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Zhi Y, Li S, Li Y, Ren W, Gao L, Zhi K. Prognostic effect of surgical treatment in elderly oral squamous cell carcinoma patients: A retrospective study. Oral Oncol 2024; 154:106849. [PMID: 38749112 DOI: 10.1016/j.oraloncology.2024.106849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Oral squamous cell carcinoma (OSCC) is one of the most prevalent malignant tumors in head and neck. However, few studies have focused on the postoperative prognosis of elderly OSCC patients undergoing surgical resection and reconstruction. METHODS We conducted a retrospective study of 349 patients diagnosed OSCC in the Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University from January 2016 to December 2022. Demographic and clinicopathological characteristics were recorded. Kaplan-Meier analysis was performed to identify the impact of age and reconstruction types on the prognosis of OSCC patients. Univariable regression analysis and multivariable Cox analysis were conducted to find independent prognostic factors of the younger and elderly OSCC patients. RESULTS Among 349 OSCC patients included in this retrospective study, 241 (69.1 %) were elderly patients and 108 (30.9 %) were younger patients. The two groups were comparable according to the demographic records. The elderly group presented a better recurrence-specific prognosis than that of the younger group (RFS: p = 0.0324). There are no remarkable differences on the prognosis of different reconstructive types. Gender, current address, life habit, invasion patterns, and TNM stage were identified as independent prognostic factors of the younger and elderly OSCC patients. CONCLUSION Elderly OSCC patients achieve a better recurrence-free survival than that of the younger patients. Meanwhile, the recurrence of OSCC patients is independent of their demographic and clinicopathological features. Elderly OSCC patients will benefit from aggressive surgical treatment as the younger patients.
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Affiliation(s)
- Yuan Zhi
- Department of Oral and Maxillofacial Reconstruction, The Affiliated Hospital of Qingdao University, 266555, Qingdao, Shandong, China; Key Lab of Oral Clinical Medicine, The Affiliated Hospital of Qingdao University, 266555, Qingdao, Shandong, China; School of Stomatology, Qingdao University, 266003, Qingdao, Shandong, China
| | - Shaoming Li
- Department of Oral and Maxillofacial Reconstruction, The Affiliated Hospital of Qingdao University, 266555, Qingdao, Shandong, China; Key Lab of Oral Clinical Medicine, The Affiliated Hospital of Qingdao University, 266555, Qingdao, Shandong, China; School of Stomatology, Qingdao University, 266003, Qingdao, Shandong, China
| | - Yizhan Li
- Department of Oral and Maxillofacial Reconstruction, The Affiliated Hospital of Qingdao University, 266555, Qingdao, Shandong, China; Key Lab of Oral Clinical Medicine, The Affiliated Hospital of Qingdao University, 266555, Qingdao, Shandong, China; School of Stomatology, Qingdao University, 266003, Qingdao, Shandong, China
| | - Wenhao Ren
- Department of Oral and Maxillofacial Reconstruction, The Affiliated Hospital of Qingdao University, 266555, Qingdao, Shandong, China; Key Lab of Oral Clinical Medicine, The Affiliated Hospital of Qingdao University, 266555, Qingdao, Shandong, China; School of Stomatology, Qingdao University, 266003, Qingdao, Shandong, China.
| | - Ling Gao
- Department of Oral and Maxillofacial Reconstruction, The Affiliated Hospital of Qingdao University, 266555, Qingdao, Shandong, China; Key Lab of Oral Clinical Medicine, The Affiliated Hospital of Qingdao University, 266555, Qingdao, Shandong, China; School of Stomatology, Qingdao University, 266003, Qingdao, Shandong, China.
| | - Keqian Zhi
- Department of Oral and Maxillofacial Reconstruction, The Affiliated Hospital of Qingdao University, 266555, Qingdao, Shandong, China; Key Lab of Oral Clinical Medicine, The Affiliated Hospital of Qingdao University, 266555, Qingdao, Shandong, China; School of Stomatology, Qingdao University, 266003, Qingdao, Shandong, China.
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Battaglia S, Crimi S, Piombino E, Villari L, Maugeri C, Minervini G, Cicciù M, Bianchi A. Nodal frozen section + elective neck dissection as an alternative to sentinel lymph node biopsy for the management of cT1-2N0 oral squamous cell carcinoma patients: a viability and accuracy study. J Cancer Res Clin Oncol 2023; 149:10465-10471. [PMID: 37278829 PMCID: PMC10423153 DOI: 10.1007/s00432-023-04941-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/24/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE Oral Squamous Cell Carcinoma (OSCC) is characterized by a high aggressiveness and a tendency to metastasize. The management of the neck in cT1-2N0 patients c follows three strategies: watchful waiting, elective neck dissection (END) or sentinel lymph node biopsy (SLNB). The aim was to assess the viability of intraoperative frozen sections of the nodes of cT1-2N0 to spot occult metastases as an alternative to SLNB, performing a modified radical neck dissection (MRND) in intraoperatively positive patients. METHODS The patients were treated at the Maxillo-Facial Surgery Unit of Policlinico San Marco of Catania between 2020 and 2022. END was performed in all patients, including frozen section examination of at least one clinically suspicious node per level. In case of positivity after frozen section examination, neck dissection was extended to levels IV and V. RESULTS All frozen sections were compared with a definitive test after paraffin inclusion. During surgery, 70 END were performed, and 210 nodes were analyzed with frozen sections. Among the 70 END, 52 were negative after frozen Sects. (156 negative nodes), and surgery was ended. Five of the 52 negative ENDs resulted in pN + after paraffin inclusion (9.6%), which underwent postoperative adjuvant treatment. The sensibility of our END + frozen section method was 75%, while the specificity of our test was 94%. The negative predictive value was 90,4%. CONCLUSIONS Elective neck dissection + intraoperative frozen section could be an alternative to SLNB to spot occult nodal metastases in cT1-2N0 OSCC due to the opportunity to perform a one-step diagnostic/therapeutic procedure.
