The Value of Surveillance Imaging of Oral Squamous Cell Carcinoma.

The evaluation of surveillance imaging of OSCC patients is a difficult task physicians have to face daily. Multiple patients experience a recurrence of this disease, which underlines the importance of regular patient monitoring programs. Our study analysed the value of surveillance imaging, such as computed tomography (CT) and nuclear magnetic resonance imaging (NMRI), as a patient monitoring programme and its effectiveness in achieving improvement in early recurrence detection. The study comprised 125 patients, out of which 56 (n = 56) showed radiological and 69 (n = 69) showed clinical and radiological conspicuous patterns in domestic follow-ups, respectively. The use of CT and NMRI showed a significant dependence on the histological result (p = 0.03). However, the different groups showed no significant dependence on the histological result (p = 0.96). The distribution of the histological biopsies, which were taken due to radiological changes, were prone to wrong positive diagnoses (false positives) in 71 percent. To conclude, imaging modalities should be chosen for each patient individually to reduce false positives, improve the early detection of recurrence, and increase the cure rate.

Clinical Experience with Autofluorescence Guided Oral Squamous Cell Carcinoma Surgery.

In our study, the effect of the use of autofluorescence (Visually Enhanced Lesion Scope-VELscope) on increasing the success rate of surgical treatment in oral squamous carcinoma (OSCC) was investigated. Our hypothesis was tested on a group of 122 patients suffering from OSCC, randomized into a study and a control group enrolled in our study after meeting the inclusion criteria. The preoperative checkup via VELscope, accompanied by the marking of the range of a loss of fluorescence in the study group, was performed before the surgery. We developed a unique mucosal tattoo marking technique for this purpose. The histopathological results after surgical treatment, i.e., the margin status, were then compared. In the study group, we achieved pathological free margin (pFM) in 55 patients, pathological close margin (pCM) in 6 cases, and we encountered no cases of pathological positive margin (pPM) in the mucosal layer. In comparison, the control group results revealed pPM in 7 cases, pCM in 14 cases, and pFM in 40 of all cases in the mucosal layer. This study demonstrated that preoperative autofluorescence assessment of the mucosal surroundings of OSCC increased the ability to achieve pFM resection 4.8 times in terms of lateral margins.

Biopsies of osseous jaw lesions using 3D-printed surgical guides: a clinical study.

BACKGROUND: Bone biopsies are often necessary to make a diagnosis in the case of irregular bone structures of the jaw. A 3D-printed surgical guide may be a helpful tool for enhancing the accuracy of the biopsy and for ensuring that the tissue of interest is precisely removed for examination. This study was conducted to compare the accuracy of biopsies performed with 3D-printed surgical guides to that of free-handed biopsies. METHODS: Computed tomography scans were performed on patients with bony lesions of the lower jaw. Surgical guides were planned via computer-aided design and manufactured by a 3D-printer. Biopsies were performed with the surgical guides. Bone models of the lower jaw with geometries identical to the patients' lower jaws were produced using a 3D-printer. The jaw models were fitted into a phantom head model and free-handed biopsies were taken as controls. The accuracy of the biopsies was evaluated by comparing the parameters for the axis, angle and depth of the biopsies to the planned parameters. RESULTS: Eight patients were included. The mean deviation between the biopsy axes was significantly lower in guided procedures than in free-handed biopsies (1.4 mm ± 0.9 mm; 3.6 mm ± 1.0 mm; p = 0.0005). The mean biopsy angle deviation was also significantly lower in guided biopsies than in free-handed biopsies (6.8° ± 4.0; 15.4° ± 3.6; p = 0.0005). The biopsy depth showed no significant difference between the guided and the free-handed biopsies. CONCLUSIONS: Computer-guided biopsies allow significantly higher accuracy than free-handed procedures.

In-house 3D-printed surgical guides for osseous lesions of the lower jaw: an experimental study.

