Early Treatment of Unilateral Condylar Hyperplasia in Adolescents: Preliminary Results.

Facial asymmetry associated with unilateral condylar hyperplasia (UCH) is a rare disease. The aim of this study was to evaluate the clinical conditions of progressive facial asymmetry in young subjects treated with high condylectomy. A retrospective study was performed including nine subjects diagnosed with UCH type 1B and progressive facial asymmetry around 12 years old with an upper canine progressing towards dental occlusion. After an analysis and a decision of treatment, orthodontics began one to two weeks prior to the condylectomy (with a mean vertical reduction of 4.83 ± 0.44 mm). Facial and dental asymmetry, dental occlusion, TMJ status and an open/closing mouth were analyzed before surgery and in the final stage of treatment, almost 3 years after surgery. Statistical analyses were performed using the Shapiro-Wilk test and a Student's t-test considering a p value of <0.05. Comparing T1 (before surgery) and T2 (once orthodontic treatment was finalized), the operated condyle showed a similar height to that observed in stage 1 with a 0.12 mm difference in height (p = 0.8), whereas the non-operated condyle showed greater height increase with an average of 3.88 mm of vertical growth (p = 0.0001). This indicated that the non-operated condyle remained steady and that the operative condyle did not register significant growth. In terms of facial asymmetry in the preoperative stage, a chin deviation of 7.55 mm (±2.57 mm) was observed; in the final stage, there was a significant reduction in the chin deviation with an average of 1.55 mm (±1.26 mm) (p = 0.0001). Given the small number of patients in the sample, we can conclude that high condylectomy (approx. 5 mm), if performed early, especially in the mixed-dentition stage before full canine eruption, is beneficial for the early resolution of asymmetry and thus the avoidance of future orthognathic surgery. However, further follow-up until the end of facial growth is required.

Diagnosis and Treatment in Unilateral Condylar Hyperplasia.

Unilateral condylar hyperplasia (UCH) is an uncommon disease involving progressive facial asymmetry. The aim of this research was to perform an analysis of the diagnosis and treatment of patients with UCH in a clinical series. An observational retrospective study was performed on subjects with progressive facial asymmetry in the lower third of the face; all the subjects were under treatment with condylectomy and orthodontics to improve occlusion and face balance. Variables such as age, sex, clinical type, SPECT (single photon emission computed tomography) intensity and a requirement for secondary surgery were included; the Shapiro Wilk test was performed to analyze the normality of the data and nonparametric analysis and the Kruskal-Wallis or Mann-Whitney tests were used to assess the association between the SPECT difference and the variables, where 2-tailed p values < 0.05 were considered to be statistically significant. Forty-nine patients between 10 and 45 y.o. (average age: 19.1 ± 7.4 y.o.) were included in the study. There were 41 female (83.6%) and 8 male (16.4%) subjects. The SPECT analysis comparing the right and left condyles with more than 10% in caption of the isotope was present in 46 subjects; the results obtained using SPECT were not statistically related to the age or sex of the sample (p = 0.277). The patients were classified into clinical types I, II and III, and no correlations could be confirmed between the clinical type and other variables. High condylectomy was conducted on all patients, among which 14 patients underwent a secondary surgery for orthognathic or cosmetic treatment, and was not related to the initial variables used in diagnosis (p = 0.98); interestingly, the second surgical treatment was more present in the clinical type I and in subjects under 16 years old with no statistical differences. Clinical analysis, medical records, 3D imaging and SPECT should be used as a complementary analysis in assessing the diagnosis of UCH and progressive facial asymmetry.

Feasibility of iterative closest point algorithm for accuracy between virtual surgical planning and orthognathic surgery outcomes.

