Biomedical subjects

V Pinsolle

Publications and source records attributed to V Pinsolle.

22 records · Page 2Linked to original sources

PubMed1997

Prognostic value of histologic findings in neck dissections for squamous cell carcinoma.

BACKGROUND: Cervical node involvement is the most significant prognostic factor in head and neck squamous cell carcinoma. When histologic findings show node invasion, the number of positive nodes and the presence of extracapsular spread are commonly accepted as prognostic factors. OBJECTIVE: To confirm the findings of recent reports that there is no significant difference in outcome associated with extracapsular spread. SETTING: Referral center. DESIGN: Retrospective study. PATIENTS: Three hundred thirty-seven patients under-going 487 neck dissections for carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx from January 1, 1985, to December 31, 1992. For N3 node involvement, a radical neck dissection was performed; other patients underwent supraomohyoid or functional neck dissection. Two hundred forty-two patients underwent postoperative radiotherapy (mean dose, 59 Gy). OUTCOME MEASURES: Survival capabilities calculated by the Kaplan-Meier method and significance calculated by the log rank test. RESULTS: Overall 5-year survival was 50.8%. The study of prognostic factors showed no significance for extracapsular spread (P = 45). Conversely, the number of positive nodes had a significant value (P < .001). CONCLUSIONS: Extracapsular node spread per se might be considered as no longer having a definitive prognostic value. These results, consistent with those of previous reports, may be due to wider use of combined treatment modalities.

Carcinoma, Squamous Cell↗

PubMed1997

[Spinal accessory nerve and lymphatic neck dissection].

Radical neck dissection was the golden standard of treatment for cervical nodes in head and neck tumors. From the seventies, the preservation of the spinal accessory nerve has become increasingly popular in order to improve the functional result of the neck dissections. The aim of this study was to assess the degree of functional disability associated with each type of neck dissection and the value of anatomical references for dissection of the spinal accessory nerve. One hundred twenty seven patients were evaluated 1 month and 1 year after radical, functional or supraomohyoid neck dissection with a questionnaire and a physical examination. Anatomical measurements of the spinal accessory nerve were performed in 20 patients. We found considerable or severe shoulder dysfunction in 7%, 34% and 51% respectively of patients in whom supraomohyoid, functional and radical neck dissections were performed. Furthermore 49% of patients having undergone a radical neck dissection had little or no symptoms. Sacrifice of the spinal accessory nerve in radical neck dissection may lead to shoulder dysfunction. A functional disability may also be associated, although in a less extent, with any neck dissection in which the spinal accessory nerve is dissected and placed in traction. There is a large variation in the degree of functional disability and pain in patients with similar neck dissections. The course of the spinal accessory nerve in the neck makes it particularly vulnerable to injury during the dissection near the sternocleidomastoid muscle and in the posterior cervical triangle.

Accessory Nerve↗

PubMed1997

[Posterior marginal mandibulectomy for cancer of the oral cavity and oropharynx. Experience with 14 clinical cases].

Marginal mandibulectomies are now widely performed in the anterior aspect of the mandible providing that the preoperative clinical and radiologic evaluation shows no bone invasion. These marginal resections can be extended to the posterior area. Molar, retromolar and ascending ramus resections can be performed. This removes the upper bone segment preserving the dental canal whenever possible. From 1990, 14 patients were treated with this technique for carcinoma of the retromolar triangle (9 cases) and oropharynx (5 cases). 11 different flaps were used to cover the soft tissue defect and 3 direct sutures were performed. Eleven patients underwent postoperative radiotherapy with a mean dose of 58 Gray. Median follow-up was 32 months. Functional and cosmetic results were very satisfactory due to preservation of mandibular continuity. We found no osteomyelitis, postoperative fracture or radionecrosis. This technique avoids a segmental resection in some well-defined cases and the disability produced as a result of this treatment. There is therefore, no need for complex reconstruction and the operating time is shortened in fragile patients.

Adult↗

PubMed1995

[Mandibular reconstruction in oncology: discussion of indications].

The aim of the study was to assess the results of segmental mandibular resections and the validity of mandibular reconstructions. The medical records of 95 patients treated between January 1, 1987 and December 31, 1992 were reviewed. There were 82 (86%) carcinomas, 9 ameloblastomas and 4 sarcomas. Among the 82 patients treated for carcinoma, the overall 2- and 5-year survival rates were 70% and 33% respectively. The functional results evaluated one year after surgery showed no significant difference according to the reconstruction procedure: myocutaneous flap, osteomyocutaneous flap, titanium mandibular reconstruction plate or microsurgical transfer. The most important factor in functional rehabilitation is the amount of soft tissue resected. In head and neck oncology, aggressive surgical reconstruction of the mandible must only be used in patients with good general status and fair survival probability.

Adolescent↗