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PURPOSE: As the population gets older, the prevalence of complete or partial tooth loss is increasing, significantly impacting people's quality of life. Scientific research demonstrates that implant-fixed complete dentures offer high levels of satisfaction. In certain cases, tooth loss can lead to significant bone atrophy, necessitating pre-implant bone reconstruction. We conducted a retrospective cohort study involving 43 arches, including or not bone grafts, rehabilitated using a stackable guided approach, which included an immediate loading protocol. The primary outcome measure was the survival rate of the implant at 4 months. MATERIAL AND METHODS: The digital workflow helps the design of the provisional prothesis before the implant surgery, which will be loaded immediately after the implant's placement. The stacked guides integrate both surgical and prosthetic considerations into a digital workflow. RESULT: A total of 284 implants were placed. After a 4-month follow-up period, 10 implants (3.5%) exhibited no osseointegration and were subsequently replaced, resulting in an overall success rate of 96.5%. After 1 year of follow-up, a prosthetic success rate of 100% was observed, with all patients being able to progress to the stages for the permanent fixed dentures. CONCLUSION: Our findings support the use of this protocol for all patients, whether they require bone grafts or not. However, a long-term follow-up is essential for a comprehensive evaluation of these treatment outcomes.
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This article describes a reliable surgical alternative for the repair of wide oromandibular defects that require bone and soft tissues, which was applied in two patient cases. While microvascular free flap transfer, especially the fibula flap, is the gold standard for mandibular reconstruction, this reconstruction is challenging in patients with a vessel-depleted neck and/or severe arteriosclerosis. The pedicled osteomuscular dorsal scapular (OMDS) flap is a surgical alternative to free flap transfer in this clinical setting. The technique described involves harvesting of the OMDS flap to include a skin paddle, which is often required to close wide oral mucosal defects.
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Colgajos Tisulares Libres , Procedimientos de Cirugía Plástica , Humanos , Escápula/cirugía , Trasplante Óseo/métodos , Cuello/cirugíaRESUMEN
The early detection and management of oral premalignant lesions (OPMDs) improve their outcomes. Animal models that mimic histological and biological processes of human oral carcinogenesis may help to improve the identification of OPMD at-risk of progression into oral squamous cell carcinoma and to develop preventive strategies for the entire field of cancerization. No animal model is perfectly applicable for investigating human oral carcinogenesis. However, the 4-nitroquinoline 1-oxide (4-NQO) mouse model is well established and mimics several morphological, histological, genomic and molecular features of human oral carcinogenesis. Some of the reasons for the success of this model include its reproducible experimental conditions with limited variation, the possibility of realizing longitudinal studies with invasive intervention or gene manipulation, and sample availability for all stages of oral carcinogenesis, especially premalignant lesions. Moreover, the role of histological and molecular alterations in the field of cancerization (i.e., macroscopically healthy mucosa exposed to a carcinogen) during oral carcinogenesis can be easily explored using this model. In this review, we discuss the advantages and drawbacks of this model for studying human oral carcinogenesis. In summary, the 4-NQO-induced murine oral cancer model is relevant for investigating human oral carcinogenesis, including the immune microenvironment, and for evaluating therapeutic and chemoprevention agents.