PURPOSE: To evaluate the feasibility of iterative closest point (ICP) algorithm for assessing the accuracy between virtual surgical planning (VSP) and outcomes in orthognathic surgery. MATERIALS AND METHODS: VSP and results of surface mesh (SM0 and SM1) from CBCT scans of 25 patients who had been undergone bi-maxillary orthognathic surgery were converted into STL-format files and then imported to Geomagic software for semi-automatic alignment. ICP algorithm was used to calculate mean deviations (MD) and root mean square (3D error) at different calibrations of ±2 mm (T1), ±5 mm (T2) and ±10 mm (T3), with workflow being performed by two evaluators. Colour maps were generated to assess the 3D congruence qualitatively. Linear regression analysis was used to estimate whether SM0 or SM1 could condition the ICP and t-tests were used to assess whether MD and 3D error values were ≤-2 mm and ≥2 mm. Descriptive statistics was used to assess the method's feasibility by comparing T2 to T1 and T3. RESULTS: High intra- and inter-rater correlations supported the workflow reproducibility with the software. SM0 conditioned the ICP algorithm regarding both evaluators, and t-tests demonstrated that MD and 3D error were >-2 mm and <2 mm. MD and 3D error at T3 were 30% higher than those at T1. CONCLUSIONS: ICP algorithm provided a reproducible method, but its feasibility was limited due to underestimation or overestimation of the results as they affect the validity of the actual deviations.

Alteration of Occlusal Plane in Orthognathic Surgery: Clinical Features to Help Treatment Planning on Class III Patients.

Dentofacial deformities (DFD) presenting mainly as Class III malocclusions that require orthognathic surgery as a part of definitive treatment. Class III patients can have obvious signs such as increasing the chin projection and chin throat length, nasolabial folds, reverse overjet, and lack of upper lip support. However, Class III patients can present different facial patterns depending on the angulation of occlusal plane (OP), and only bite correction does not always lead to the improvement of the facial esthetic. We described two Class III patients with different clinical features and inclination of OP and had undergone different treatment planning based on 6 clinical features: (I) facial type; (II) upper incisor display at rest; (III) dental and gingival display on smile; (IV) soft tissue support; (V) chin projection; and (VI) lower lip projection. These patients were submitted to orthognathic surgery with different treatment plannings: a clockwise rotation and counterclockwise rotation of OP according to their facial features. The clinical features and OP inclination helped to define treatment planning by clockwise and counterclockwise rotations of the maxillomandibular complex, and two patients undergone to bimaxillary orthognathic surgery showed harmonic outcomes and stables after 2 years of follow-up.

Accuracy of computer-guided surgery for dental implant placement in fully edentulous patients: A systematic review.

Assess clinical studies regarding accuracy between virtual planning of computer-guided surgery and actual outcomes of dental implant placements in total edentulous alveolar ridges. A PubMed search was performed to identify only clinical studies published between 2011 and 2016, searching the following combinations of keywords: "Accuracy AND Computer-Assisted Surgery AND Dental Implants." Study designs were identified using the terms: Case Reports, Clinical study, Randomized Controlled Trial, Systematic Reviews, Meta-Analysis, humans. Level of agreement between the authors in the study selection process was substantial (k = 0.767), and the study eligibility was considered excellent (k = 0.863). Seven articles were included in this review. They describe the use of bone and muco-supported guides, demonstrating angular deviations cervically and apically ranging from (minimum and maximum means), respectively, 1.85-8.4 (°), 0.17-2.17 (mm), and 0.77-2.86 (mm). Angular deviations obtained most inaccuracy in maxila. For cervical and apical deviations, accuracy was preponderantly lower in maxilla. Despite the similar deviations measurement approaches described, clinical relevance of this study may be useful to warn the surgeon that safety margins in clinical situations.

Management of Peri-Implant Hypertrophic Scarring for an Ear Prosthesis.

The clinical report describes a case of a 14-year-old patient with a traumatic amputation of the left auricle and severe hypertrophic scarring. The management of peri-implant soft tissue was challenging, but successful in the rehabilitation of a patient with auricular prosthesis retained by implants. The prosthesis restored the patient's facial aesthetics and contributed not only to function, but also to psychosocial well-being.

Bone Formation in Maxillary Sinus Lift Using Autogenous Bone Graft at 2 and 6 Months.

The aim of this study is to compare the bone formation in maxillary sinus lift with an autogenous bone graft in histological evaluation at 2 or 6 months. A comparative study was designed where 10 patients with missing teeth bilaterally in the posterior zone of the maxilla were selected. Patients received a particulate autogenous bone graft under the same surgical conditions, selecting a site to collect a biopsy and histological study at two months and another at six months postoperatively. Histomorphometry was performed and were used Kolmogorov-Smirnov test, student's t-test and Spearman's correlation coefficient, considering a value of p<0.05. Differences were observed in inflammatory infiltrate and vascularization characteristics; however, the group analyzed at two months presented 38.12% ± 6.64 % of mineralized tissue, whereas the group studied at 6 months presented an average of 38.45 ± 9.27 %. There were no statistical differences between the groups. It is concluded that the bone formation may be similar in intrasinus particulate autogenous bone grafts in evaluations at two or six months; under these conditions, early installation of implants is viable.

