Ghana 3D Telemedicine International MDT: A proof-of-concept study

A real-time 3D Telemedicine system - leveraging Microsoft's Holoportation™ communication technology - enabled an international multidisciplinary team meeting (MDT) to consult with complex reconstructive patients before, during, and after an overseas surgical collaboration.

METHODS

A proof-of-concept international 3D MDT clinic took place in November 2022, between the Canniesburn Plastic Surgery Unit, UK, and the National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Ghana. The 3D system was utilised 1) previsit to assess patients and enable logistical planning, 2) on-site in Ghana to further allow patients to see themselves and proposed operations in 3D, and 3) post visit to debrief the team and patients.

RESULTS

Four Ghana patients were followed through their patient journey (mandibular ameloblastoma, sarcoma thigh, maxillary tumour, sarcoma back). Thirteen participants (four patients, four Ghana clinicians, and five UK clinicians) completed feedback on the 3D MDT. Outcome measures were rated highly with satisfaction 84.31/100, perceived benefit 4.54/5, overall quality 127.3/147 (Telehealth Usability Questionnaire), and usability 83.2/100 (System Usability Scale). These data show close alignment with that previously published on high-income countries.

CONCLUSIONS

This novel technology has the potential to enhance the delivery of overseas surgical visits to low-to-middle-income countries, by improving planning, informed discussion with patients, expert consensus on complex cases, and fostering engagement with professionals who may be thousands of miles away. This is the first demonstration that real-time 3D Telemedicine can both work, and enhance care within an international MDT clinic, and may thus enable change in the approach to overseas surgical collaborations.

[Long-term quality of life in patients with BrownⅡ maxillary defect repaired by different methods]

Objective: To analyze the long-term quality of life of patients with Brown Ⅱ maxillary defect repaired by tissue flap or prosthesis. Methods: Patients who underwent surgery for maxillary malignant tumors in the First Affiliated Hospital of Bengbu Medical College from 2014 to 2017 were selected to investigate the postoperative long-term (>5 years) quality of life using the fourth edition of the University of Washington quality of life questionnaire (UW-QOL). Mann Whitney U test was used to examine the differences between two groups. Results: In this study, 4 cases were lost to follow-up, 9 died, and a total of 46 valid questionnaires were collected, including 24 males and 22 females, aged 19-86 years. There were 26 cases of class Ⅱb/c and 20 cases of class Ⅱd. Tissue flap reconstruction was performed in 29 cases (tissue flap group) and prosthesis restoration in 17 cases (prosthesis group). The score of chewing QOL in the prosthesis group was higher than that in the tissue flap reconstruction group (Z=-2.787, P=0.005), but the scores of entertainment, swallowing, speech and emotion QOL in the former group were respectively lower than those in the latter group (Z=-3.185, -2.091, -2.556 and -1.996, respectively, all P values<0.05). In patients with Brown Ⅱb/c defect, the prosthesis repair could improve the chewing QOL score (Z=-2.830, P=0.005), but no statistically significant differences in other QOL scores between two groups. In patients with Brown Ⅱd defect, the tissue flap reconstruction could improve the scores of pain, entertainment, swallowing and speech QOL (Z=-2.741, -2.517, -2.320 and -2.843, respectively, all P values<0.05), and the average QOL score in tissue flap reconstruction group was also higher than that of the prosthesis group (Z=-2.276, P=0.023). Conclusion: For postoperative long-term quality of life, both prosthesis and tissue flap reconstruction can offer satisfactory results in patients with Brown Ⅱb/c defect, and patients with Brown Ⅱd defect repaired by tissue flap reconstruction have better speech and swallowing functions. Tissue flap reconstruction may bring more entertainment and emotional benefits.