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Carcinoma de Células Escamosas , Neoplasias de la Boca , 4-Nitroquinolina-1-Óxido/toxicidad , Animales , Carcinogénesis , Carcinógenos/toxicidad , Carcinoma de Células Escamosas/inducido químicamente , Carcinoma de Células Escamosas/genética , Ratones , Neoplasias de la Boca/inducido químicamente , Microambiente TumoralRESUMEN
The ongoing shortage in healthcare services and the increasing cancer incidence, highlight the need for new strategies to ensure optimal treatments, cares and follow-up for all patients. Digitalized healthcare, which includes various concepts (digital health, telemedicine, telemonitoring and digital therapeutics), are a promising option to meet these needs. In this scoping review, we provide an overview of the recent available research evidence on digitalized healthcare for HNC patients and caregivers. Through the interrogation of PubMed and Cochrane Library databases, a total of 32 relevant articles reporting the use of digitalized healthcare in different settings of HNC patients' care management, were analyzed. Overall, HNC patients as well as caregivers were highly satisfied, especially because digitalized healthcare allows the early detection of health disorders, improve patient's management, quality of life, self-confidence and communication. Furthermore, digitalized healthcare were significantly time- and cost-effective. While the benefits digitalized healthcare has been reported to be feasible and clinically relevant, our future efforts should focus on the demonstration of their clinical utility in well-designed clinical trials. It is tempting to anticipate that this approach will improve patients' management and quality of life and change the way patients interact with family and professional health care givers.
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Neoplasias de Cabeza y Cuello , Calidad de Vida , Comunicación , Atención a la Salud , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias de Cabeza y Cuello/terapia , HumanosRESUMEN
BACKGROUND AND PURPOSE: PET/MRI with 18F-FDG has demonstrated the advantages of simultaneous PET and MR imaging in head and neck cancer imaging, MRI allowing excellent soft-tissue contrast, while PET provides metabolic information. The aim of this study was to evaluate the added value of gadolinium contrast-enhanced sequences in the tumor delineation of head and neck cancers on 18F-FDG-PET/MR imaging. MATERIALS AND METHODS: Consecutive patients who underwent simultaneous head and neck 18F-FDG-PET/MR imaging staging or restaging followed by surgery were retrospectively included. Local tumor invasion and lymph node extension were assessed in 45 head and neck anatomic regions using 18F-FDG-PET/MR imaging by 2 rater groups (each one including a radiologist and a nuclear medicine physician). Two reading sessions were performed, one without contrast-enhanced sequences (using only T1WI, T2WI, and PET images) and a second with additional T1WI postcontrast sequences. The results were compared with the detailed histopathologic analysis, used as reference standard. The κ concordance coefficient between the reading sessions and sensitivity and specificity for each region were calculated. RESULTS: Thirty patients were included. There was excellent agreement between the contrast-free and postgadolinium reading sessions in delineating precise tumor extension in the 45 anatomic regions studied (Cohen κ = 0.96, 95% CI = [0.94-0.97], P < .001). The diagnostic accuracy did not differ between contrast-free and postgadolinium reading sessions, being 0.97 for both groups and both reading sessions. For the 2 rater groups, there was good sensitivity for both contrast-free (0.83 and 0.85) and postgadolinium reading sessions (0.88 and 0.90, respectively). Moreover, there was excellent specificity (0.98) for both groups and reading sessions. CONCLUSIONS: Gadolinium chelate contrast administration showed no added value for accurate characterization of head and neck primary tumor extension and could possibly be avoided in the PET/MR imaging head and neck workflow.
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Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Tomografía de Emisión de Positrones/métodos , Adulto , Anciano , Medios de Contraste , Femenino , Fluorodesoxiglucosa F18 , Gadolinio , Humanos , Masculino , Persona de Mediana Edad , Radiofármacos , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
The main objectives of the reform of the 3rd cycle of medical studies in France that was instituted in 2017 after eight years of preparation, are to train future specialists in a consistent and equitable fashion and to replace the previous time-based qualification by training based on the progressive acquisition of skills. This reform was an opportunity for the 13 different French surgical specialty Colleges involved to share reflections on what a surgeon actually was and to define training in surgical sub-specialties. The current reform is well adapted to these specifications and has fostered training models that are consistent with each other. This article discusses the historical construction of this reform, what will change in the training of future surgeons, as well as some points that warrant caution. The third cycle reform has also triggered a reform of the second cycle, which is expected to come into force for the 2020 academic year. Its objective will be to eliminate the guillotine effect created by the National Classifying Examinations and to allow students to better understand and test their desire and skills for a given specialty. It will be up to these same surgical Colleges to determine how to do this for the sub-specialties of the "surgery" discipline.