Influência da cirurgia ortognática na harmonia facial: série de casos / Influence of orthognathic surgery on facial harmony: case series

A cirurgia ortognática é uma opção terapêutica viável no tratamento daqueles pacientes que apresentam deformidades dento-esqueléticas. De acordo com a literatura, esse procedimento cirúrgico possibilita aos pacientes resultados funcionais e estéticos, proporcionando mudanças significativas na vida destes. Sendo assim, este trabalho teve por objetivo relatar uma série de casos de pacientes submetidos à cirurgia ortognática, cujos resultados pós-operatórios demonstram uma importante melhora na harmonia facial destes, o que vem a confirmar que esse procedimento é um importante instrumento de mudança na vida dos pacientes, possibilitando uma convivência normal destes em sociedade... (AU)

The orthognathic surgery is a viable therapeutic option in the treatment of those patients who have dental-skeletal deformities. According to the literature, this surgical procedure allows the functional and aesthetic results patients, providing significant changes in their lives. Thus, this study aimed to report a case series of patients undergoing orthognathic surgery whose postoperative results show a significant improvement in facial harmony of the same, which confirms that this procedure is an important tool change in the lives of patients, allowing a normal coexistence of these patients in society... (AU)

Desafios na reconstrução mandibular devido a lesões extensas ou traumatismos / Challenges in mandibular reconstruction due to extensive injuries or trauma

A perda de grande parte do osso mandibular, seja devido à necessidade de ressecção óssea ou por outros fatores como a ocorrência de traumatismos, afeta diretamente a vida dos pacientes. Mesmo com a melhoria contínua dos materiais, surgimento de novas tecnologias e técnicas cirúrgicas, o tratamento dessas grandes lesões e perdas ósseas permanece como grande desafio ao cirurgião. Nesse sentido, o objetivo do presente trabalho foi relatar dois casos clínicos de pacientes, sendo um de fibroma ossificante central de mandíbula que foi submetido à ressecção mandibular e tratado através da colocação de uma placa de reconstrução do sistema 2.4 mm. O segundo caso envolveu perda de substancia devido a paciente ter sido vitima de ferimento por arma de fogo (FAF), evoluindo com fratura do sistema de fixação colocado na primeira cirurgia. Em segundo momento cirúrgico a paciente foi submetida à reconstrução óssea do defeito, associado à colocação de nova fixação. Deste modo, podemos afirmar que os procedimentos reconstrutivos são importantes instrumentos para tratamento dos pacientes.

The loss of much of the mandibular bone, is due to the need for bone resection or by other factors such as the occurrence of injuries, directly affects the lives of patients. Even with the continuous improvement of materials, development of new technologies and surgical techniques, treatment of these large lesions and bone loss is still a major challenge for the surgeon. In this sense, the objective of this study was to report two clinical cases of patients, a central ossifying fibroma of the mandible who underwent mandibular resection and treated by placement of a reconstruction plate system 2.4mm. The second case involved loss of substance because the patient has been the victim of injury by firearms (FAF), evolving with fracture fixation system placed in the first surgery. In the second surgical time the patient underwent bone reconstruction of the defect associated with the placement of new fixation. Thus, we can say that reconstructive procedures are important tools for treatment of patients.

Treatment of atrophic maxilla with zygomatic implants in 29 consecutives patients.

Atrophic maxilla is a common condition in older population; some treatments are proposed with bone reconstruction or zygomatic implant. Long-term follow up show the efficiencies of zygomatic implant but limited data are associated to consecutive patient. The aim of this study was to evaluate retrospectively the zygomatic implants performed consecutively in 29 patients. Data from clinical records of 29 patients treated with zygomatic implants were analyzed; were include patient with at least 10 month of prosthetic function. Four surgeons realized all surgeries using local anesthesia with a slot technique on local anesthesia; the variables analyzed were implant survival, complications, prosthetic load and satisfaction of patient; data collection was analyzed by descriptive statistic and chi-square test with p<0.05 for significance statistical. 67 zygomatic implants and 84 conventional implants were installed in patients between 35 and 69 year old being 18 (62%) female and 11 (38%) male.The main indication was the case of severe alveolar resorption in 21 cases (72.41%), followed by failures in maxillary reconstruction with bone graft in 4 (13.79%). The implant success was 79.1% and the immediate or delayed load was not associated to statistical difference (p=0.104). The main complication was the loss of osseointegration and mucositis. Analogue Visual Scale (AVS) for satisfaction show acceptable esthetic and function. Finally we conclude that zygomatic implant present adequate survivor and a good response of patient; important complication can be present in a learn curve for this surgery.