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Affiliation(s)
- Salvatore Battaglia
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, CT Italy
| | - Salvatore Crimi
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, CT Italy
| | - Eliana Piombino
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, CT Italy
- Pathology Unit San Marco Hospital, San Marco Hospital, Catania, Italy
| | - Loredana Villari
- Pathology Unit San Marco Hospital, San Marco Hospital, Catania, Italy
| | - Claudia Maugeri
- Division of Maxillofacial Surgery Surgical Science dpt., Città Della Salute e Delle Scienze Hospital, University of Turin, Turin, Italy
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, CT Italy
| | - Alberto Bianchi
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, CT Italy
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Wei X, Jing M, Zhang X, Li C, Li L. Nurses' practice and educational needs in oral care for postoperative patients with oral cancer in ICUs: a multicenter cross-sectional study. BMC Oral Health 2022; 22:389. [PMID: 36071441 PMCID: PMC9454168 DOI: 10.1186/s12903-022-02426-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/30/2022] [Indexed: 12/24/2022] Open
Abstract
Background Surgical incision, endotracheal intubation, structural changes in the oral cavity, and other factors lead to a divergence in oral care between patients after oral surgery and ordinary inpatients. High-quality oral care can reduce the incidence of incision infection and ventilator-associated pneumonia. However, there is a lack of guidelines or expert consensus on oral care after oral cancer surgery. Therefore, the aim of this study was to assess the practicing situation of nurses in the intensive care unit (ICU) for postoperative patients with oral cancer and their need for training. Methods A multicenter cross-sectional study design was conducted in 19 ICUs of 11 tertiary hospitals from Henan province in China. Data were collected from 173 nurses and 19 head nurses online using a structured questionnaire. Mann–Whitney U and Kruskal–Wallis H tests were performed to analyze the data using SPSS (Version 25.0). Results Seven ICUs (36.8%) developed evaluation regulations for the oral care of postoperative patients with oral cancer, and eight ICUs (42.1%) described the operating standards. A total of 173 nurses completed the questionnaire, and the median score was 75 (68, 78). Almost all of the examined nurses (91.2%) assessed patients’ oral hygiene at a fixed time, while in 52.0% and 28.3% of nurses, the first oral care and frequency of oral care after surgery was determined based on the individual patient’s situation. More than half of the nurses (55.5%) spent approximately 5–10 min conducting oral care for patients. Physiological saline solution (82.7%), swabbing (91.9%), and oral care package with cotton ball (86.1%) were the most popular oral care mouthwash, method, and tool, respectively. Nurses sought help from senior nurses (87.3%) and doctors (83.8%), mostly to solve difficulties of oral care. Moreover, 76.9% of the nurses believed that the lack of knowledge and skills surrounding oral care was the main barrier for nurses to implement oral care. The majority of participants (69.4%) had never received continuing education or training in oral care for postoperative patients with oral cancer, and almost all (98.8%) of the respondents stated their preference to receive training in standardized oral care skills. Indications and contraindications (84.4%), tools (81.5%), and mouthwash (80.9%) of oral care were the items that the respondents were most eager to learn about. Approximately three quarters of nurses preferred scenario simulation practice as the training method. Conclusion Although the participants had high oral care scores for postoperative patients with oral cancer, there was great diversity in the practice. The lack of oral care knowledge was deemed the main barrier in delivering quality oral care, and the educational need was stated by almost all participants. We suggest that a standard protocol or clinical practice guidelines for oral care for postoperative patients with oral cancer should be developed, and nurses should be educated to equip them with professional knowledge and skills.
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Affiliation(s)
- XiaoJing Wei
- Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, Henan, China
| | - MengJuan Jing
- Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, Henan, China
| | - XianXian Zhang
- Department of Infectious Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, Henan, China
| | - ChunPeng Li
- Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, Henan, China
| | - LiMing Li
- Department of Nursing, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, Henan, China.
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Manzoor F, Golbang A, Dixon D, Mancuso E, Azhar U, Manolakis I, Crawford D, McIlhagger A, Harkin-Jones E. 3D Printed Strontium and Zinc Doped Hydroxyapatite Loaded PEEK for Craniomaxillofacial Implants. Polymers (Basel) 2022; 14:polym14071376. [PMID: 35406250 PMCID: PMC9002955 DOI: 10.3390/polym14071376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 02/05/2023] Open
Abstract
In this study, Strontium (Sr) and Zinc (Zn) doped-HA nanoparticles were synthesized and incorporated into polyetheretherketone (PEEK) up to 30 wt.% and processed by a novel approach i.e., fused deposition modelling (FDM) 3D printing for the production of patient specific cranial implants with improved bioactivity and the required mechanical performance. Filaments were produced via extrusion and subsequently 3D-printed using FDM. To further improve the bioactivity of the 3D-printed parts, the samples were dip-coated in polyethylene glycole-DOPA (PEG-DOPA) solution. The printing quality was influenced by filler loading, but was not significantly influenced by the nature of doped-HA. Hence, the printing conditions were optimized for each sample. Micro-CT and Scanning Electron Microscopy (SEM) showed a uniform distribution of bioceramic particles in PEEK. Although agglomeration of particles increased with increase in filler loadings. Differential Scanning Calorimetry (DSC) showed that the melting point and crystallinity of PEEK increased with an increase in doped-HA loading from 343 °C to 355 °C and 27.7% to 34.6%, respectively. Apatite formation was confirmed on the 3D-printed samples after immersion in simulated body fluid (SBF) for 7, 14 and 28 days via SEM, X-ray diffraction (XRD) and Fourier Transform Infrared Spectroscopy (FTIR). The tensile strength and impact strength decreased from 75 MPa to 51 MPa and 14 kJ/m2 to 4 kJ/m2, respectively, while Young’s modulus increased with increasing doped-HA content from. However, the tensile strengths of composites remained in the range of human cortical bone i.e., ≥50 MPa. In addition, there was a slight increase in mechanical strength after 28 days immersion which was attributed to apatite formation. Water contact angle showed that the hydrophilicity of the samples improved after coating the 3D-printed samples with PEG-DOPA. Hence, based on the results, the 3D-printed PEEK nanocomposites with 20 wt.% doped-HA is selected as the best candidate for the 3D-printing of craniomaxillofacial implants.
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Affiliation(s)
- Faisal Manzoor
- Department of Mechanical Engineering, School of Engineering, Ulster University, Shore Road, Newtownabbey BT37 0QB, UK; (A.M.); (E.H.-J.)
