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At least 433 records · Page 24Linked to original sources
PubMed1986

Management of advanced stage squamous cell carcinoma of the head and neck.

Squamous cell tumors of the head and neck make up 5% of tumors diagnosed in this country. The combination of excessive tobacco and alcohol use is the most common causative factor for these tumors. Their natural history is characterized by a tendency for early local-regional recurrence and the late appearance of distant metastases. A significant proportion of patients present with advanced (stage III or IV) disease, which has a poor prognosis when treated with surgery and radiotherapy. The use of adjuvant chemotherapy with surgery and radiotherapy in previously untreated patients holds promise for improving cure rates in patients with this disease. The use of chemotherapy in patients with recurrent head and neck tumors results in response in approximately one third of patients. The majority of these responses are partial and short-lived, but those patients achieving a complete remission appear to have a significant prolongation of survival. The combination of chemotherapy and radiotherapy in patients with advanced disease is being tested in a number of trials. It is hoped that this combination will increase the response rate and result in prolonged survival.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

Revascularization of free mandibular reconstruction after early emergency arterial ligation.

A 70-year-old man with a squamous cell carcinoma involving the anterior arch and body of the mandible underwent resection and reconstruction with a 10-cm free vascularized iliac crest bone graft, preserving periosteum and minimal adjacent soft tissue. On postoperative day 12, he experienced bleeding from an orocutaneous fistula, requiring emergency ligation of the arterial pedicle to control hemorrhage. After ligation, continued bleeding was noted from the margin of the graft, with active filling of the venous pedicle. The 10-cm mandibular bone graft survived without appreciable resorption during a period of follow-up of 5 years. We believe that bone graft survival in the present case was due to early vascular communication between the periosteum and adjacent soft tissues of the graft with the recipient bed. This mechanism may serve to maintain bone graft viability after early arterial disruption, when repeat arterial anastomosis is believed to be contraindicated.

Aged↗
PubMed2006

Single-stage total and near-total resection of massive pediatric head and neck neurofibromas.

Plexiform neurofibromas traditionally have posed a surgical challenge in pediatric patients. Expert preoperative planning, advanced surgical techniques, and vigilant postoperative care results in minimal morbidity and resolution of tumor symptomatology. A retrospective review of four consecutive pediatric patients with massive head and neck neurofibromas who underwent single-stage total or near-total removal of their tumors was performed. All four patients had obstructive airway symptoms. There were two minor complications. All patients had complete relief of their symptoms and return of function without any additional neurologic deficits. It is possible to safely achieve total or near-total removal of extensive plexiform neurofibromas with minimal morbidity while restoring lost function.

Adolescent↗
PubMed2004

Pedicled temporoparietal fascial flap reconstruction of select intraoral defects.

OBJECTIVES/HYPOTHESIS: Multiple modalities exist for reconstruction of oral cavity defects following resection. Although microvascular free tissue transfer is often the first choice for complex intraoral defect reconstruction, not all patients are suitable candidates for "free flaps." The authors present their experience with the pedicled temporoparietal fascial flap (TPFF) for reconstruction of selected intraoral defects. STUDY DESIGN: Retrospective chart review. METHODS: Charts of patients who underwent a TPFF for reconstruction of intraoral defects at a tertiary academic institution between 2001 to 2003 were reviewed. Information regarding tumor, surgical procedure, complications, and results was gathered. The anatomy and surgical technique of using the TPFF for intraoral reconstruction were reviewed. RESULTS: Three patients underwent reconstruction of an intraoral defect with a TPFF. All defects were on the lateral buccal space with significant anterior or posterior extension. All patients had specific contraindications for free flaps, including compromised donor site or recipient site vascularity and medical comorbidity. The procedures were uncomplicated. There was no incidence of flap failure, and all flaps accepted a split-thickness skin graft. The average hospital stay was 7 days. An oral diet was begun on the fifth postoperative day. The cosmetic result at the donor site was excellent. Follow-up has ranged from 7 to 30 months. Mild contracture of the flap developed in two patients, limiting mandibular motion. CONCLUSION: The TPFF is a thin, vascular, durable flap that is a viable option for reconstruction of selected intraoral defects in patients who are not suitable candidates for other methods.