BACKGROUND: The accuracy of computer-assisted biopsies at the lower jaw was compared to the accuracy of freehand biopsies. METHODS: Patients with a bony lesion of the lower jaw with an indication for biopsy were prospectively enrolled. Two customized bone models per patient were produced using a 3D printer. The models of the lower jaw were fitted into a phantom head model to simulate operation room conditions. Biopsies for the study group were taken by means of surgical guides and freehand biopsies were performed for the control group. RESULTS: The deviation of the biopsy axes from the planning was significantly less when using templates. It turned out to be 1.3 ± 0.6 mm for the biopsies with a surgical guide and 3.9 ± 1.1 mm for the freehand biopsies. CONCLUSIONS: Surgical guides allow significantly higher accuracy of biopsies. The preliminary results are promising, but clinical evaluation is necessary.

Is There a Significant Difference in Relapse and Complication Rate of Surgically Assisted Rapid Palatal Expansion Using Tooth-Borne, Bone-Borne, and Orthodontic Mini-Implant-Borne Appliances?

PURPOSE: For surgically assisted rapid palatal expansion (SARPE), studies comparing different devices are missing. The aim was to evaluate expansion, relapse, and the complication rates for 3 different appliances. PATIENTS AND METHODS: In this retrospective cohort study, tooth-borne (TB, n = 29), bone-borne (BB, n = 12), or orthodontic mini-implant (OMI)-borne (n = 13) appliances were used for SARPE in 2 clinical centers. Patients presenting with a maxillary width discrepancy greater than 5 mm were included. Measurements of cast models and radiographs were performed preoperatively, immediately after consolidation, and at 1 year postoperatively. All distances were measured between canines, premolars, and molars. Complications (tooth damage, infection, technical failure) were evaluated. The outcome variables were expansion, relapse, and complications. Type of appliance was selected as predictor variable. Within- and between-group differences regarding expansion, relapse, and complications for the 3 appliances were statistically analyzed. RESULTS: In 54 patients (aged 28.8 ± 8.6 years), mean expansion (±standard deviation) for the TB, BB, and OMI appliances immediately after consolidation was 5.29 ± 1.39 mm, 5.22 ± 1.72 mm, and 3.81 ± 2.19 mm, respectively, at the dental level, and 5.51 ± 1.40 mm, 4.66 ± 2.03 mm, and 3.51 ± 1.66 mm, respectively, at the bone level. Mean (±standard deviation) relapse for the TB, BB, and OMI appliances at 1 year postoperatively measured 1.44 ± 1.01 mm, 0.76 ± 1.37 mm, and 0.27 ± 1.63 mm, respectively, at the tooth level and 1.19 ± 0.93 mm, 0.71 ± 0.96 mm, and 0.12 ± 1.56 mm, respectively, at the bone level. Analysis of variance and the Tukey test showed significant differences between the TB and OMI appliances for expansion and relapse (P = .034 and P = .024, respectively). The overall complication rate differed significantly (P < .001), with rates of 17.2%, 66.7%, and 15.4% for the TB, BB, and OMI appliances, respectively. CONCLUSIONS: BB and OMI appliances resulted in less relapse. Owing to the high complication rate, the further use of BB appliances is questionable.

Hospital Based Quality of Life in Oral Cancer Surgery.

The diagnosis of cancer and its treatment have an incomparable impact on a patient's life. In the early postoperative stages after the surgical treatment of oral squamous cell carcinoma (OSCC), functions and well-being are limited, which leads to a fundamental decline of the quality of life (QoL). To date, no studies have been performed that focus on the development of special aspects during the time of the in-patient stay of OSCC patients. With the results of this cross-sectional study, we are able to identify those patients who tend to require special support. This cross-sectional study determined the postoperative QoL with a questionnaire (QU) that was handed out twice to OSCC patients after surgery during their inpatient stay. The questions were based on the European Organisation for Research and Treatment of Cancer (EORTC)'s Quality of Life Questionnaire (QLQ)-C30 and QLQ-H&N35. In our study, we found that for postoperative OSCC patients, eating, swallowing and speech were influenced the most. After decannulation, tracheotomy showed no impact on functions. Social contact was impaired at both timepoints. Especially female patients consider themselves to be more impaired on the scale of social contact. QoL should be checked with a standardized QU as an established tool during hospitalization in every oncology department. Only this procedure can pinpoint those patients who have struggles with their surgical outcome and need more assistance.

