Stage and mRNA expression of survivin in lymph node as prognostic indicators in patients with oral squamous cell carcinoma.

Squamous cell carcinoma (SCC) is the most common malignant head and neck tumor and is responsible for more than 90% of head and neck cancers and accounts for 4.5% of all malignant tumors in males and 3.5% in females in South Korea. The purpose of this study was to investigate the correlation of suggested clinico-pathological prognostic factors such as gender, age, T score (T number in TNM), clinical stage, proliferation, invasion index, and lymph node metastasis to the survival of SCC patients in Korea. Furthermore, cytokeratin (CK), carcinoembryonic antigen (CEA), and recently documented apoptosis related protein, survivin, were analyzed by RT-PCR. In 113 patients, survival curves were estimated by the Kaplan-Meier method and nominal or numeric variable influence on survival was studied by Univariate and Multivariate Regression analysis (Cox proportional hazards model). Univariate analysis demonstrated that gender and age factor had no significant effect on survival rate. T score, on the other hand, significantly influenced survival and univariate analysis demonstrated that Stage 4 group had a significantly lower survival rate than the other stage groups but differentiation and invasion index factors had no significant effect on survival rate. Using a 50% cut-off point, patients with lower PCNA scores showed no survival advantages over those with higher PCNA scores but lymph node metastasis was a significant survival predictor in univariate analysis. In addition, lymph node CK and survivin mRNA expression have significant effects on OSCC patient survival rate. This means that prognostic value can be amplified by coincident analysis of T score, pathologically confirmed lymph node metastasis, and lymph node CK or survivin mRNA expression. Multivariate analysis using Cox's proportional hazards model, clinical TNM stage and lymph node survivin mRNA expression were independent OSCC prognostic factors, which support cancer staging based on the TNM as a powerful prognostic variable and lymph node survivin expression might provide predictive information for OSCC patient survival.

Mandibular condylar-ramal reconstruction using vascularised costochondral graft based on the serratus anterior composite flap.

BACKGROUND: Nonvascularised autogenous costochondral rib grafts are the gold standard for replacement of the mandibular ramus and condyle. However, condylar defects present a difficult condition to treat when soft tissue defects are involved. Thus, we used vascularised costochondral grafts (VCGs) with a cartilaginous cap based on the serratus anterior muscle flap to reconstruct these composite defects. The purpose of this study was to evaluate the advantages and effectiveness of VCGs based on long-term observation. METHODS: We evaluated 15 patients who underwent mandibular condyle and ramus reconstruction using VCG after a mean follow-up of 75.9 months (range 46-156 months). Our 15 case of mandibular reconstruction with a serratus anterior/rib composite free flap due to congenital or acquired defects involved a total of 18 condyles (bilateral reconstruction in 3 cases and unilateral reconstruction in 12 cases). RESULTS: Our success rate with the use of the serratus anterior/rib composite free flap was 100%, and there were no cases of resorption or malunion of the graft. The mean maximum mouth opening (MMO) at the last follow-up was 31.29 ± 7.56 mm (range 15-45 mm). Although two patients exhibited excessive growth of the graft, deficient growth of the graft was also found in our paediatric patients. Four patients who developed ankylosed TMJ during the follow-up period received additional gap arthroplasty. CONCLUSION: VCG based on a serratus anterior flap was an excellent treatment modality for patients with uni-or bilateral composite defects of the ramus and condyle, in which soft tissue and hard tissue, including both bone and cartilage, were necessary.