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Competencia Clínica , Curriculum , Educación Médica/organización & administración , Cirugía General/educación , Especialidades Quirúrgicas/educación , Francia , HumanosRESUMEN
INTRODUCTION: In surgical approaches to condylar fractures, there is a risk of damage to the transverse facial artery (TFA) which may in turn account for impaired blood supply to the temporomandibular joint (TMJ). In order to investigate the risk of damage to the TFA, and prevent lesions to this artery resulting from TMJ surgical procedures, we studied the distance between the TFA and the head of the condylar process. METHODOLOGY: A dissection study was conducted on 10 fresh cadavers (20 condylar specimens dissected), involving fifty CT scans of the face with intravenous contrast. Vertical distance from the TFA to the top of the mandibular condyle head and distance from the TFA to the lateral aspect of the mandibular condyle were measured. RESULTS: The lateral aspect of the mandibular condyle is vascularized by branches emanating from the superficial temporal artery (STA) and the TFA. The TFA was located 1.84 ± 0.6 cm below the condylar process of the mandible and ran 1.09 ± 0.54 mm lateral to the head of the mandibular condyle. DISCUSSION: In order to spare the TFA in fractures involving the condylar neck, surgical approaches to the condyle should preserve the uppermost 2 cm of the lateral surface of the condyle during dissection. Due to the necessity for periosteal elevation of the lateral surface of the condyle in condylar head fractures, it is possible to spare the TFA, running lateral to the condylar neck, and the medial condylar surface in order to leave the branches that derive from the maxillary artery (MA) intact.
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Fracturas Óseas , Cóndilo Mandibular , Humanos , Mandíbula , Arteria Maxilar , Articulación TemporomandibularRESUMEN
INTRODUCTION: Malpractice lawsuits in medicine and facial surgery are on the rise and they become an influencing factor in everyday practice for any surgeon. AIM: We aim to analyze the possible causes for litigation in an effort to avoid these claims in the future. MATERIALS: One hundred and thirty litigation cases filed over a 10 year period (2005-2015) were evaluated. METHODS: Depending on the expert's opinion, it was determined whether the lawsuit was due to actual faulty treatment or either a lack of informed consent or discrepancy between the expected and the final result. RESULTS: A total of 136 claims were filed and examined. Dissatisfaction about the esthetic or functional result topped the list with 47% (n = 64) of the cases followed by nerve damage with 20% (n = 27). Medical negligence and failed treatment accounted both for 9% of all cases (n = 12). The list was completed by post-operative complications (n = 11), death (n = 6) and incorrect or late diagnosis (n = 4). In the expert's opinion only in 21 (15%) cases there was actual fault and in the remaining cases litigation was due to lack of informed consent (n = 70; 51%) or a discrepancy between the expected and achieved result (n = 45; 33%). CONCLUSION: A considerable portion of the lawsuits in facial surgery seem to originate out of a lack of communication between physician and patient and not faulty treatment. Efforts in informing the patient about possible side effects, complications and expectations will benefit the physician greatly by minimizing his liability and risk at prosecution.
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Estética Dental , Mala Praxis , Testimonio de Experto , Cara/cirugía , Humanos , Consentimiento Informado , Gestión de RiesgosRESUMEN
Oral squamous cell carcinoma (OSCC) is a major cause of cancer-associated morbidity and mortality. Although OSCC may develop from easily accessible oral preneoplastic lesions (OPLs), no intervention has been reported so far that reduces the rate of malignant transformation. A comprehensive molecular characterization of oral carcinogenesis may help refining treatment strategies both in patients with OPLs and OSCC. Herein, we review main molecular alterations occurring at different steps during oral carcinogenesis and show how molecularly-based medicine and surgery may impact the outcome of OSCC in the future.
