Patient-reported quality of life outcomes following treatment for oral cancer

Patient-reported quality of life (QoL) outcomes have the potential to assist clinicians in providing individually tailored treatment decisions. QoL assessments were collected prospectively for 168 consecutive patients treated for oral cancer between 1 January 2010 and 31 December 2014 using the University of Washington Quality of Life Questionnaire. Patients were followed up for 18 months post-treatment. Sub-group analyses were performed using paired t-tests and analysis of variance (ANOVA) to compare the effects of adjunctive chemoradiotherapy, type of bone resection, and methods of soft and hard tissue flap reconstruction. The greatest statistically significant reduction in QoL for all oral cavity sub-sites was found following the treatment of floor of mouth tumours (-18.9%, P=0.018). Laser excision for matched patient cohorts resulted in improved resultant QoL compared to other excision techniques (P=0.0002). No significant difference in QoL was found when radial forearm and anterolateral thigh flaps were matched, or when fibula and scapula flaps were matched. These findings support the use of laser excision and the avoidance of postoperative radiotherapy if curative intent and survival outcomes are maintained.

Health-related quality of life after maxillectomy: obturator rehabilitation compared with flap reconstruction

Health-related quality of life (QoL) reported by patients has the potential to improve care after ablative surgery of the midface, as existing treatment algorithms still generally revolve around outcomes assessed traditionally only by clinicians. Decisions in particular relate to reconstruction with a flap compared with rehabilitation with an obturator, the need for adjuvant treatment, and morbidity related to the size of the defect. We prospectively collected health-related QoL assessments for 39 consecutive patients treated by maxillectomy between 01 January 2010 and 31 December 2014 using the University of Washington Quality of Life Questionnaire, and who had a mean (SD) duration of follow-up of 14 (4). We made sub-group analyses using paired t tests and analysis of variance (ANOVA) to compare reconstruction with a flap with rehabilitation with obturators, size of the vertical defect, and whether adjuvant treatment with radiotherapy or chemoradiotherapy adversely affected it. Overall there was a significant decrease in health-related QoL after treatment compared with before (p<0.001), but there was no significant difference in the effects of any of the paired reconstructive and rehabilitation treatments on it. Obturators remain an important option for rehabilitation in selected patients in addition to reconstruction with a flap. We found that neither increasing the size of the vertical defect (in an attempt to ensure clear margins) nor the use of postoperative radiotherapy seemed to have any adverse effect on QoL. More patients are required before we can conclude that the potential survival benefits of such measures may outweigh any adverse effects.

CD30-Positive T-Cell Lymphoproliferative Disorder of the Oral Mucosa—An Indolent Lesion: Report of 4 Cases

Four cases of CD30-positive T-cell lymphoproliferative disorder (CD30+ LPD) of the oral mucosa are described. This article aims to draw attention to this entity and to emphasize its usual benign clinical behavior despite its resemblance to T-cell lymphoma. All the patients were adults. Three of the lesions were on the dorsal surface of the tongue and 1 affected the buccal mucosa. All biopsies showed a dense lymphoid infiltrate composed of CD30+ atypical T cells with a polymorphous infiltrate in the background, which included eosinophils. In 1 case, monoclonal T-cell expansion was detected by molecular techniques. Three cases tested for Epstein—Barr virus were all negative. It is concluded that primary CD30+ T-cell LPD of the oral mucosa can be regarded as the oral counterpart of cutaneous CD30+ LPD such as lymphomatoid papulosis or anaplastic large cell lymphoma. Recognition of the condition is important to avoid overtreatment.

Haematoma of anterior ethmoidal artery after reduction of fracture of zygomatic complex

Extraconal intraorbital haemorrhage is a rare complication after reduction of a fracture of the zygomatic complex. We present a case of postoperative intraorbital haematoma that arose from the anterior ethmoidal artery. We stress the advantages of imaging before decompression and of the medial approach.

Epithelioid hemangioendothelioma of the parotid salivary gland

Epithelioid hemangioendothelioma is a borderline neoplasm characterized by proliferation of endothelial cells with epithelioid morphology. The tumor, in terms of histology and behavior, occupies an intermediate position between hemangioma and conventional angiosarcoma. It is encountered in a wide variety of sites, such as soft tissues and skin, visceral organs, and bone. This article describes a slowly growing, painful tumor that developed in the parotid gland of a 48-year-old white woman and was treated with a superficial parotidectomy. Microscopically, the lesion consisted of short strands, cords, or small clusters of epithelioid vacuolated cells that exhibited strong immunoreactivity for endothelial cell markers (CD 31, CD 34, and factor VIII-related antigen). Previous reports have presented epithelioid hemangioendotheliomas in the head and neck region but, to our knowledge, this is the first reported case in the parotid salivary gland.

Precautions against cross-infection during operations for maxillofacial trauma

One hundred oral and maxillofacial units in the UK were sent a postal questionnaire. Surgical staff of all grades were asked which infection-control measures were taken during the treatment of maxillofacial fractures. Two hundred and ninety-four questionnaires were completed, a response rate of 49%. If the patient was known to be infected by a blood-borne viral disease, significantly more surgeons used standard barrier precautions such as eye protection, fluid-resistant gowns, drapes, ball-ended clips, adhesive tapes and intermediate trays (P<0.0001). Bone-plating techniques were used in preference to wire osteosynthesis (P<0.0001). Only 31 (10.5%) of surgeons routinely used double gloves but 250 (85%) did so if the patient was an infection risk (P<0.0001). Universal precautions were not applied equally to all patients.

[Surgical removal of a lower semimpacted wisdom tooth displaced in the pterygomandibular space]

In the case which is reported in this paper there was a dislodgement of a semimpacted lower left third molar (38) into the pterygomandibular space, from a removal attempt, without the usual fracture of the lingual plate of the alveolar bone. There is an anatomical description of the pterygomandibular space, the operative complications during removal of impacted lower teeth and more specific the displacement of teeth or roots into adjacent soft tissues, ways of prevention and treatment of such complications. Finally, we describe the technique which we followed to extract the dislocated lower molar in our case.

[Apicoectomy and reverse filling procedure in posterior teeth]

In this paper, we present the apicoectomy with reverse filling procedure in posterior teeth, as an alternative surgical method, in those cases where conservative endodontic treatment is unable or fails to bring successful results (prosthetic restorations, broken instruments, calcified and tortuous root canals, dens in dente, unfinished root apex). We choose to restrict our presentation in posterior teeth where the surgical procedure is more difficult due to anatomical conditions (maxillary sinus, mandibular canal, number of root canals, inaccessible posterior oral cavity, etc). We analyse the indications of such an operation and the elements we examine to evaluate the cases. We are showing the different stages of the operation as well as the usage of original instruments for the retrograde amalgam procedure. There is a further discussion on problems from the usage of the filling material, the dental amalgam, and, the problems throughout the procedure (level and degree of the apical bevel, cavity preparation, etc).