Aged↗
PubMed1999

Uptake of liposome-encapsulated 99Tcm-MIBI by sensitive and multidrug-resistant tumour cell lines.

It is well established that accumulation of 99Tcm-sestamibi (99Tcm-MIBI) is much higher in sensitive than multidrug-resistant tumour cells expressing the permeability glycoprotein 170 (Pgp 170) as well as a multidrug-resistance related protein (MRP). Thus 99Tcm-MIBI is a good candidate for diagnosing the multidrug-resistance phenotype by in vivo imaging. However, the blood clearance of 99Tcm-MIBI is too rapid to achieve optimal accumulation in tumours and uptake in the liver, spleen, heart and muscle is too high for it to be an excellent in vivo tumour tracer. One way of prolonging the bioavailability of 99Tcm-MIBI is to use liposomes which do not affect its accumulation in tumour cells. We explored this possibility in vitro using two sensitive and five resistant cell lines, two of them expressing Pgp 170 and three others over-expressing MRP. 99Tcm-MIBI was incorporated into liposomes prepared by thin film hydration with phosphate-buffered saline using distearoyl phosphatidyl choline, distearoyl phosphatidyl ethanolamine and cholesterol in a ratio of 1.85:0.15:1.00. Liposome diameter was 97.9 +/- 4.5 nm as determined by dynamic light scattering. 99Tcm-MIBI uptake was quantified by measuring radioactivity retained in the cells incubated at 37 degrees C with liposome-encapsulated 99Tcm-MIBI or with free radiotracer in the presence of empty liposomes. In both experimental cases, 99Tcm-MIBI accumulation was similar to that obtained in the presence of free 99Tcm-MIBI only: it was much higher in sensitive than in resistant Pgp 170-positive and MRP-positive cells. Encapsulation in liposomes does not alter the potency of 99Tcm-MIBI to distinguish the sensitive and resistant tumour cells. Our results suggest that future studies should assess the usefulness of the encapsulated form of 99Tcm-MIBI for in vivo imaging of tumours.

Adenocarcinoma↗
PubMed1985

Benefits of the CO2 laser in oral hemangioma excision.

Twenty-one patients with small localized oral cavity hemangiomas of the lips, tongue, and buccal mucosa are reported in this series. Although the lesions were not massive or high-flow/high-pressure vascular tumors, the simultaneous cutting and coagulation capabilities of the CO2 laser were demonstrated, rendering such excisional surgery more precisely and easily accomplished with a great deal less bleeding and a marked reduction in postoperative pain and edema. Many of the patients in this series were done as outpatients under local anesthesia. Results were acceptable and complications were minimal. Thus this laser is recommended both for the patient care and comfort aspects and the ability to render oral cavity hemangioma excisional surgery much more safely and easily done with a significant decrease in hospital utilization and overall medical expenses.

Carbon Dioxide↗
PubMed1997

A new design of the iliac crest microsurgical free flap without including the "obligatory" muscle cuff.

The iliac crest free flap has undergone a gradual evolution to provide more functional and cosmetic oromandibular reconstructions. The soft-tissue cutaneous component has largely resisted refinement and currently constitutes the flap's principal drawback. Conventionally, the cutaneous vessel's soft-tissue encasement and a protective cuff of abdominal muscle are harvested to ensure skin perfusion. These protective measures, however, produce a bulky flap that is tethered to the bone and difficult to inset into complex three-dimensional defects. A series of anatomic and clinical investigations has confirmed that in 30 percent of individuals, the skin island can be elevated on a dominant cutaneous branch from the deep circumflex iliac artery. Harvesting the skin as an axial pattern flap greatly increases its independence from the bone, improving maneuverability. A small collar of abdominal muscle is incised around the pedicle, obviating the need for the customary 2.5-cm protective muscle cuff. Exclusion of the abdominal muscular component reduces the flap's volume, decreases the need for secondary debulking, and reduces the donor site morbidity.

