Medical treatment of osteoradionecrosis of the mandible by PENTOCLO: preliminary results.

INTRODUCTION: Osteoradionecrosis (ORN) is a severe, generally irreversible complication of radiotherapy due to failure of healing. The pentoxifylline-tocopherol combination decreases the superficial fibrosis induced by radiotherapy. Potentiation by Clodronate (PENTOCLO) appears to be effective in ORN of the mandible. The objectives of this study were to evaluate the efficacy and safety of PENTOCLO to treat osteoradionecrosis of the mandible. METHODS: Retrospective study of 27 patients with a mean age of 65±12 years, managed for ORN of the mandible secondary to irradiation for head and neck cancer, treated by the PENTOCLO protocol between January 2010 and March 2011. The primary endpoint was regression of exposed bone until complete healing. Assessment was both clinical (measurement of mucosal ulceration) and radiological (panoramic dental x-rays) before treatment, after antibiotic-corticosteroid combination therapy for one month (M1), and then after 3, 6, 12 months of PENTOCLO. RESULTS: An improvement of mucosal ulceration was observed in 16/21 patients after 3 months and in 12/17 patients after 6 months of PENTOCLO. Healing was obtained in 16 patients. Median healing time was 82 days (range: 32-266), and was shorter after surgery and radiotherapy (49 days) and longer after chemoradiotherapy (169 days). Radiological healing was achieved later than clinical healing with improvement in 9 out of 20 patients at 3 months. The safety and efficacy of treatment were evaluated by intraoral clinical examination, and assessment of feeding, weight and analgesic consumption. No patient discontinued treatment because of adverse effects. CONCLUSION: The PENTOCLO protocol achieved clinical and radiological regression of ORN with, in parallel, a reduction of the indications for major surgery. These preliminary results need to be confirmed by prospective studies comprising quality of life assessment.

Revascularized free scapular flaps in mandibular reconstruction. Report of 93 cases (April 1997 - October 2009).

OBJECTIVE: The aim of the present article is to demonstrate the relevance of revascularized free scapular flap in mandibular reconstruction in oncological cervicofacial salvage surgery. We will discuss the advantages and the disadvantages, indications and contraindications, together with possible complications and sequelae for this type of surgical flap. MATERIAL AND METHODS: Retrospective study of 93 revascularized free scapular flaps used to reconstruct segmental substance defects in the mandible from April 1997 to October 2009 (in 91 patients). All patients benefited from 10 months to 12 years follow-up surgical and functional results. Functional assessment following anatomic site restoration focused on the quality of feeding and deglutition. RESULTS: The anatomical success rate was 94.63% (5 complete necroses out of 93 flaps). Results were considered to be good (normal or close to normal function for feeding and deglutition) in the majority of patients (83% at 6 months, 91% at 18 months). On the donor site: Functional sequelae were moderate when post-operative reeducation was correctly performed. CONCLUSION: Vascularized free scapular flap bone graft is very interesting for the reconstruction of mandibular discontinuity, composite (soft tissue and cutaneous resection) or exclusively osseous defects (not in excess of 13 cm), secondary to oncologic or osteoradionecrotic resections.

Mandibular reconstruction following cyst removal by the autologous cancellous bone and marrow grafts.

This article presents the surgical technique of using the autologous cancellous bone and marrow grafts for filling defects following cyst removal in the mandible, and reports long-term results.

[Laryngeal schwannoma: a case report and review of the literature]. / Schwannome laryngé: a propos d'un cas et revue de la littérature.

OBJECTIVES: In presenting a case of laryngeal schwannoma, the authors emphasize the difficulties in diagnosing this rare pathology and review treatment options. The recent literature concerning this benign tumour is reviewed. MATERIALS AND METHOD: The authors present a case of laryngeal schwannoma in a 29 year old man, revealed by exertional inspiratory dyspnea. RESULTS: The patient was treated by a conservative surgery with no recurrence after two years follow-up. CONCLUSION: CT scan and magnetic resonance imaging provide essentiel data on the spread of this benign tumour. The possibility of malignant change and recurrence warrant long-term follow-up.

[Extemporaneous histologic examination of cutaneous carcinoma of the face]. / Examen histologique extemporané dans les carcinomes cutanés de la face.

One hundred thirty-eight skin cancers of the face were reviewed retrospectively in order to evaluate the extemporaneous histology examination. The results obtained were satisfactory and in agreement with those in the literature. This technique is perfectly adapted to cancers with a facial localization. In our opinion, the indication for extemporaneous examinations should be widened to all cases of epithelioma of the face.

[The use of toluidine blue in the diagnosis of neoplastic lesions of the oral cavity]. / Utilisation du bleu de toluidine dans le diagnostic des lésions néoplasiques de la cavité buccale.

Toluidine blue staining is not used extensively in the diagnosis of mucosal lesions of the buccal cavity. It is, however, an effective aid, being a diagnostic tool of choice, particularly during screening for neoplastic lesions in populations at risk.

[The use of cryotherapy in oral pathology. Our experience in 36 cases]. / Utilisation de la cryothérapie en pathologie buccale. Notre expérience sur 36 cas.

Cryotherapy is a simple to use, weakly invasive technique provoking only moderate complications in the treatment of certain mucosal lesions of the buccal cavity. Indications of choice for this type of treatment are angioma and papilloma. Long term follow up of patients treated for reactive keratosis or epithelioma in situ is at present insufficient to establish precise indications.