Ultrasound-Guided Maxillary Nerve Block and Superficial Cervical Plexus Block During Surgery for Maxillary Malignancy: A Case Report

We report a case of ultrasound-guided craniocervical nerve blocks performed with ropivacaine for perioperative local/regional anesthesia in a patient who underwent right partial maxillary resection and neck dissection under general anesthesia. The patient was an 85-year-old woman with multiple medical comorbidities in whom analgesia using nonsteroidal anti-inflammatory drugs and opioids was expected to increase the risk of postoperative complications. Bilateral ultrasound-guided maxillary (V2) nerve blocks and a right superficial cervical plexus block were performed, which provided adequate perioperative anesthesia and avoided postoperative complications. The use of ultrasound-guided craniocervical nerve blocks with ropivacaine can be an effective approach for providing prolonged perioperative local anesthesia and analgesia, minimizing the need for other potentially problematic analgesics.

Solitary Large Intraoral Neurilemmoma of the Maxillary Vestibule: A Rare Case with Brief Literature Review

AIM

This current report aimed at presenting a rare case of a large solitary intraoral neurilemmoma of the buccal vestibule followed by a brief review of literature of neurilemmoma published between 1997 and 2017.

BACKGROUND

The diagnosis of slow-growing intraoral lesions requires a thorough patient history and clinical examination. Despite the best efforts of even the most experienced oral medicine expert, a definitive diagnosis may sometimes only be reached through excisional biopsy and histopathological evaluation.

CASE DESCRIPTION

To the best of our knowledge, there have been only two cases of neurilemmoma of the buccal vestibule reported in the literature till date and, looking at the size of the lesion, our case is the largest among the ones reported.

CONCLUSION

In the present case, a rare presentation of solitary buccal vestibular neurilemmoma establishes the need for the consideration of a wide range of pathologies in the differential diagnosis.

CLINICAL SIGNIFICANCE

Clinicians should include neurilemmoma in their differential diagnosis for asymptomatic, slow-growing intraoral growths and ensure complete excision to prevent tumor recurrence. The reader should be able to recognize the clinical features of neurilemmoma and describe the histopathological features and management of the condition.

Infantile Intraosseous Maxillary Hemangioma

BACKGROUND

Primary osseous hemangiomas of the facial skeleton mimic malignancy. Their location in maxillary sinus, especially in infants is extremely rare.

CASE CHARACTERISTICS

1- month-old full term boy with maxillary swelling.

OBSERVATIONS

Biopsy from oral route revealed hemangioma showing vascular channels lined by endothelial cells. Patient improved on oral steroids.

MESSAGE

Hemangiomas should be considered as one of the differential diagnosis of unilateral maxillary swelling in infants. Steroids may serve as the primary mode of treatment as opposed to tumor excision.

[Odontogenic ghost cell carcinoma: a case report]

Odontogenic ghost cell carcinoma is a rare malignant tumor, which has an odontogenic cystic tumor-derived calcification features and characteristics of the malignant cytology and invasive growth of the tumor. In the article, a case of odontogenic ghost cell carcinoma on maxillary bone was reported.

[Reconstruction of maxillary defects combination with pedicled buccal fat pad graft, temporalis myofascial flap and titanium mesh]

OBJECTIVE

To study the feasibility of close and three-dimensional reconstruction of maxillary defects combination with pedicled buccal fat pad graft, temporalis myofascial flap and titanium mesh.

METHODS

Among 11 patients with maxillary tumors, 9 were malignant and 2 were benign. 8 cases underwent subtotal maxillectomy and 3 cases underwent total maxillectomy. Maxillary defects were closely reconstructed combination with pedicled buccal fat pad graft (BFP), temporalis myofascial flap (TMF) and titanium mesh to restore the profile of maxilla.

RESULTS

All flaps were alive with satisfactory function and aesthetic appearance. The uncovered BFP and the facial muscle surface of TMF epithelialized within 4-6 weeks. Their degree of mouth opening ranged from 2.5 to 4.0 cm and without nasal foods return. All patients had a good voice quality.

CONCLUSION

Making use of BFP, TMF and titanium mesh can restore the good contour and function of maxillary. It is an effective method of reconstruction of maxillary defects, and is easy to manipulate. It is worthy to popularization.