Descompressão cirúrgica no tratamento de lesões císticas da cavidade oral / Surgical decompression in the treatment of cystic lesions of the oral cavity

Os cistos são lesões formadas por uma cavidade revestida de tecido epitelial, as quais contêm, em seu interior, material líquido ou semisólido, podendo ser classificados em cistos odontogênicos e não odontogênicos. Apesar de existirem diversas modalidades de tratamentos descritas na literatura para tratamentos dos cistos da cavidade oral, até o presente momento, não se observa um consenso em relação à qual técnica que oferece os melhores resultados. Sendo assim, procurou-se relatar um caso clínico com a utilização da técnica de descompressão, procurando evidenciar suas indicações, vantagens, desvantagens e demais peculiaridades... (AU)

Cysts are lesions formed by a cavity lined with epithelial tissue, which contains in its interior material liquid or semisolid, and may be classified into odontogenic cysts and non-odontogenic. Although there are several treatment modalities described in the literature for treatment of cysts of the oral cavity, to date not seen a consensus as to which technique offers the best results. Therefore, we sought to a case report using the technique of decompression, seeking to highlight their indications, advantages, disadvantages and other peculiarities... (AU)

Soft tissue calcified in mandibular angle area observed by means of panoramic radiography.

The aim of this research is to determine the prevalence of soft tissue calcifications detectable on panoramic radiographs, in the mandibular angle area. 3,028 digital panoramic radiographs taken between June 2009 and June 2011 were evaluated. Soft tissue calcifications found in the mandibular angle area were recorded according to gender, age and bilaterality. Data were analyzed with the Chi squared test and Fisher's exact test, with α< 0.05 being considered statistically significant. The panoramic radiographs analyzed revealed a total of 79 calcifications (2.61%) in 75 individuals, of which 55.7% were women and 44.3% were men. The calcifications found were tonsilloliths (56%), carotid artery calcification (29%), sialoliths (11%), calcified lymph nodes (4%). A statistically significant link was found between being over age 40 with tonsilloliths (p<0.001) and calcifications of the carotid artery (p<0.001). In terms of gender, men had a higher likelihood of tonsilloliths (p=0.007). Conclusions There is a low prevalence of soft tissue calcifications detectable on panoramic radiographs, which increases with age.

Seleccion de osteosintesis en la reconstruccion maxilar con injerto oseo de cresta Iliaca / Selection of osteosynthesis in maxillary reconstruction with iliac crest bone graft

La reconstrucci¢n ¢sea maxilar con injertos libres junto a la osteotom¡a Le Fort I ha sido desarrollada para dar respuesta a las necesidades cl¡nicas funcionales y est‚ticas de los pacientes, debido principalmente a la discrepancia antero-posterior de las maxilas atr¢ficas. Dentro de la t‚cnica, existe necesidad de osteos¡ntesis mediante fijaci¢n interna r¡gida (FIR) que puede ser desarrollada tanto con dispositivos met licos como con dispositivos reabsorbibles. El presente estudio eval£a el uso de ambos materiales de fijaci¢n, relatando las caracter¡sticas, comparaciones y situaciones cl¡nicas que podr¡an estar asociados a su elecci¢n.

The maxillary bone reconstruction with free flaps with LeFort I osteotomy has been developed to give answer to the functional and aesthetic clinical needs of patients, mainly due to the anteroposterior discrepancy of atrophic maxillae. Within the technique, there is need for osteosynthesis though rigid internal fixation (RIS) that can be developed as both metal devices and absorbable devices. This study evaluates the use of both fixing materials, relating the features, comparisons and clinical situations that might be associated with its choice.

Oral lichen planus treated with tacrolimus 0.1%.

