Are elderly patients presenting with squamous cell carcinoma of the oral cavity given the appropriate treatment?

OBJECTIVES: There is no consensus for the specific management of elderly patients presenting with oral cavity squamous cell carcinomas (OC SCC). We report our findings in the treatment of primary OC SCC, for patients of 70 years of age or more, in a French university hospital center. PATIENTS AND METHODS: One hundred and twenty five patients diagnosed between 2000 and 2010, were included retrospectively. Independent risk factors of post-operative complications were identified using a logistic regression. The overall survival (OS) was estimated using the Kaplan Meier method. Independent factors of survival were calculated using a Cox model. RESULTS: The patient's median age was 78. Women presented significantly more premalignant lesions, less alcohol intoxication, and less tobacco consumption. Half of the population sample was staged T4 in the TNM classification. Eighty eight percent of the patients received a curative treatment. The independent risk factors for post-operative complications were T3/T4 stages (OR 4.3 [1.3-14.4]), lymph node metastasis (OR 6.9 [2.1-22.7]), and alcohol abuse (OR 3.5 [1.1-11.0]). The median OS was 14.0 months. The independent negative prognostic factors for OS for patients treated curatively were: age >79 years (HR 1.9 [1.2-3.2]), stage T2/T3/T4 tumor vs. T1 (HR = 3.0 [1.5-6.0], P = 0.001) and substandard surgery (HR = 1.8 [1.1-2.9], P = 0.03). CONCLUSIONS: The management of OC SCC in elderly patients is complex and requires collaboration among gerontologists, surgeons and oncologists. The treatment choice is related to the disease extent and preoperative morbid conditions.

The key to accuracy of zygoma repositioning: Suitability of the SynpliciTi customized guide-plates.

This study aimed at assessing the suitability and accuracy for secondary zygoma repositioning of custom-made drilling guides and plates designed from a computer-assisted reversed planning. Mini-plates and pre-drilling guides were designed starting from the virtual planning of the repositioned zygoma. The pilot holes were drilled first during surgery. The zygoma was repositioned by inserting the screws in the pilot holes using the custom-made plates. Surgical planning and postoperative CT-scan were superimposed. The distances between each point of the planned and final zygoma positions indicated the accuracy of repositioning. We included 11 zygoma repositioning procedures in 10 consecutive patients. The medians of the distances between the planned and final zygoma positions in this cohort ranged from 0.05 mm to 0.38 mm (0.20 mm on average). 93%, 81%, and 57% of the points of the planned and final zygoma were less than 2 mm, 1 mm, and 0.5 mm away, respectively. The SynpliciTi customized guide-plate system allowed achieving highly accurate zygoma repositioning in short operative times in this series, without the need for expensive equipment with difficult implementation. Larger cohorts are needed to assess the overall benefit and cost-effectiveness of the SynpliciTi.