[Use of intubating laryngeal mask airway for three patients with difficult intubation]

We used intubating laryngeal mask airway (ILM) for three patients with difficult intubation, and tracheal intubation was successfully performed through the ILM in all three cases. Difficult intubation in the first case was caused by direct invasion of malignant lymphoma into the right maxillary sinus leading to restricted mouth opening. Neck stiffness due to invasion of metastatic cancer into the cervical spine in the second case and facial trauma caused by traffic accident in the third case gave rise to the difficult intubation. Insertion of the ILM was successfully performed in all the patients following induction of general anesthesia, and the ventilation through the ILM was possible without any difficulties. Subsequently, all patients were intubated through the ILM successfully. We realized that the ILM is useful and should be prepared on the induction of anesthesia in patients suspected of difficult intubation.

Apoptosis-promoting gene (bax) transfer potentiates sensitivity of squamous cell carcinoma to cisplatin in vitro and in vivo

Modulation of apoptosis may potentiate the sensitivity of tumor cells to chemotherapeutic agents, thus improving the clinical outcome of cancer treatment. Bax, an apoptosis-promoting member of the bcl-2 family, may be a key factor influencing the chemosensitivity of tumor cells, however, its involvement in cellular sensitivity to anti-cancer drugs remains uncertain in squamous cell carcinoma (SCC). To investigate the role of bax gene expression in modulating cisplatin (CDDP)-induced apoptosis in vitro, an established CDDP-resistant human head and neck SCC (IMC-3 cell line) was transfected with bax gene-bearing mammalian expression vector. Overexpression of the bax gene in CDDP-resistant IMC-3 cells elevated the CDDP susceptibility of tumor cells to a level similar to that of the parental IMC-3 cells. In an in vivo study, percutaneous transfer of apoptosis-promoting bax gene by particle-mediated (gene gun) delivery caused overexpression of Bax in SCC, which was confirmed by immunohistochemical staining, and inhibited the growth of mouse CDDP-resistant SCC. Furthermore, combination therapy with bax gene transfer and subcutaneous administration of CDDP at 3-day intervals markedly inhibited the growth of mouse SCC. Thus, overexpression of bax in SCC by a gene gun system appears to be a rational approach to improving the efficacy of chemotherapy and treatment outcome. We suggest that exogenous bax expression may have therapeutic applications for enhancing chemotherapy in SCC.

THE ROLE OF CHEMOTHERAPY IN ADVANCED CANCER OF THE HEAD AND NECK. A REVIEW OF EIGHTY CASES

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THE AFRICAN LYMPHOMA (BURKITT TUMOUR): SURVIVALS EXCEEDING TWO YEARS

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THE CALCIFYING EPITHELIAL ODONTOGENIC TUMOUR: REPORT OF A CASE AND A STUDY OF ITS HISTOGENESIS

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ORAL MELPHALAN THERAPY IN ADVANCED MALIGNANT DISEASE

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[Comparisons of three simple nutritional assessments applied to patients with oral and maxillofacial malignancies]

Combined subjective and objective nutritional assessment (SNA), concise nutritional assessment (CNA), general nutritional status score (GNS), and subjective global assessment of nutritional status (SGA) were applied to assess the nutritional status of 127 patients with oral and maxillofacial malignancies. On this base SNA was used as a standard nutritional assessment to compare the validities of CNA, GNS, and SGA. The results showed: 1) the total agreement rate of CNA (88.2%) was higher than that of GNS (78.0%) and SGA (78.7%); 2) the false positive rate (9.9%) and false negative rate (15.2%) of CNA was lower than that of GNS (17.3%, 30.4%) and SGA (14.8%, 32.6%); 3) the diagnosis index of CNA (74.9%) was significantly (P < 0.05) higher than that of GNS (52.3%) and SGA (52.6%); and 4) the nutritional parameters of CNA were measured by instruments with little man-made errors. These results indicate that CNA can be regarded as the best nutritional assessment for the patients in oral and maxillofacial surgery.