Oral lichen planus (OLP) is considered a chronic autoimmune inflammatory disease and its presence may be related to increased emotional stress. The clinical relevance of OLP is the possibility of developing a squamous cell carcinoma, the etiology of which is still unknown. The aim of this study is to treat OLP lesions resistant to conventional treatment with corticosteroids, using topical tacrolimus 0.1% (Protopic(®)) twice a day for a period of eight weeks. Fifteen patients were selected who had filled out a history form and a visual analog scale for pain before and after treatment. All patients underwent an initial biopsy to diagnose the disease and another at the end of the treatment period to evaluate the effect of the medication on the infiltrate. A weekly check was carried out, observing the clinical appearance, pain symptoms and occurrence of side effects which, where present, were mild and transient. The results showed twelve patients (80%) with total or nearly total remission of pain symptoms and lesions, two patients (13.33%) showed clearer lesions and only one patient (6.67%) had no change in clinical symptoms or pain. Histopathological analysis showed OLP had a moderate or strong regression in twelve patients (80%) and an absent or mild regression in three patients (20%). Based on these results, it was concluded that tacrolimus 0.1% (Protopic(®)) is a safe and effective medication that improves the clinical appearance of the lesion, reduces pain as well as the histopathological features of OLP.

Facial asymmetry and condylar hyperplasia: considerations for diagnosis in 27 consecutives patients.

Facial asymmetry associated with condylar hyperplasia (CH) has been become the object of study in recent years. The aim of this study is to demonstrate the importance of analyzing the presence of CH in cases of facial asymmetry. Twenty-seven consecutive patients were studied without distinction of age or gender; all the patients consulted for treatment of facial and/or mandibular asymmetry and voluntarily agreed to participate in the study. All the patients underwent facial cone beam tomography and bilateral TMJ as well as a detailed history where they indicated the progression of the disease; in cases of active evolution determined by clinical analysis and imaging, a SPECT analysis was performed to define the isotope uptake. 29.6% of the subjects with scintigram exhibited active CH with a more than 10% difference in uptake between the two condyles; 18.5% presented differences in uptake between 5% and 10%. Active CH was related to the age and gender of the subjects, being more prevalent in women than in men. The aggression level of the uptake was also related to the subject's age. 55% of the subjects presented with some type of orthodontic treatment with no diagnosis of TMJ pathology in the initial consultation. It can be concluded that CH is associated with facial asymmetries and must be studied integrally before assessing treatment options.

Mandible condylar hyperplasia: a review of diagnosis and treatment protocol.

Condylar hyperplasia (CH) is a bone disease characterized by the increased development of one mandibular condyle. It regularly presents as an active growth with facial asymmetry generally without pain. Statistically it affects more women in adolescence, although it does not discriminate by age or gender. Its best-known consequence is asymmetric facial deformity (AFD), which combined with alteration of the dental occlusion with unilateral crossbite or open bite. It is not known when CH begins and how long it lasts; diagnostic examinations are described and are efficient in some research about diagnosis. Protocol treatment is not well studie and depends on the criteria described in this paper. The aim of this research is to provide up-to-date information about the diagnosis of this disease and to analyze the treatment protocol, visualizing the CH and AFD presented.

Histometric analyses of cancellous and cortical interface in autogenous bone grafting.

Surgical procedures involving the rehabilitation of the maxillofacial region frequently require bone grafts; the aim of this research was to evaluate the interface between recipient and graft with cortical or cancellous contact. 6 adult beagle dogs with 15 kg weight were included in the study. Under general anesthesia, an 8 mm diameter block was obtained from parietal bone of each animal and was put on the frontal bone with a 12 mm 1.5 screws. Was used the lag screw technique from better contact between the recipient and graft. 3-week and 6-week euthanized period were chosen for histometric evaluation. Hematoxylin-eosin was used in a histologic routine technique and histomorphometry was realized with IMAGEJ software. T test was used for data analyses with p<0.05 for statistical significance. The result show some differences in descriptive histology but non statistical differences in the interface between cortical or cancellous bone at 3 or 6 week; as natural, after 6 week of surgery, bone integration was better and statistically superior to 3-week analyses. We conclude that integration of cortical or cancellous bone can be usefully without differences.