Temporary tracheotomy in microvascular reconstruction in maxillofacial surgery: Benefit or threat?

BACKGROUND: Temporary tracheotomies are often used in oral microvascular flap reconstruction surgery to secure postoperative airway management and avoid emergency tracheotomies. Even when planned electively, a tracheotomy can cause severe and life-threatening complications. The aim of this study was to evaluate the complications of tracheotomies performed on oral cancer patients with microvascular flap reconstructions and differentiated patterns, which could lead to postoperative complications. METHODS: 150 patients, treated in the Department of Oral and Maxillofacial Surgery from March 2017 to August 2018, were included in this study. Patient records and perioperative data were analysed and the following specific items were evaluated: time after surgery until removal of the tracheal cannula, complications, cause and point of time of reinsertion of the cannula, anticoagulative treatment, ASA grade (American Society of Anaesthesiologists), TNM stage, and patient-specific data. RESULTS: 30 patients (20%) developed tracheotomy-associated complications, most commonly pneumonia (50%). There was a significant correlation between the time period until removal of the cannula and the occurrence of complications such as pneumonia and bleeding. CONCLUSION: The results of our study lead us to recommend continuing to perform temporary tracheotomies in oral cancer surgery with microvascular flap reconstruction. The overall complication rate is low and postoperative airway management can be performed in a safe and controlled manner. Nevertheless, the time period for the inserted cannula should be kept as short as possible.

Skeletal-versus soft-tissue-based cephalometric analyses: is the correlation reproducible?

OBJECTIVES: Dentofacial deformities can be analyzed by skeletal and soft tissue cephalometric analysis (CA). The aim was to evaluate the difference in reproducibility between both methods. MATERIALS AND METHODS: Lateral cephalograms of 112 patients (65 females and 47 males, 27.7 ± 9.0 years) were oriented in natural head position (NHP) and digitized. The distances of skeletal (SNA, SNB, SnPog) and soft tissue (A', B' and Pog') landmarks relative to the respective norm values and the angles between the Nasion Sella line (NSL) and Frankfurt horizontal (FH) to NHP were measured for statistical evaluation and compared with respective data of an adult control group (CG) with class I occlusion and harmonic facial balance. RESULTS: The mean differences (mm ± SD) of skeletal and soft tissue landmarks were -2.4 ± 4.4 (A), -7.0 ± 9.3 (B), -6.3 ± 11.2 (Pog), -0.9 ± 1.8 (A'), -4.7 ± 6.2 (B'), and -6.1 ± 7.8 (Pog'), respectively. Pearsons's correlation (r) between the measurements of SNA/A', SNB/B' and SNPog/Pog' were r = .158 (p = .092), r = .662 (p < .001) and r = .655 (p < .001), respectively. The mean (±SD) angles between NSL and FH to NHP were -9.8° ± 5 and 0.0° ± 3.9, respectively. CONCLUSION: Variability of cranial-based measurements could give a possible explanation for the high variation and the low reproducibility of skeletal cephalometric analysis with soft tissue measurements. Soft-tissue cephalometric analysis would probably improve facial analysis and treatment planning.

Comparative analysis of bone regeneration behavior using recombinant human BMP-2 versus plasmid DNA of BMP-2.

Bone regeneration and the osteoinductive capacity of implants are challenging issues in clinical medicine. Currently, recombinant growth factors and nonviral gene transfer are the most frequently investigated methods for bone growth enhancement, although the more favorable method remains unclear. There is a lack of knowledge in literature about the in vivo comparison of these methods for bone regeneration. BMP-2, which is the most commonly used growth factor for osteogenesis, was applied at its most efficient dose as a recombinant growth factor (rhBMP-2) and as a growth-factor-encoding copolymer protected gene vector (pBMP-2) in a critical size bone defect (CSD) model to determine the most suitable method for bone regeneration. CSDs were induced bilaterally in 32 Sprague-Dawley rats. RhBMP-2 (62.5 µg) or pBMP-2 (2.5 µg) was embedded in poly(d,l-)lactide-coated titanium discs. Survival times were set at 14, 28, 56, and 112 days. After euthanasia, samples were analyzed via micro-computed tomography, polychrome sequential fluorescent labeling, and immunohistochemistry. Whereas defects in both groups were bridged with new bone after 56 days, rhBMP-2 initially induced ectopic new bone formation that was later remodeled in an unorganized hypodense manner. In contrast, pBMP-2 led to slower but steady bone regeneration with physiological tissue morphology, as confirmed by high osteoblast activity shown by osteocalcin staining. CD68 and TRAP staining verified high osteoclast activity for the rhBMP-2 group. pBMP-2 successfully induced locally controlled physiological bone regeneration, whereas rhBMP-2 triggered rapid and ectopic but insufficient bone formation. Thus, nonviral gene transfer appears to be more favorable for clinical applications. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 163-173, 2019.