- Correspondence: (F.M.); (A.G.)
| | - Atefeh Golbang
- Department of Mechanical Engineering, School of Engineering, Ulster University, Shore Road, Newtownabbey BT37 0QB, UK; (A.M.); (E.H.-J.)
- Correspondence: (F.M.); (A.G.)
| | - Dorian Dixon
- Nanotechnology and Integrated Bio-Engineering Centre (NIBEC), Ulster University, Shore Road, Newtownabbey BT37 0QB, UK; (D.D.); (E.M.)
| | - Elena Mancuso
- Nanotechnology and Integrated Bio-Engineering Centre (NIBEC), Ulster University, Shore Road, Newtownabbey BT37 0QB, UK; (D.D.); (E.M.)
| | - Usaid Azhar
- Precision Engineering, Materials & Manufacturing (PEM) Research Centre, Institute of Technology Sligo, Ash Lane, F91 YW50 Sligo, Ireland; (U.A.); (I.M.)
- Department of Life Sciences, Institute of Technology Sligo, Ash Lane, F91 YW50 Sligo, Ireland
| | - Ioannis Manolakis
- Precision Engineering, Materials & Manufacturing (PEM) Research Centre, Institute of Technology Sligo, Ash Lane, F91 YW50 Sligo, Ireland; (U.A.); (I.M.)
- Department of Life Sciences, Institute of Technology Sligo, Ash Lane, F91 YW50 Sligo, Ireland
| | - Daniel Crawford
- Axial 3D, Alexander House, 17a Ormeau Ave, Belfast BT2 8HD, UK;
| | - Alistair McIlhagger
- Department of Mechanical Engineering, School of Engineering, Ulster University, Shore Road, Newtownabbey BT37 0QB, UK; (A.M.); (E.H.-J.)
| | - Eileen Harkin-Jones
- Department of Mechanical Engineering, School of Engineering, Ulster University, Shore Road, Newtownabbey BT37 0QB, UK; (A.M.); (E.H.-J.)
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Mortality Within 30 Days After Head and Neck Free Flap Reconstruction: A Systematic Review. J Craniofac Surg 2021; 32:1738-1741. [PMID: 34081420 DOI: 10.1097/scs.0000000000007548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The aim of this systematic review is to analyze the 30-day postoperative mortality in patients undergoing free flap reconstruction for head and neck cancer published in literature and to identify associated factors. METHODS The authors performed a literature search between January 1950 and February 2020 in PubMed, EMBASE, and Scopus, using a combination of Medical Subject Headings headings and text keywords related to head and neck cancer; microsurgery or free flap reconstruction; and 30-day mortality. Inclusion criteria were: original studies in English reporting on 30-day mortality after head and neck free flap reconstruction in adult population. RESULTS Thirty-one publications reported on a total of 13,447 patients who underwent head and neck free flap reconstruction. The published 30-day postoperative mortality ranged from 0% to 6.3%, with an average of 1.21%. A number of studies examined the association between mortality and body mass index, American Society of Anesthesiologists, and comorbidity score and age. One study found that underweight patients had significantly higher mortality. Two studies found no association between the American Society of Anesthesiologists score and 30-day postoperative mortality; however, 1 study reported significantly higher mortality with increased comorbidity score. Regarding association with age, 3 studies found significant higher mortality in older patients, while 5 studies found no difference. CONCLUSIONS The average 30-day postoperative mortality in patients undergoing head and neck free flap reconstruction is 1.21% and is; therefore, not negligible. Careful patient selection and preoperative optimization are essential in order to reduce mortality in head neck free flap reconstruction.
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Cordova A, Toia F, Salgarello M, Pinto V, Lucattelli E, Sgarzani R, Figus A, Cherubino M, Bassetto F, Santanelli di Pompeo F, Bonfirraro PP, Maruccia M, Faini G, Cigna E, Starnoni M, Baraziol R, Riccio M, Mazzucco W, Rubino C, Bonomi S. Safety of Reconstructive Microsurgery in the Elderly Population: a Multicentric Prospective Study. J Plast Reconstr Aesthet Surg 2021; 74:3281-3288. [PMID: 34247960 DOI: 10.1016/j.bjps.2021.05.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/05/2021] [Accepted: 05/24/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Safety of reconstructive microsurgery in elderly patients is still a topic of debate, because no conclusive evidence exists that provides indications and risk evaluation in elderly patients. The purpose of this study, which the Italian Society for Plastic, Reconstructive, and Aesthetic Surgery (SICPRE) has promoted, is to evaluate the safety and the complication risk of elective reconstructive microsurgery in elderly patients as well as to identify patient- or procedure-related risk factors. The secondary aim is to evaluate the predictive role for complications of the Geriatric 8 score (G8). METHODS A total of 194 consecutive patients from 18 centers, aged 65 or older, who received an elective microsurgical flap between April 2018 and April 2019 were prospectively evaluated. Patient-related, treatment-related, and outcomes data were recorded and statistically analyzed through multiple-adjusted logistic regression models. RESULTS Our study showed an increased risk of complications and a longer hospitalization in patients aged ≥75 years with the American Society of Anesthesiologists (ASA) score ≥3 (or G8 score ≤11) as compared to patients >65 years of age and <75 years of age who undergo reconstruction with a microsurgical flap. Instead, flap survival did not significantly vary with age, but was associated only with ASA score ≥3 (or G8 score ≤11) and surgeries that last longer than 480 min; however, flap survival (92.3%) was slightly lower than that commonly reported for in the general population. CONCLUSIONS Reconstructive microsurgery in the elderly is generally safe. The ASA score is easier and quicker than the G8 score and equally useful for risk stratification.