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Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/terapia , Perfilación de la Expresión Génica , Neoplasias de la Boca/genética , Neoplasias de la Boca/terapia , Medicina de Precisión/tendencias , Biomarcadores de Tumor/análisis , Biomarcadores de Tumor/genética , Carcinoma de Células Escamosas/diagnóstico , Transformación Celular Neoplásica/genética , Transformación Celular Neoplásica/patología , Perfilación de la Expresión Génica/métodos , Humanos , Márgenes de Escisión , Terapia Molecular Dirigida , Neoplasias de la Boca/diagnóstico , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/genética , Recurrencia Local de Neoplasia/terapia , Estadificación de Neoplasias , Procedimientos Quirúrgicos Orales/métodos , Lesiones Precancerosas/patología , Medicina de Precisión/métodos , Transcriptoma/fisiologíaRESUMEN
BACKGROUND: Never-smokers and never-drinkers patients (NSND) suffering from oral squamous cell carcinoma (OSCC) are epidemiologically different from smokers drinkers (SD). We therefore hypothesized that they harbored distinct targetable molecular alterations. PATIENTS AND METHODS: Data from The Cancer Genome Atlas (TCGA) (discovery set), Gene Expression Omnibus and Centre Léon Bérard (CLB) (three validation sets) with available gene expression profiles of HPV-negative OSCC from NSND and SD were mined. Protein expression profiles and genomic alterations were also analyzed from TCGA, and a functional pathway enrichment analysis was carried out. Formalin-fixed paraffin-embedded samples from 44 OSCC including 20 NSND and 24 SD treated at CLB were retrospectively collected to perform targeted-sequencing of 2559 transcripts (HTG EdgeSeq system), and CD3, CD4, CD8, IDO1, and PD-L1 expression analyses by immunohistochemistry (IHC). Enrichment of a six-gene interferon-γ signature of clinical response to pembrozulimab (PD-1 inhibitor) was evaluated in each sample from all cohorts, using the single sample gene set enrichment analysis method. RESULTS: A total of 854 genes and 29 proteins were found to be differentially expressed between NSND and SD in TCGA. Functional pathway analysis highlighted an overall enrichment for immune-related pathways in OSCC from NSND, especially involving T-cell activation. Interferon-γ response and PD1 signaling were strongly enriched in NSND. IDO1 and PD-L1 were overexpressed and the score of response to pembrolizumab was higher in NSND than in SD, although the mutational load was lower in NSND. IHC analyses in the CLB cohort evidenced IDO1 and PD-L1 overexpression in tumor cells that was associated with a higher rate of tumor-infiltrating T-cells in NSND compared with SD. CONCLUSION: The main biological and actionable difference between OSCC from NSND and SD lies in the immune microenvironment, suggesting a higher clinical benefit of PD-L1 and IDO1 inhibition in OSCC from NSND.
