (OLP). Subjects included 38 patients with oral cancer and 34 patients with OLP from whom serum was collected to detect GBV-C-RNA using reverse transcription (RT) "nested" PCR. GBV-C-RNA was positive in 1 (2.6%) oral cancer patient and 3 (8.8%) OLP patients. All 4 GBV-C-positive patients were also positive both for the antibody for hepatitis C virus (anti-HCV) and HCV-RNA, indicating simultaneous infection with GBV-C and HCV. In conclusion, GBV-C infection was found in 5.5% (4/72) of oral cancer or OLP patients and all patients infected with GBV-C also had HCV infection. This suggests that GBV-C infection is unlikely to play an important role in the pathogenesis of oral cancer and OLP.

Oncogenic osteomalacia caused by a phosphaturic mesenchymal tumor of the oral cavity: a case report

We report a case of oncogenic osteomalacia associated with a phosphaturic mesenchymal tumor in a 31-year-old woman. She was presented with severe generalized bone and muscle pain and was restricted to bed. She lost 20 cm in height over the 8 years since she had first noticed a pain in her thigh. A walnut-sized, hard, soft tissue tumor was found very easily beside her lower molar teeth Radiologic examination revealed a remarkable decrease in bone density and multiple pathologic fractures of spine, femur and phalangeal bones. Severe hypophosphatemia, hyperphosphaturia, low plasma 1,25-dihydroxyvitamin D3 level and high plasma PTH level were disclosed at presentation. Histomorphometric examination revealed an extensive area of unmineralized osteoid and little mineralizing activity. A pharmacologic dose of 1 alpha-hydroxyvitamin D3 or or 1,25-dihydroxyvitamin D3 slightly increased the serum phosphate level and renal tubular reabsorption of phosphate, and slightly decreased plasma PTH level without any symptomatic improvement. Histologic examination of the tumor revealed a mixed connective tissue tumor that consisted of central woven bones and surrounding primitive spindle cells with prominent vascularities. After removal of the tumor, all biochemical, hormonal and radiologic abnormalities disappeared with remarkable symptomatic improvement.

Teratoid cyst of the floor of the mouth

Because the term 'dermoid' is frequently used in the literature, some authors believe that this term should be used for all congenital cysts of the floor of the mouth. Three subclasses of congenital floor of the mouth cysts are described in the literature: (1) epidermoid (simple) cysts, (2) dermoid (complex) cysts and (3) teratoid (complex) cysts. The teratoid cyst is the least common. Most of these cases present during the second and third decades of life, thus presentation during infancy is extremely rare. Surgical excision is the treatment of choice. We present a 2-month old male who underwent expedient surgical excision for progressive airway compromise secondary to a teratoid cyst of the floor of the mouth. Radiographic and histopathologic evidence, as well as a review of the literature is presented.

Halitosis. A common oral problem

Halitosis is caused primarily by bacterial putrefaction and the generation of volatile sulfur compounds. Ninety percent of patients suffering from halitosis have oral causes, such as poor oral hygiene, periodontal disease, tongue coat, food impaction, unclean dentures, faulty restorations, oral carcinomas, and throat infections. The remaining 10 percent of halitosis sufferers have systemic causes that include renal or hepatic failure, carcinomas, diabetes or trimethylaminuria. Modern analytical and microbiological techniques permit diagnosis of bad breath. Management of halitosis involves maintaining proper oral hygiene, and periodontal treatment, including tongue brushing.

[Oral candidiasis following radiotherapy for neoplasms of the oromaxillofacial area]

The authors report the clinical and histopathologic factors of oral candidiasis in patients treated with irradiation for head and neck cancer and predisposing antimycotic related treatments.

Radiation treatment of oral epidemic Kaposi's sarcoma lesions: potential adverse effects

Epidemic Kaposi's sarcoma, which has consistently been the most prevalent malignancy in people with HIV disease, frequently presents with lesions in the oral cavity. Guidelines for treating oropharyngeal lesions with radiotherapy are ubiquitous in the literature. Treatment indications include pain, dysphagia, and obstruction. Radiotherapy dosage and fractionation differ from that prescribed for non HIV-infected people. Current literature reveals better treatment outcomes for people infected with HIV if treatment is managed by practitioners experienced in HIV care. This article presents a review of the literature and a case study of a HIV-infected patient who experienced severe adverse effects of irradiation.

Intensive care unit stay is prolonged in chronic alcoholic men following tumor resection of the upper digestive tract

BACKGROUND

The prevalence of chronic alcohol misuse in patients with oral, pharyngeal, laryngeal or esophageal carcinomas exceeds 60%. No data is available, to our knowledge, on the morbidity and mortality of chronic alcoholics in surgical intensive care units (ICU) following tumor resection. We investigated whether the subsequent ICU stay in chronic alcoholics following tumor resection was prolonged and whether the incidence of pneumonia and sepsis was increased.

METHODS

213 patients with carcinomas of the upper digestive tract were evaluated regarding their drinking habits. Chronic alcoholics met either the DSM-III-R criteria for alcohol abuse or dependence. Conventional laboratory markers and serum carbohydrate-deficient transferrin were determined preoperatively. Major intercurrent complications during ICU stay such as an alcohol withdrawal syndrome, pneumonia and sepsis as well as the frequency of death were documented.

RESULTS

Patients did not differ significantly between groups regarding age or APACHE score on admission to the ICU.121 patients were diagnosed as being chronic alcoholics, 39 as being social drinkers and 61 as being non-alcoholics. In chronic alcoholics the frequency of death was significantly increased. Due to the increased incidence of pneumonia and sepsis the ICU stay was significantly prolonged in chronic alcoholics by approximately 8 days.

CONCLUSIONS

The increased mortality and morbidity rate demonstrates that chronic alcoholics undergoing major tumor surgery have to be considered as high-risk patients during their postoperative ICU stay. Further studies are required with respect to the immuno-competence of chronic alcoholics and the prevention of alcohol withdrawal syndrome, pneumonia and sepsis in these patients.

Functional results in oral cavity reconstruction using reinnervated versus nonreinnervated free fasciocutaneous grafts

Recent advances in free-tissue transfer have given the otolaryngologist--head and neck surgeon a number of reliable options for reconstruction of the oral cavity following ablative procedures. One recent modification has been the transfer of free reinnervated fasciocutaneous grafts in the hope of enhancing oral rehabilitation following surgery. To assess the efficacy of this modification, a protocol was established to retrospectively evaluate patients that received either reinnervated or non-reinnervated free-tissue transfers. Factors including site, surgical resection, type of tissue transfer, and follow-up period were controlled. Evaluation of free-graft sensory return and quality of life was carried out through physical examination and patient interview. Speech assessment was carried out using standardized tests of intelligibility administered by a speech pathologist. Swallowing assessment was carried out with videocinefluoroscopic and scintigraphic techniques, and the oropharyngeal swallow efficiency was calculated. Sensory return in the reinnervate free grafts was superior; however, there was not statistical difference between groups in the speech and swallowing tests. Quality of life was judged to be good in both groups. Sensory return and functional outcome in intraoral reconstruction after tumour ablation was reviewed and discussed