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Affiliation(s)
- Adriana Cordova
- Plastic and Reconstructive Surgery. Department of Surgical, Oncological and Oral Sciences. University of Palermo, Italy
| | - Francesca Toia
- Plastic and Reconstructive Surgery. Department of Surgical, Oncological and Oral Sciences. University of Palermo, Italy.
| | - Marzia Salgarello
- Istituto di Clinica Chirurgica, Dipartimento Scienze della Salute della Donna e del Bambino, Università Cattolica del Sacro Cuore e Unità di Chirurgia Plastica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Elena Lucattelli
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Rossella Sgarzani
- U.O.Centro Grandi Ustionati, Servizio di Chirurgia Plastica, Ospedale Maurizio Bufalini, Cesena, Italy
| | - Andrea Figus
- Unit of Plastic Surgery, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Mario Cherubino
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Franco Bassetto
- Plastic and Reconstructive Surgery Unit, Padova University Hospital, Padova, Italy
| | - Fabio Santanelli di Pompeo
- Plastic Surgery, Nesmos Department, Faculty of Medicine and Psychology, University La Sapienza of Rome-Sant'Andrea Hospital, Rome, Italy
| | | | - Michele Maruccia
- Section of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation (DETO), University of Bari 'Aldo Moro', Bari, Italy
| | - Gianpaolo Faini
- Plastic and Reconstructive Surgery, Spedali Civili Brescia, Brescia, Italy
| | - Emanuele Cigna
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marta Starnoni
- Division of Plastic Surgery, Modena University Hospital, Modena, Italy
| | - Roberto Baraziol
- Azienda Sanitaria Universitaria Integrata di Udine, Plastic Surgery Unit, Udine, Italy
| | - Michele Riccio
- Azienda Ospedaliero Universitaria "Ospedali Riuniti," Ancona, Italy
| | - Walter Mazzucco
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Corrado Rubino
- Plastic Surgery Unit of Oncology and Haematology, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital Trust, University of Sassari, Sassari, Italy
| | - Stefano Bonomi
- Department of Plastic Reconstructive Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Dai X, Li P, Xu H. Free Flap Transplantation on the repair of defects caused by oral and maxillofacial tumors resection. Pak J Med Sci 2019; 35:1339-1343. [PMID: 31489003 PMCID: PMC6717448 DOI: 10.12669/pjms.35.5.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 06/14/2019] [Accepted: 06/20/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the efficacy of free flap transplantation on the repair of tissue defects after oral and maxillofacial malignant tumor resection and its effects on serum sialic acid (SA) and interleukin-2 (IL-2). METHODS Fifty-eight patients with oral and maxillofacial tumors were enrolled and set as the observation group. After the tumor resection, free flap transplantation was performed for postoperative repair. The postoperative efficacy, adverse reactions and follow-up indicators were observed. Moreover, 55 patients with benign tumors were enrolled into the control group, and 55 healthy persons were set as the healthy group. The levels of SA and IL-2 of the three groups were detected. RESULTS In the observation group, 55 patients were successfully repaired (94.83%); 15 patients had adverse reactions after surgery. The follow-up duration was two to four years, and 45 patients survived for three years, with a survival rate of 77.59%. Before treatment, the serum SA level of patients with oral malignant tumor was significantly higher than those of the control group and healthy group, while the IL-2 level was significantly lower than those of the other two groups, and the differences were statistically significant (P<0.05). The serum IL-2 level in the observation group one day and fourteen days after surgery was higher than that before surgery, while the serum SA level was lower than that before surgery; the differences were statistically significant (P<0.05). CONCLUSION The application of free flap transplantation in the repair of postoperative tissue defects of oral and maxillofacial tumor resection is effective and has less complications, and the determination of both serum SA and IL-2 levels offers important references to recovery of patients with oral and maxillofacial tumors and prognosis evaluation.
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Affiliation(s)
- Xuemei Dai
- Xuemei Dai, Health Management Center, Binzhou People’s Hospital, Shandong 256600, China
| | - Pengchong Li
- Pengchong Li, Stomatology Department, Binzhou People’s Hospital, Shandong 256600, China
| | - Haiyan Xu
- Haiyan Xu, Endoscopy Room, Binzhou People’s Hospital, Shandong 256600, China
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Carbon Fiber Reinforced PEEK Composites Based on 3D-Printing Technology for Orthopedic and Dental Applications. J Clin Med 2019; 8:jcm8020240. [PMID: 30759863 PMCID: PMC6406436 DOI: 10.3390/jcm8020240] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 01/31/2019] [Accepted: 02/05/2019] [Indexed: 11/17/2022] Open
Abstract
Fused deposition modeling (FDM) is a rapidly growing three-dimensional (3D) printing technology and has great potential in medicine. Polyether-ether-ketone (PEEK) is a biocompatible high-performance polymer, which is suitable to be used as an orthopedic/dental implant material. However, the mechanical properties and biocompatibility of FDM-printed PEEK and its composites are still not clear. In this study, FDM-printed pure PEEK and carbon fiber reinforced PEEK (CFR-PEEK) composite were successfully fabricated by FDM and characterized by mechanical tests. Moreover, the sample surfaces were modified with polishing and sandblasting methods to analyze the influence of surface roughness and topography on general biocompatibility (cytotoxicity) and cell adhesion. The results indicated that the printed CFR-PEEK samples had significantly higher general mechanical strengths than the printed pure PEEK (even though there was no statistical difference in compressive strength). Both PEEK and CFR-PEEK materials showed good biocompatibility with and without surface modification. Cell densities on the "as-printed" PEEK and the CFR-PEEK sample surfaces were significantly higher than on the corresponding polished and sandblasted samples. Therefore, the FDM-printed CFR-PEEK composite with proper mechanical strengths has potential as a biomaterial for bone grafting and tissue engineering applications.
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Ren ZH, Wu K, Wang Y, Tian ZW, Hu JZ. Role of a two-step suture in the prevention of postoperative transoral salivary fistulas during reconstruction of the oral cavity. Br J Oral Maxillofac Surg 2019; 57:164-168. [PMID: 30686575 DOI: 10.1016/j.bjoms.2019.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 01/11/2019] [Indexed: 11/29/2022]
Abstract
Transoral salivary fistulas are one of the most serious postoperative complications after operations for oral cancer, and we propose a new, two-step suture method to avoid them. From January 2005 to September 2017, 240 patients were recruited at the Shanghai Ninth People's Hospital and divided into experimental (n=89) or control (n=151) groups. The experimental group was treated by a two-step suture technique, while the control group had conventional sutures. Statistical differences were assessed using the chi squared and t tests, as appropriate. Only two patients developed transoral salivary fistulas in the experimental group, while in the control group there were 14 (9%). The incidence of fistulas in the experimental group was significantly lower than that in the control group (p=0.035). Regression analysis showed that there was a significant correlation between the groups and the incidence of salivary fistulas (p=0.032). The two-step suture technique is safe, effective, and easy to learn, and could reduce the incidence of postoperative salivary fistulas.