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Antígeno B7-H1/antagonistas & inhibidores , Carcinoma de Células Escamosas/inmunología , Indolamina-Pirrol 2,3,-Dioxigenasa/antagonistas & inhibidores , Neoplasias de la Boca/inmunología , Microambiente Tumoral , Anciano , Consumo de Bebidas Alcohólicas , Alphapapillomavirus/aislamiento & purificación , Antígeno B7-H1/genética , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/virología , Estudios de Cohortes , Femenino , Perfilación de la Expresión Génica , Humanos , Indolamina-Pirrol 2,3,-Dioxigenasa/genética , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/genética , Neoplasias de la Boca/virología , FumarRESUMEN
OBJECTIVES: To determine prognostic factors in gingivo-alveolar squamous cell carcinoma of the maxilla (GA-SCC-M), and particularly the prognostic value of both vertical and antero-posterior tumor spread. MATERIAL AND METHODS: Our retrospective study included all naïve-treatment patients treated in our center between 2006 and 2013 for GA-SCC-M. Posterior involvement was considered when the tumor extended behind the mesial side of the first maxillary molar. Spread posterior to the maxillary tuberosity was defined by the spread to at least one of the following structures: pterygomaxillary fissure, pterygoid muscles, and processes. Involvement of the maxillary sinus floor, nasal fossa, and orbital floor was assessed, concerning the vertical spread. RESULTS: A radiological tumor spread to the nasal fossa, maxillary sinus floor, and orbital floor were prognostic factors independently of age, cervical lymph node metastasis and positive margins in multivariate analysis (p < 0.05). Radiological suggested spread tended to be noticeably more predictive of a poor prognosis than histological proven tumoral spread. The prognosis was not significantly different between clinical tumoral spread anteriorly or posteriorly to the first molar (p = 0.46). The prognosis was not worsened, even in case of radiological suggested spread posterior to the maxillary tuberosity (p = 0.09). CONCLUSION: A vertical radiological spread of GA-SCC-M was a prognostic factor but not the extension posteriorly to the maxillary tuberosity. T4b tumors were mostly resectable, proving that a T4b stage was not predictive of unresectability in GA-SCC-M of the maxilla.
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Adenocarcinoma Bronquioloalveolar/patología , Carcinoma de Células Escamosas/secundario , Neoplasias Gingivales/patología , Neoplasias Maxilares/patología , Adenocarcinoma Bronquioloalveolar/diagnóstico por imagen , Adenocarcinoma Bronquioloalveolar/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/cirugía , Femenino , Estudios de Seguimiento , Neoplasias Gingivales/diagnóstico por imagen , Neoplasias Gingivales/cirugía , Humanos , Metástasis Linfática , Masculino , Neoplasias Maxilares/diagnóstico por imagen , Neoplasias Maxilares/cirugía , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
The patency of the naso-frontal duct is a key issue in the surgical management of chronic frontal sinusitis. Most of the current operative techniques only provide access to the paramedian portions of the frontal sinus. A canalization approach that allows a functional frontal sinus to be maintained while providing good access to the most lateral areas of the sinus is described herein. Two cases of severe post-traumatic frontal sinusitis, operated on successfully by canalization method based on the conservation of the frontal sinus and the maintenance of the patency of the naso-frontal duct, using both open and endonasal approaches, are reported. One patient was followed-up for 8 years and the other for 7 months. Canalization requires validation in a larger series. This approach provides an alternative to both cranialization and strictly endoscopic methods in lateralized frontal sinus retentions and allows mucocele to be avoided.
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Seno Frontal/cirugía , Sinusitis Frontal/cirugía , Adulto , Endoscopía , Estudios de Seguimiento , Seno Frontal/lesiones , Sinusitis Frontal/etiología , Humanos , Masculino , Persona de Mediana Edad , Mucocele/prevención & control , Tratamientos Conservadores del Órgano/métodos , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Fracturas Craneales/complicaciones , Factores de TiempoRESUMEN
INTRODUCTION: Hepatitis C virus (HCV) infections are associated with extrahepatic manifestations in 40-75 % of cases. Sialitis and secondary Sjögren syndrome are well characterized complications of chronic HCV infections but the mechanisms (primary or secondary) leading to xerostomia are not understood. Similarly, brain lesions due to HCV can be primary or secondary but the pathology of primary HCV-related brain lesions is not well described. CASE REPORT: We report the postmortem case of a 60-year old patient initially presenting with sicca syndrome and dementia. HCV was identified in the brain but not in the salivary glands using transcription-mediated amplification (TMA). Focal sialitis was found in submandibular glands. Neuropathological examination revealed the presence of multiple dot-sized demyelination foci. CONCLUSION: Sicca syndrome is a common concern in chronic HCV infections and may be due to secondary immune mechanisms (we could not isolate HCV in salivary gland tissues). TMA had never been applied to the detection of viruses in salivary glands and neural tissues and proves to be a promising technique. Neuropathological reports in HCV infections are rare and the lesions we report may be the first characterization of the direct effect of HCV on brain cells. More cases are needed to define the full spectrum of lesions potentially caused by the direct action of the HCV on salivary glands and neural tissues.