Survival in patients with oral and maxillofacial diffuse large B-cell lymphoma

The purpose of this study was to determine the survival and prognostic factors of patients with diffuse large B-cell lymphoma (DLBCL) of the oral cavity and maxillofacial region. Retrospectively, the clinical records of patients with a primary diagnosis of DLBCL of the oral cavity and maxillofacial region treated at the A.C. Camargo Hospital for Cancer, São Paulo, Brazil, between January 1980 and December 2005 were evaluated to determine (A) overall survival (OS) at 2 and 5 years and the individual survival percentage for each possible prognostic factor by means of the actuarial technique (also known as mortality tables), and the Kaplan Meier product limit method (which provided the survival value curves for each possible prognostic factor); (B) prognostic factors subject to univariate evaluation with the log-rank test (also known as Mantel-Cox), and multivariate analysis with Cox's regression model (all the variables together). The data were considered significant at p ≤ 0.05. From 1980 to 2005, 3513 new cases of lymphomas were treated, of which 151 (4.3%) occurred in the oral cavity and maxillofacial region. Of these 151 lesions, 48 were diffuse large B-cell lymphoma, with 64% for OS at 2 years and 45% for OS at 5 years. Of the variables studied as possible prognostic factors, multivariate analysis found the following variables have statistically significant values: age (p = 0.042), clinical stage (p = 0.007) and performance status (p = 0.031). These data suggest that patients have a higher risk of mortality if they are older, at a later clinical stage, and have a higher performance status.

Retrospective study of the survival and associated risk factors of wedge-shaped implants.

PURPOSE: To assess the long-term behavior of wedge-shaped implants and evaluate the influence of the associated risk factors on implant survival rates. MATERIALS AND METHODS: A retrospective review of clinical records of patients treated with wedge-shaped implants between 1992 and 2011 was conducted. Data on patient sex, age, smoking habits, and history of periodontitis; details of implant length, diameter, angle, and location; and data on surgical, reconstructive, and prosthetic procedures, and systemic disease were selected for analysis. RESULTS: A total of 1,169 implants placed in 154 patients (mean age 55.17 ± 11.33 years) were evaluated. Women received 637 implants, and men received 532 implants; 60.4% were placed in patients who were undergoing periodontal maintenance care, 17.9% in smokers, 17.7% in hypertensive patients, 5.7% in diabetic patients, and 4.4% in cardiac patients. The mean overall survival for implants was 194.26 ± 9.91 months. Seventy-three implants were lost: 3 before implant loading and 70 after loading. The cumulative survival rates at 5 and 10 years were 96.6% (confidence interval [CI]: 95.5% to 97.7%) and 91.8% (CI: 90.1% to 94.1%), respectively. Univariate analysis indicated tobacco smoking (P = .014) and implant location (P < .001) as significant risk factors for implant failure. The multivariate analysis showed tobacco smoking (P = .016), location (P = .001), and male sex (P = .038) as significant, and the latter factor was associated with previous periodontal disease. CONCLUSIONS: Overall survival of the wedge-shaped implant showed good long-term results. Male sex, tobacco smoking, and posterior maxillary location were associated with a greater risk of implant failure.

Survival in patients with oral and maxillofacial diffuse large B-cell lymphoma.

The purpose of this study was to determine the survival and prognostic factors of patients with diffuse large B-cell lymphoma (DLBCL) of the oral cavity and maxillofacial region. Retrospectively, the clinical records of patients with a primary diagnosis of DLBCL of the oral cavity and maxillofacial region treated at the A.C. Camargo Hospital for Cancer, São Paulo, Brazil, between January 1980 and December 2005 were evaluated to determine (A) overall survival (OS) at 2 and 5 years and the individual survival percentage for each possible prognostic factor by means of the actuarial technique (also known as mortality tables), and the Kaplan Meier product limit method (which provided the survival value curves for each possible prognostic factor); (B) prognostic factors subject to univariate evaluation with the log-rank test (also known as Mantel-Cox), and multivariate analysis with Cox's regression model (all the variables together). The data were considered significant at p≤0.05. From 1980 to 2005, 3513 new cases of lymphomas were treated, of which 151 (4.3%) occurred in the oral cavity and maxillofacial region. Of these 151 lesions, 48 were diffuse large B-cell lymphoma, with 64% for OS at 2 years and 45% for OS at 5 years. Of the variables studied as possible prognostic factors, multivariate analysis found the following variables have statistically significant values: age (p=0.042), clinical stage (p=0.007) and performance status (p=0.031). These data suggest that patients have a higher risk of mortality if they are older, at a later clinical stage, and have a higher performance status.