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Affiliation(s)
- Z-H Ren
- Department of Oral and Maxillofacial & Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhizhaoju Road, Shanghai 200011, China.
| | - K Wu
- Department of Oral and Maxillofacial & Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhizhaoju Road, Shanghai 200011, China.
| | - Y Wang
- Department of Oral and Maxillofacial & Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhizhaoju Road, Shanghai 200011, China.
| | - Z-W Tian
- Department of Oral and Maxillofacial & Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhizhaoju Road, Shanghai 200011, China.
| | - J-Z Hu
- Department of Oral and Maxillofacial & Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhizhaoju Road, Shanghai 200011, China.
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Sharma A, Kim JW, Paeng JY. Clinical analysis of neck node metastasis in oral cavity cancer. J Korean Assoc Oral Maxillofac Surg 2018; 44:282-288. [PMID: 30637242 PMCID: PMC6327011 DOI: 10.5125/jkaoms.2018.44.6.282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/12/2018] [Accepted: 03/22/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives The purpose of this study was to evaluate the neck node metastasis pattern and related clinical factors in oral cavity cancer patients. Materials and Methods In total, 76 patients (47 males, 29 females) with oral squamous cell carcinoma (OSCC) who had no previous malignancies and were not undergoing neoadjuvant concomitant chemoradiotherapy or radiotherapy were selected for analysis. Results Occult metastases were found in 8 of 52 patients with clinically negative nodes (cN0, 15.4%). Neck node metastases were found in 17 patients (22.4%). There was a statistically significant relationship between neck node metastasis and T stage (P=0.014) and between neck node metastasis and distant metastasis (Fisher's exact test, P=0.019). Conclusion Neck node metastasis was significantly related to tumor size and distant metastasis during follow-up.
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Affiliation(s)
- Aditi Sharma
- Department of Oral and Maxillofacial Surgery, Kyungpook National University School of Dentistry, Daegu, Korea
| | - Jin-Wook Kim
- Department of Oral and Maxillofacial Surgery, Kyungpook National University School of Dentistry, Daegu, Korea
| | - Jun-Young Paeng
- Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Seoul, Korea
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Parsemain A, Philouze P, Pradat P, Ceruse P, Fuchsmann C. Free flap head and neck reconstruction: Feasibility in older patients. J Geriatr Oncol 2018; 10:577-583. [PMID: 30497979 DOI: 10.1016/j.jgo.2018.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/02/2018] [Accepted: 11/08/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The main purpose of this study was to evaluate the perioperative morbidity of free flap head and neck reconstructive surgery in patients aged 70 years and over (Group A) by comparison with a cohort of younger patients (Group B). Secondary objectives included assessment of survival rates and functional outcomes in these older patients, likewise by comparison with a cohort of younger patients. METHODS A retrospective study was conducted on all patients aged 70 years and over who underwent free flap reconstruction between 2012 and 2017. They were compared to a control group of younger patients to investigate hospital length of stay, postoperative complications and survival rates, and functional outcomes. RESULTS No significant difference was observed between the two groups in terms of variables such as hospital length of stay and medical/surgical complications. In multivariate analysis, comorbidity was the only predictive factor for postoperative medical complications, and pharyngolaryngeal location the only significant predictive factor for surgical complications. Factors significantly associated with hospital length of stay were older age, active smoking, pharyngolaryngeal location and the Charlson Comorbidity Index (CCI). Overall survival was the only factor that was substantially lower in the over 70 group, while disease-specific and relapse-free survival were comparable in both groups. CONCLUSION Old age per se should not be considered a contraindication to major surgery combined with free flap reconstruction in older patients.
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Affiliation(s)
- Aurélie Parsemain
- Department of Otolaryngology-Head and Neck Surgery, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pierre Philouze
- Department of Otolaryngology-Head and Neck Surgery, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pierre Pradat
- Clinical Research Center, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Cancer Research Center of Lyon, UMR Inserm U1052, CNRS 5286, Lyon, France; Claude Bernard University, Lyon 1, France
| | - Philippe Ceruse
- Department of Otolaryngology-Head and Neck Surgery, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard University, Lyon 1, France
| | - Carine Fuchsmann
- Department of Otolaryngology-Head and Neck Surgery, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
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Wu K, Lei JS, Mao YY, Cao W, Wu HJ, Ren ZH. Prediction of Flap Compromise by Preoperative Coagulation Parameters in Head and Neck Cancer Patients. J Oral Maxillofac Surg 2018; 76:2453.e1-2453.e7. [PMID: 30076809 DOI: 10.1016/j.joms.2018.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 07/01/2018] [Accepted: 07/01/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE Studies on coagulation parameters (including activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen [FIB], platelet count, and D-dimer) in flap compromise are limited. The aim of the present study was to compare coagulation parameter variables in patients with and without flap compromise. MATERIALS AND METHODS In this retrospective cohort study, patients were recruited from the Department of Oral and Maxillofacial Surgery at the Second Xiangya Hospital (Changsha, Hunan, China) from July 2016 through July 2017. The primary predictor variable was a set of coagulation parameters. The primary outcome variable was flap compromise. The other variables were age, gender, tumor stage, smoking, and prior radiotherapy. Descriptive, bivariate, receiver operating characteristic (ROC) curves and regression statistics were computed. Statistical significance was set at less than .05 with 95% reliability. RESULTS A total of 503 patients with 42 compromised flaps were identified in this study. Venous thrombosis, arterial thrombosis, or no confirmed reason for compromise was observed in 28, 5, or 9 compromised flaps, respectively. Only FIB was associated with flap compromise or venous thrombosis at adjusted analyses, although the predictive values were low at ROC analysis. For patients with D-dimer lower than 0.4 μg/mL, the likelihood of venous thrombosis was greater than that for patients with D-dimer of at least 0.4 μg/mL (P = .0414). For patients with FIB lower than 3.5 g/L, the likelihood of venous thrombosis was greater than that for patients with FIB of at least 3.5 g/L (P = .0336). CONCLUSION Decreased FIB was associated with a higher rate of flap compromise. In patients with D-dimer lower than 0.4 μg/mL or FIB lower than 3.5 g/L, the risk of venous thrombosis was higher.