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INTRODUCTION: Submandibular swelling most frequently involves the submandibular gland. It is often due to lithiasis or to tumor. Some rare cases of submandibular swelling have been reported such as submandibular localizations of thyroid lesions. Our case study concerns one of these rare occurrences. OBSERVATION: A 47-year-old female patient consulted for a right-sided submandibular mass progressively increasing in size during the previous 2 years. The patient had undergone a total thyroidectomy, 4 years before consulting, for a toxic multinodular goiter THAT had been treated by L-thyroxin replacement therapy per os since the surgery. TSH and LT4 levels were normal. A CT scan revealed a large tumor in the right submandibular space with heterogeneous contrast. Fine needle cytopuncture allowed observing follicular cellules suggesting thyroid origin. The cervicotomy confirmed the diagnosis of an ectopic goiter. DISCUSSION: Thyroid disorders may in rare cases concern the submandibular space. A history of thyroid disorders should be taken into account for the etiological diagnosis of unusual submandibular masses in maxillo-facial surgery.
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Edema/etiología , Complicaciones Posoperatorias/diagnóstico , Enfermedades de las Glándulas Salivales/etiología , Glándula Submandibular/patología , Tiroidectomía/efectos adversos , Edema/patología , Femenino , Bocio Nodular/cirugía , Humanos , Persona de Mediana Edad , Enfermedades de las Glándulas Salivales/diagnóstico , Factores de TiempoRESUMEN
The reconstruction of jaws with a free fibula flap can be anticipated virtually. The simulation can be transferred to the operating theater using customized devices obtained from computer-assisted design and manufacturing in a complete digital workflow. Several alternatives are available, from cutting guides to customized titanium osteosynthesis plates, to obtain the best accuracy and reproducibility of reconstruction. Moreover, these new processes allow integrating prosthetic planning concomitantly with reconstruction. We present the virtual three-dimensional planning method for jaw reconstruction with a free fibula flap and the various alternatives of surgery guided by customized devices provided by this planning.
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Diseño Asistido por Computadora , Peroné/trasplante , Colgajos Tisulares Libres/trasplante , Reconstrucción Mandibular , Medicina de Precisión , Cirugía Asistida por Computador , Simulación por Computador , Marcadores Fiduciales , Humanos , Imagenología Tridimensional/instrumentación , Imagenología Tridimensional/métodos , Reconstrucción Mandibular/instrumentación , Reconstrucción Mandibular/métodos , Implantación de Prótesis Maxilofacial/instrumentación , Implantación de Prótesis Maxilofacial/métodos , Osteotomía/instrumentación , Osteotomía/métodos , Medicina de Precisión/instrumentación , Medicina de Precisión/métodos , Cuidados Preoperatorios , Cirugía Asistida por Computador/métodosRESUMEN
CONTEXT: Late stage diagnosis of Head and Neck Squamous Cell Carcinoma (HNSCC) makes the prognosis worse. However, the influence of inequalities of health care and socio-economic factors has never been investigated in this pathology. OBJECTIVES: To identify any inequalities in health care and socio-economic factors influencing late-stage diagnosis of HSNCC. DESIGN: The ASED study (Acces aux Soins avant Endoscopie Diagnostique) was a cross-sectional observational, multi-centric (19 centers) study on metropolitan French territory. Data was collected from 1st December 2010 to 30th June 2012. SETTING: Patients were included prospectively in Head and Neck Surgery departments. A self-administered form was completed by the patients at the time of ambulatory diagnostic endoscopy (38 items describing demographic, socio-economic and health care access characteristics). A second form was completed by the surgeon at the time of histological confirmation of HNSCC (11 items describing the tumor). PATIENTS: Six hundred and ninety patients aged 18 or more with a first HNSCC were included. Exclusion criteria were second HSNCC or loco-regional recurrence of HNSCC. MAIN OUTCOME MEASURE(S): Late-stage was defined as T3/T4 tumor, and early-stage was defined as T1/T2 tumor, according to the TNM classification. RESULTS: Independent factors associated with late-stage diagnosis were: hypopharyngeal location (OR=3.5 [1.8-7.3] versus