Adult↗
PubMed2000

Osteosynthesis and bony healing between two consecutive free fibular bone grafts.

This case report describes a recurrent squamous cell carcinoma in the oral cavity requiring two consecutive free fibula transfers at different times. In a unique application of the fibula, rigid miniplate fixation was used between the two independent free flaps to reconstitute the contour of the mandible for an extensive composite oromandibular defect, extending from the left angle to the right ascending ramus. This application underscores the utility of the free osteocutaneous fibular flap for reconstruction of complex mandibular defects.

Adult↗
PubMed1997

Incidence of tobacco and alcohol-related cancers in western Europe.

The relative importance of the tobacco and alcohol-related cancer burden varies across countries. Within western Europe, the incidence of lung cancer has a clearly different geographical pattern to the incidence of alcohol-related cancer. Each country's public health policies should take into account its own tobacco and alcohol-related morbidities.

Alcohol Drinking↗
PubMed1976

Radiological bone changes produced by intraoral squamous carcinomata involving the lower alveolus.

Forty-eight per cent of patients with clinical involvement of the lower alveolus by an intraoral squamous carcinoma showed radiological evidence of bone involvement. This was usually an irregular invasive bone defect, but a smooth pressure erosion is also common. 'Floating teeth', displaced bony fragments, pathological fractures, and rarely an expanded inferior canal are less common radiological signs.

Alveolar Process↗
PubMed1996

Mandibular invasion diagnosed by SPECT.

To date no investigation has proven accurate and reliable for assessing mandibular invasion by carcinoma prior to surgery. This prospective study compared a new imaging modality, single photon emission computed tomography (SPECT), with clinical examination and high resolution CT scanning to evaluate the sensitivity and specificity of each method in detecting mandibular invasion by squamous cell carcinoma. Twenty-nine patients (21 men, 8 women) with an oral cavity/oropharyngeal carcinoma were studied. All underwent primary surgery and/or radiotherapy where indicated. Resected mandibles were decalcified and examined for tumour infiltration. Imaging studies were read independently by two experienced observers. Clinical examination predicted bone invasion with a sensitivity of 90% and a specificity of only 25%. CT had a sensitivity of 89% and a specificity of 57% while SPECT imaging had a sensitivity of 100% and a specificity of 29%. Using Fisher's exact test and the Kappa statistic for pairwise comparisons between each method, SPECT imaging was complementary to CT in the pre-operative assessment of mandibular invasion.

Aged↗
PubMed1997

The temporalis muscle flap in intraoral reconstruction.

BACKGROUND: Reconstruction following excision of intraoral tumours presents a challenge to the head and neck surgeon. The purpose of hte present study was to review the authors' initial experience with the temporalis muscle flap. METHODS: A retrospective review fo the use of 21 temporalis muscle flaps in intraoral reconstruction at Christchurch Hospital was performed. The muscle was used to reconstruct defects of the oral tongue, tongue base, buccal mucosa, maxilla, soft palate, retromolar trigone and tonsillar region. Epithelial cover was provided by either split-skin grafting or ingrowth from adjacent mucosa. RESULTS: One flap necrosed and one patient developed a wound haematoma requiring drainage. One patient developed a transient frontal weakness. The long-term functional results were excellent, except for one patient with slight tongue tethering. In one patient bilateral flaps were used to reconstruct a bilateral maxillectomy defect. CONCLUSION: The temporalis muscle flap is a useful option for reconstruction of moderate defects in the posterior oral cavity and oropharynx.

Female↗