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Affiliation(s)
- Kun Wu
- Resident, Department of Oral and Maxillofacial and Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing-Shi Lei
- Resident, Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yuan-Yuan Mao
- Resident, Department of Anesthesiology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Wei Cao
- Associate Professor, Department of Oral and Maxillofacial and Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Han-Jiang Wu
- Department Head, Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhen-Hu Ren
- Resident, Department of Oral and Maxillofacial and Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Goh CSL, Kok YO, Yong CPC, Tan EWX, Goh LG, Chew KY, Teo CEH, Goh TLH. Outcome predictors in elderly head and neck free flap reconstruction: A retrospective study and systematic review of the current evidence. J Plast Reconstr Aesthet Surg 2018; 71:719-728. [DOI: 10.1016/j.bjps.2017.12.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/25/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
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Yang X, Wu K, Li S, Hu L, Han J, Zhu D, Tian X, Liu W, Tian Z, Zhong L, Yan M, Zhang C, Zhang Z. MFAP5 and TNNC1: Potential markers for predicting occult cervical lymphatic metastasis and prognosis in early stage tongue cancer. Oncotarget 2018; 8:2525-2535. [PMID: 27713166 PMCID: PMC5356821 DOI: 10.18632/oncotarget.12446] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/20/2016] [Indexed: 12/27/2022] Open
Abstract
The purpose of this study is to identify candidate genes that could predict prognosis of early-stage tongue squamous cell carcinoma (TSCC) and its occult cervical lymphatic metastasis by large-scale gene expression profiling. Tumor tissue and matched normal mucosa samples were collected from patients with TSCC and analyzed with Affymetrix HTA2.0 high-density oligonucleotide array. Differentially expressed genes in TSCC with cervical lymph node metastasis (CLNM) were further analyzed with Gene Ontology and Kyoto Encyclopedia of Genes and Genomes for their functions and related pathways. A total of 107 differentially expressed genes (p < 0.05) were identified by microarray in TSCC samples with CLNM (n = 6) compared to those without CLNM (n = 6). Genes involved in the cell-matrix adherens junction and migration function including MFAP5, TNNC1, MGP, FBFBP1 and FBXO32 were selected and validated by RT-PCR in TSCC samples (n = 32). Of the five genes, MFAP5 and TNCC1 expressions were further validated by immohistochemistry (n = 61). The significant positive correlation between MFAP5 and TNNC1 expression (p<0.001) was observed. Notably, over-expression of MFAP5 and TNNC1 were correlated with CLNM, metastasis relapse-free survival and overall survival. Our findings indicated that MFAP5 and TNNC1 may be potential markers for predicting occult cervical lymphatic metastasis and prognosis of oral tongue carcinoma.
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Affiliation(s)
- Xi Yang
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Kailiu Wu
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Siyi Li
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Longwei Hu
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Jing Han
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Dongwang Zhu
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Xuerui Tian
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Wei Liu
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Zhen Tian
- Department of Oral Pathology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Laiping Zhong
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Ming Yan
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Chenping Zhang
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Zhiyuan Zhang
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
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15
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Yao Z, Huang K, Luo S, Sun L, Zhou H, Wu S, Xiao J. [Reconstruction of oral and maxillofacial soft tissue defects with anterolateral thigh (myocutaneous) flap assisted by computed tomography angiography]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:702-708. [PMID: 29798652 PMCID: PMC8498290 DOI: 10.7507/1002-1892.201612132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/13/2017] [Indexed: 11/03/2022]
Abstract
Objective To investigate the efficacy of anterolateral thigh (myocutaneous) flap designed with computed tomography angiography (CTA) to reconstruct oral and maxillofacial soft tissue defects. Methods Between January 2011 and December 2015, 23 cases of oral and maxillofacial tumors were treated. There were 14 males and 9 females with the age range from 45 to 72 years (mean, 56.8 years). There were 12 cases of tongue carcinoma, 5 cases of buccal mucosa carcinoma, 4 cases of mouth floor carcinoma, and 2 cases of oropharynx carcinoma; all were squamous cell carcinoma. According to standard TNM staging of the Union for International Cancer Control (UICC), 8 cases were rated as T 2N 0M 0, 3 cases as T 2N 1M 0, 1 case as T 2N 2M 0, 4 cases as T 3N 0M 0, 2 cases as T 3N 1M 0, 2 cases as T 3N 2M 0, 2 cases as T 4N 1M 0, and 1 case as T 4N 2M 0. The course of disease was 1-6 months (mean, 2.4 months). CTA was performed before operation to locate the perforator vessel and its surface projection of emerging point and to design anterolateral thigh (myocutaneous) flap by computer. The defects of soft tissue ranged from 6 cm×4 cm to 11 cm×7 cm after resection of tumor. The flap was used to repair defects, including 14 thinned anterolateral thigh flaps, 7 anterolateral thigh myocutaneous flaps, and 2 anterolateral bilobed flaps; and the flap area ranged from 7 cm× 5 cm to 12 cm×8 cm. The donor sites were sutured directly. Results CTA showed that myocutaneous perforators penetrated at the fascias of the vastus lateralis muscles in 22 cases with a location rate of 95.7% (22/23). Submandibular fistula occurred in 1 case at 5 days after operation and fistula healed after changed dressings. Other wounds at recipient site and donor site healed at primary stage. Anastomose with 2 vein was performed because of poor venous return in 1 case, and the flap survived. The other flaps survived well. All the patients were followed up 6-36 months (mean, 16.4 months). At 3 months after operation, the simplified recovery standard of speech function and swallow function was established according to the University of Washington Quality of Life Scale (UW-QOL). The speech and swallow function recovered satisfactorily in 22 cases, and not very satisfactorily in 1 case of well differentiated squamous cell carcinoma of the right mouth floor (T 4N 1M 0). No obvious tissue atrophy was observed in 23 cases. No dysfunction was found at the donor site. There was no tumor recurrence in 21 patients; 1 patient accepted the second operation due to lymphonodi metastasis of contralateral neck at 6 months after first operation, who died after 23 months; 1 patient died of distant metastasis at 10 months after first operation. Conclusion The anterolateral thigh (myocutaneous) flap designed with CTA could well recover the morphology and function of the recipient site.