oral cavity location), age (OR=1.02 [1.00-1.04]), male sex (OR=1.7 [1.1-2.6]) and being born in France (OR=2 [1.2-3.3]). Factors associated with early-stage diagnosis were previous consultation to a specialist physician (OR=0.5 [0.4-0.8]), ease of access to this specialist (OR=0.6 [0.4-0.9]), and having a health professional in close contact (OR=0.6 [0.4-0.8]). Time to consultation was identical in both groups. No significant association was found between socio-economic factors (especially deprivation or alcohol and tobacco consumption) and late-stage diagnosis of HNSCC. CONCLUSION: Health care access in France plays a major role in the stage of HNSCC at diagnosis. Easy access to a specialist protects from late-stage diagnosis. Absence of socio-economic factors may be due to the French social security system and its comprehensive coverage of the population.
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Carcinoma de Células Escamosas/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Disparidades en Atención de Salud/estadística & datos numéricos , Anciano , Carcinoma de Células Escamosas/epidemiología , Estudios Transversales , Femenino , Francia/epidemiología , Neoplasias de Cabeza y Cuello/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Factores SocioeconómicosRESUMEN
INTRODUCTION: Many authors have reported the possible malignant transformation of oral lichen. The incidence of this event remains controversial. Many authors make a distinction between the "true" oral lichen planus (OLP) and lichenoid lesions (LL) according to the WHO clinical and histological classification. For these authors an increased risk of development of oral cancer could occur only on LL. Our aim was to check this hypothesis on a cohort followed for 10 years. MATERIAL AND METHODS: We included patients who were referred to our team for the first time between 1995 and 1997, still followed in 2010, with a histological diagnosis of buccal lichen planus. We classified lesions as OLP or LL according to the WHO clinical and histological classification: the two clinical criteria for OLP were a reticulated aspect and bilateral and symmetric lesions. Three histological criteria were necessary for the diagnosis: dense inflammatory infiltrate in the upper lamina propria, liquefaction degeneration of basal keratinocytes, and no signs of dysplasia. The final diagnosis was OLP, when all clinical ad histological criteria were met otherwise it was LL. We studied the patient's outcome between their first consultations and May 2010. RESULTS: Thirty-two patients, whose data was available, met inclusion criteria. Eight were diagnosed with OLP and 24 with LL. The mean follow-up was 164 months [154-183]. No oral cancer was observed in the OLP group. Two patients in the LL group presented with oral cancer after 45 and 143 months of follow-up. DISCUSSION: Malignant transformations were observed only in the LL group. Our results correlate with those of Van Der Meij et al. published in 2006. The strict use of the WHO diagnostic criteria seems to allow identifying patients at risk of developing oral cancer (LL) and others with only a benign course of this chronic oral mucosal disease. These results need to be confirmed by prospective multicentric studies.
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Transformación Celular Neoplásica , Liquen Plano Oral/patología , Erupciones Liquenoides/patología , Neoplasias de la Boca/etiología , Adulto , Anciano , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Humanos , Liquen Plano Oral/epidemiología , Erupciones Liquenoides/clasificación , Erupciones Liquenoides/diagnóstico , Erupciones Liquenoides/epidemiología , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/epidemiología , Neoplasias de la Boca/patologíaRESUMEN
OBJECTIVES: To set out good practice guidelines for locoregional extension assessment of squamous cell carcinoma of the head and neck (excluding nasopharynx, nasal cavities and sinuses). MATERIALS AND METHODS: A critical multidisciplinary review of the literature on locoregional extension assessment of squamous cell carcinoma of the head and neck was conducted, applying levels of evidence in line with the French health authority's (HAS) literature analysis guide of January 2000. CONCLUSION: Based on the levels of evidence of the selected articles and on work-group consensus, graded guidelines are set out for clinical, endoscopic and imaging locoregional extension assessment of head and neck cancer.