An unusual cause of maxillary tuberosity enlargement

Myelomatous involvement of the maxilla is rare. A case is presented where bilateral enlargement of the maxillary tuberosities lead to a diagnosis of plasma cell myeloma (multiple myeloma) in an edentulous 54-year-old female.

Pattern assembly--an aid to flap design during oral microsurgical reconstruction

Surgical ablation of tumors within the oral cavity results in a three-dimensional defect and a potential puzzle for the reconstructive surgeon. Although a myriad of papers discussing the relative advantages and disadvantages of various methods of reconstruction are readily available for consultation, very few publications have provided the surgeon with a guide either to visualization of the defect or to how to reconstruct a three-dimensional defect with an essentially two-dimensional flap. Our intention is not to provide the answer for every oral reconstructive problem--after all, no two patients are alike--but we will demonstrate that an appreciation of the defect in three-dimensions, together with an understanding of oral function, provides a template for flap design and inset. This is achieved by simplifying the complex anatomical shape of the oral cavity into a geometric form from which a series of simple, easily recognisable shapes can be derived and assembled as necessary into a pattern that reproduces the defect, providing a template for flap design and inset.

Maxillary ameloblastoma: case report

Ameloblastoma of the maxilla is an unusual epithelial tumor of odontogenic origin. Although it is considered benign, it can behave in a slowly growing infiltrative fashion, with multiple recurrences and eventual intracranial, or even distant, spread. Information on this tumor consists, to a large extent, of case reports presented in the oral surgery literature. This study is a retrospective review of our combined institutional experience with nasomaxillary tumors from 1980 to 1988. Among these cases were four patients with maxillary ameloblastoma, two males and two females, ranging in age from 16 to 66 years at presentation. Disease extent varied from ameloblastoma localized to a cyst in the maxillary sinus to extensive maxillary and ethmoid involvement. Follow-up ranged from 2 to 13 years, and disease course varied from apparent disease control to persistent intracranial tumor, despite attempts at extirpation. An analysis of this experience and the related literature is presented, along with recommendations for radical therapy, when appropriate, to best ensure control.

[Oral presentation of non-Hodgkin's lymphoma. Literature review apropos of a clinical case]

The author makes a review of Non Hodgkin's Lymphoma and Oral Presentations, and includes a case report of the Oral and Maxilo-Facial Surgery of the Snt. António's Hospital--Porto.

[Inverted papilloma: implications for the oral and maxillofacial surgeon]

7 patients with inverted papillomas of the maxillofacial area were subjected to a post-treatment evaluation. Inverted papillomas were found in maxillary and frontal sinuses, ethmoid cells, nasal septa and as isolated lesions in the mucosa of the mandibular alveolar process. Apart from an inverted papilloma, one patient also had a mucoepidermoid carcinoma. The tendency to recur correlated well with the surgical approach. Radical removal of the mucosa must be called for as primary therapy in the paranasal sinus area. In order to safely exclude a concurrent carcinoma, the entire resected material must be examined histologically.

Diagnosis and treatment of metastatic ameloblastoma

Although there are several theoretic mechanisms for metastasis of ameloblastoma, hematogenous and lymphangitic spread are the most likely. Metastatic ameloblastoma in the lung can be accurately diagnosed by transbronchial biopsy. Surgical excision of metastatic ameloblastoma is one choice for treatment, but there is no good evidence that this benefits the patient. Treatment of metastatic ameloblastoma with previously used chemotherapeutic regimens has shown little clinical response and has always been followed by disease progression. There may be a role for our chemotherapy regimen for local control in dangerous locations, thereby facilitating further surgical removal and minimizing postoperative sequelae.

[Large odontoma of the left maxilla: report of a case]

An odontoma is a tumor in which both epithelial and mesenchymal cells exhibit complete differentiation and is comosed of enamel, dentin, cementum and pulp tissue. Three types are complex odontoma, compound odontoma and cystic odontoma. The case reported here is a relatively large complex odontoma which was found in the left maxilla of a 23-year-old male.