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Affiliation(s)
- Zhihao Yao
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Kui Huang
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Shihong Luo
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Libo Sun
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Hangyu Zhou
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Shuangjiang Wu
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Jingang Xiao
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000,
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16
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Khan MN, Perez E, Goljo E, Iloreta A, Park RCW, Genden EM, Miles BA. The price of free tissue transfer after tongue reconstruction: quantifying the risks. Laryngoscope 2017; 127:1551-1557. [DOI: 10.1002/lary.26461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/01/2016] [Accepted: 11/14/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Mohemmed N. Khan
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York U.S.A
| | - Enrique Perez
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York U.S.A
| | - Erden Goljo
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York U.S.A
| | - Alfred Iloreta
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York U.S.A
| | - Richard Chan Woo Park
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York U.S.A
| | - Eric M. Genden
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York U.S.A
- Department of Otolaryngology-Head and Neck Surgery; Rutgers University; Newark New Jersey U.S.A
| | - Brett A. Miles
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York U.S.A
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17
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Ren ZH, Gong ZJ, Wu HJ. Unit resection of buccal squamous cell carcinoma: Description of a new surgical technique. Oncotarget 2016; 8:52420-52431. [PMID: 28881740 PMCID: PMC5581039 DOI: 10.18632/oncotarget.14191] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 11/20/2016] [Indexed: 12/18/2022] Open
Abstract
This study characterized the infiltration of primary tumors along the muscles, fascia and spaces of the maxillofacial region in buccal squamous cell carcinoma (BSCC) and suggested a new surgical strategy that is suitable for most stages. Based on the anatomic characteristics and infiltration of the primary tumor a new surgical approach - unit resection buccal surgery (URBS) - was developed. We evaluated this new surgical strategy, across a cohort of 127 BSCCs: 60 cases treated with URBS and 67 cases treated with conventional surgery. Notably there was no statistical difference in the clinicopathological variables between the two groups. After initial treatment with curative intent, the patients were regularly followed-up with clinical examination and imaging. URBS proved suitable for almost all stages of BSCC, and was particularly advantageous for advanced stages of BSCC. At 2 years post-treatment, the rates of overall survival were 83.3% in the URBS group and 60.1% in the conventional surgery group, respectively (hazard ratio 0.38; 95% CI 0.20 to 0.75; P=0.005). Similarly, the rates of disease-free survival were 76.6% and 51.9% in the URBS group and the conventional surgery group, respectively (hazard ratio 0.42; 95% CI 0.23 to 0.75; P=0.003). The principles of URBS are suitable for almost all stages of BSCC, especially advanced stages. URBS may improve the prognosis of BSCC patients.
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Affiliation(s)
- Zhen-Hu Ren
- Department of Oral and Maxillofacial surgery, Second Xiangya hospital of Central South University, Changsha, Hunan, 410011, China.,Department of Oral Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Zhao-Jian Gong
- Department of Oral and Maxillofacial surgery, Second Xiangya hospital of Central South University, Changsha, Hunan, 410011, China
| | - Han-Jiang Wu
- Department of Oral and Maxillofacial surgery, Second Xiangya hospital of Central South University, Changsha, Hunan, 410011, China
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Ren ZH, Wu HJ, Ji T, Wang K, Gokavarapu S, Zhang CP. Clinical Application of an Original Vascular Anastomosis: A Clinical Multicenter Study. J Oral Maxillofac Surg 2016; 74:2288-2294. [DOI: 10.1016/j.joms.2016.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 02/25/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
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Hwang K, Lee JP, Yoo SY, Kim H. Relationships of comorbidities and old age with postoperative complications of head and neck free flaps: A review. J Plast Reconstr Aesthet Surg 2016; 69:1627-1635. [PMID: 27697538 DOI: 10.1016/j.bjps.2016.08.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 07/29/2016] [Accepted: 08/31/2016] [Indexed: 11/16/2022]
Abstract
The aim of this study was to determine the relationships between free flap complications and old age or comorbidities. In a PubMed and Scopus search, the search terms (1) free flap OR microvascular anastomosis AND (2) elderly OR old age AND (3) complications OR comorbidity OR co-morbidity were used. Among the 62 full-text articles from 241 abstracts, 31 papers without sufficient content were excluded and 10 mined papers were added. Subsequently, 41 papers were reviewed. Overall complication rates of free flap increased significantly with age (p < 0.001; y = 0.457x + 13.464; 40.9% at 60 years, 45.5% at 70 years, and 50.0% at 80 years). Flap survival rates increased significantly (p < 0.001; y = 0.025x + 93.876). Donor site complication rates also increased significantly with age (p < 0.001; y = 1.238x - 63.700; 10.9% at 60 years, 23.0% at 70 years, and 35.3% at 80 years). The Kaplan-Feinstein index (KFI, OR = 7.944, 9.563), the Adult Comorbidity Evaluation-27 (ACE-27, OR = 5.854), the American Society of Anesthesiologists score (ASA, OR = 4.397), and the Index of Coexistent Diseases score (ICED, OR = 3.584) had statistically significant impacts on flap survival (p < 0.05). Diabetes (OR = 4.562) and chronic obstructive pulmonary disease (OR = 2.300) had statistically significant negative impacts on the flap survival rate (p < 0.05). Elderly patients had significantly higher Charlson Comorbidity Index (CCI) and ASA scores (p < 0.001). Similarly, elderly patients exhibited a significantly higher prevalence of dementia (p < 0.001) and use of aspirin at the time of surgery (p < 0.001). On the basis of these results, we suggest that the incidence of complications is directly related to the preoperative medical condition of an individual patient rather than to age.
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Affiliation(s)
- Kun Hwang
- Department of Plastic Surgery, Inha University School of Medicine, Incheon, South Korea.
| | - Jin Pyo Lee
- Inha University School of Medicine, Incheon, South Korea.
| | - Si Yoon Yoo
- Inha University School of Medicine, Incheon, South Korea.
| | - Hun Kim
- Department of Plastic Surgery, Inha University School of Medicine, Incheon, South Korea.