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Carcinoma de Células Escamosas/patología , Neoplasias Laríngeas/patología , Neoplasias de la Boca/patología , Neoplasias Faríngeas/patología , Conducta Cooperativa , Progresión de la Enfermedad , Endoscopía , Medicina Basada en la Evidencia , Francia , Humanos , Comunicación Interdisciplinaria , Metástasis Linfática/patología , Imagen por Resonancia Magnética , Microscopía Confocal , Tomografía Computarizada Multidetector , Imagen de Banda Estrecha , Invasividad Neoplásica , Estadificación de Neoplasias , Neoplasias Primarias Múltiples/patología , PronósticoRESUMEN
OBJECTIVES: This report presents the French Society of ORL (SFORL) guidelines for exploration for remote metastasis and synchronous second cancer in initial staging of head and neck squamous cell carcinoma. MATERIALS AND METHODS: An exhaustive literature review was analyzed by a multidisciplinary work-group. RESULTS: The thorax is the most frequent location of remote metastases and synchronous second cancer outside of the upper aerodigestive tract. Thoracic CT is recommended as first-line examination in all cases (grade B). 18-FDG PET/CT is recommended when the thoracic CT image is doubtful or in case of high metastatic risk (grade B), for the detection of non-pulmonary remote metastasis. Esophageal exploration is recommended in case of significant risk of synchronous esophageal cancer (hypopharyngeal or oropharyngeal tumor, chronic alcohol intoxication) (grade B). The reference examination is flexible endoscopy of the upper digestive tract (grade B). CONCLUSION: The present grade B recommendations rationalize the roles of the various first-line radiological and endoscopic examinations for remote metastasis and synchronous second cancer, so as to limit the number of examinations performed, thereby reducing the time needed for initial staging.
Asunto(s)
Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/secundario , Neoplasias Laríngeas/patología , Neoplasias de la Boca/patología , Neoplasias Primarias Secundarias/patología , Neoplasias Faríngeas/patología , Neoplasias Torácicas/secundario , Consumo de Bebidas Alcohólicas/efectos adversos , Neoplasias de los Bronquios/patología , Neoplasias de los Bronquios/secundario , Endoscopía , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/secundario , Humanos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/secundario , Imagen por Resonancia Magnética , Metástasis de la Neoplasia , Estadificación de Neoplasias , Tomografía de Emisión de Positrones , Factores de Riesgo , Fumar/efectos adversos , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: The authors present the French Society of Otorhinolaryngology (SFORL) guidelines for histopathologic assessment of head and neck cancer. MATERIAL AND METHODS: [corrected] A multidisciplinary workgroup set up by the SFORL performed an exhaustive review of the literature according to levels of evidence, following the 2000 guidelines of the French national health approvals and assessment agency (ANAES). RESULTS: Comparison between histologic and clinical data is essential. In case of discrepancy between clinical, radiological and histological findings, reinterpretation or new biopsy may be required (professional consensus). Mere suspicion of carcinoma on fine-needle aspiration lymph-node biopsy only exceptionally warrants aggressive treatment (professional consensus). Exploration for HPV is not recommended as routine practice, being without therapeutic impact (professional consensus). Anti-p16 immunohistochemistry is optional, for epidemiological purposes (professional consensus). Tumor-bank tissue storage must conform strictly to prevailing legislation and good practice rules for sampling and preservation (professional consensus). CONCLUSION: Pathology assessment is mandatory in suspected H&N squamous cell carcinoma. The present guidelines are intended to optimize management.