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Ishimaru M, Ono S, Suzuki S, Matsui H, Fushimi K, Yasunaga H. Risk Factors for Free Flap Failure in 2,846 Patients With Head and Neck Cancer: A National Database Study in Japan. J Oral Maxillofac Surg 2016; 74:1265-70. [DOI: 10.1016/j.joms.2016.01.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
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Elective versus therapeutic neck dissection in node-negative oral cancer: Evidence from five randomized controlled trials. Oral Oncol 2015; 51:976-981. [PMID: 26321080 DOI: 10.1016/j.oraloncology.2015.08.009] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/10/2015] [Accepted: 08/13/2015] [Indexed: 12/19/2022]
Abstract
The aim of this study was to compare the outcomes of elective neck dissection (END) with that of a more conservative approach comprising of observation plus therapeutic neck dissection for nodal relapse (OBS), by conducting a meta-analysis of randomized controlled trials (RCTs) that compare these two surgical approaches in patients. RCTs conducted prior to May 2015 were identified from electronic databases such as MEDLINE EMBASE and Cochrane Library. Reference lists within the retrieved articles were used as secondary reference sources. Disease-free survival (DFS) and overall survival (OS) were the primary outcome measures. Five RCTs with a combined subject population of 779 patients were included. Meta-analysis of these 5 RCTs showed that DFS in END group was higher than that in the OBS group with a significant inter-group difference (Risk Ratio [RR]:1.33; 95% Confidence Interval [CI] 1.06, 1.66); P=0.01; five trials, 779 participants]. However, there was a significant statistical heterogeneity among the studies (I-squared=56%, P=0.06). Four studies had reported on OS. Meta-analysis of these 4 RCTs revealed a higher OS in the END group as compared to that that in the OBS group with a significant inter-group difference (RR: 1.18; 95% CI 1.07, 1.29); P=0.0009; four trials, 708 participants]. The statistical heterogeneity of these 4 studies is small (I-squared=14%, P=0.32). The results of this meta-analysis suggest that END at the time of resection of the primary tumor confers a DFS and OS benefit in patients with clinically node-negative oral cancer.
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22
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Ren ZH, Wu HJ, Zhang S, Wang K, Gong ZJ, He ZJ, Peng J. A new surgical strategy for treatment of tongue squamous cell carcinoma based on anatomic study with preliminary clinical evaluation. J Craniomaxillofac Surg 2015; 43:1577-82. [PMID: 26321124 DOI: 10.1016/j.jcms.2015.07.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 07/17/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND This study characterized the infiltration of primary tumors along the intrinsic and extrinsic muscles of the tongue in oral tongue squamous cell carcinoma (OTSCC), to create a new surgical strategy that is suitable for most stages. A preliminary evaluation of this novel surgical approach was also conducted. METHODS An anatomic study of macroscopic specimens from 10 human cadavers and 100 OTSCC patients was conducted. The anatomic characteristics of the primary tumors and the origin and distribution of fibers of the intrinsic and extrinsic tongue muscles were observed and measured. After initial treatment with curative intent, the 100 patients were regularly followed-up with clinical examination and imaging. RESULT Based on the anatomic characteristics of the primary tumors and tongue muscles, a new surgical approach was developed, and was described as muscle anatomy tongue surgery (MATS). MATS proved suitable for almost all stages of OTSCC. According to the morphology of the invasive tumor front, the 100 cases were divided into four types. The rate of 2-year local disease control was 98%, locoregional control 86%, disease-free survival 85%, and overall survival 89%. Tongue functions were perfectly recovered in more than 60% of the patients. CONCLUSION Application of the principles of MATS to the treatment of OTSCC proved suitable for almost all stages of the disease. MATS is a novel surgical technique that may improve outcomes in tongue cancer surgery.
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Affiliation(s)
- Zhen-Hu Ren
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China; Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China.
| | - Han-Jiang Wu
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China.
| | - Sheng Zhang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Kai Wang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Zhao-Jian Gong
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Zhi-Jing He
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Jie Peng
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
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Ren ZH, Xu JL, Fan TF, Ji T, Wu HJ, Zhang CP. The Harmonic Scalpel versus Conventional Hemostasis for Neck Dissection: A Meta-Analysis of the Randomized Controlled Trials. PLoS One 2015; 10:e0132476. [PMID: 26161897 PMCID: PMC4498925 DOI: 10.1371/journal.pone.0132476] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 06/15/2015] [Indexed: 11/18/2022] Open
Abstract
Objective Neck dissection is the most definitive and effective treatment for head and neck cancer. This systematic review aims to compare the efficacy and surgical outcomes of neck dissection between the harmonic scalpel and conventional surgical techniques and conduct a quantitative meta-analysis of the randomized trials. Methods Randomized controlled trials (RCTs) were identified from the major electronic databases (MEDLINE, EMBASE and Cochrane Library) using the keywords ‘‘harmonic scalpel’’ and ‘‘neck dissection,’’ and a quantitative meta-analysis was conducted. The operative time and intraoperative bleeding were the primary outcome measures, and other parameters assessed included the drainage fluid volume and length of hospital stay. Results Seven trials that met the inclusion criteria included 406 neck dissection cases (201 in the harmonic scalpel group). Compared with conventional surgical techniques, the HS group had an operative time that was significantly reduced by 29.3 minutes [mean difference: -29.29; 95% CI = (-44.26, -14.32); P=0.0001], a reduction in intraoperative bleeding by 141.1 milliliters [mean difference: -141.13; 95% CI = (-314.99, 32.73); P=0.11], and a reduction in drainage fluid volume by 64.9 milliliters [mean difference: -64.86; 95% CI = (-110.40, -19.32); P=0.005] , but it is not significant after removal of studies driving heterogeneity. There was no significant difference in the length of the hospital stay [mean difference: -0.21; 95% CI = (-0.48, 0.07); P=0.14]. Conclusion This systematic review showed that using the harmonic scalpel for neck dissection significantly reduces the operative time and drainage fluid volume and that it is not associated with an increased length of hospital stay or perioperative complications. Therefore, the harmonic scalpel method is safe and effective for neck dissection. However, the statistical heterogeneity was high. Further studies are required to substantiate our findings.
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Affiliation(s)
- Zhen-Hu Ren
- Department of Oral and Maxillofacial & Head and Neck Oncology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-Lin Xu
- Department of Respiratory Medicine, Shanghai chest hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Teng-Fei Fan
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Tong Ji
- Department of Oral and Maxillofacial & Head and Neck Oncology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Han-Jiang Wu
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chen-Ping Zhang
- Department of Oral and Maxillofacial & Head and Neck Oncology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- * E-mail:
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