ALDH1 as a prognostic marker for lymph node metastasis in OSCC.

Long-term survival in cases of head and neck squamous cell carcinoma, particularly oral squamous cell carcinoma (OSCC), remains a rare achievement in the field of clinical oncology. In recent years, the theory of cancer stem cells (CSCs) has emerged and been used to offer explanations for tumour recurrence and metastasis. The present aim was to investigate the role of aldehyde dehydrogenase 1 (ALDH1) as a CSC-marker for OSCC and to determine the role of p16ink4a, which is also a surrogate marker of human papilloma virus (HPV), in the expression of ALDH1. The study cohort comprised of 186 surgically-treated cases of OSCC. The primaries were located in the oral cavity. The expression of the CSC marker (CSCM) ALDH1 was evaluated via immunohistochemistry (IHC) of a tissue microarray. HPV detection was performed by polymerase chain reaction and an HPV Array kit. Furthermore, the IHC expression of p16ink4a was also analysed. Risk regression models as the Kruskal Wallis test was used to assess the association of CSCM and p16ink4a expression with tumour size and lymph node metastasis, and cox proportional hazards were analysed. Additionally, coexpression of the markers ALDH1 and p16ink4a was analysed with regard to associations with tumour classification. Overall, high expression of ALDH1 in lymph nodes was significantly associated with Union for International Cancer Control (UICC) stage IV (P=0.044) and T4 stage cancer (P=0.03). p16ink4a positivity, in cases of HPV negativity, was associated with worse survival rate compared with that of the total cohort (P=0.048). Collectively the data indicate that ALDH1 expression may be suitable for detection of unfavourable prognosis in OSCC patients, based in part on its apparent role as a marker of metastasis. HPV status was not statistically predictive of patient outcome or CSCM expression; however, p16ink4a remains a potential marker in HNSCC Further in vitro studies with ALDH1 and p16ink4a should be performed to evaluate the expression of ALDH1 and HPV in cell culture and to clarify the role of ALDH1 as a marker for increased invasiveness of OSCC cells.

Improving results in rat fracture models: enhancing the efficacy of biomechanical testing by a modification of the experimental setup.

BACKGROUND: Animal fracture models, primarily performed in rats, are crucial to investigate normal and pathological bone healing. However, results of biomechanical testing representing a major outcome measure show high standard deviations often precluding statistical significance. Therefore, the aim of our study was a systematical examination of biomechanical characteristics of rat femurs during three-point bending. Furthermore, we tried to reduce variation of results by individually adapting the span of bearing and loading areas to the bone's length. METHODS: We examined 40 paired femurs of male Wistar-rats by DXA (BMD and BMC of the whole femur) and pQCT-scans at the levels of bearing and loading areas of the subsequent biomechanical three-point bending test. Individual adjustment of bearing and loading bars was done respecting the length of each specimen. Subgroups of light (< 400 g, n = 22) and heavy (> 400 g, n = 18) animals were formed and analysed separately. We furthermore compared the results of the individualised bending-setting to 20 femurs tested with a fix span of 15 mm. RESULTS: Femurs showed a length range of 34 to 46 mm. The failure loads ranged from 116 to 251 N (mean 175.4 ± 45.2 N; heavy animals mean 221 ± 18.9 N; light animals mean 138.1 ± 16.4 N) and stiffness ranged from 185 N/mm to 426 N/mm (mean 315.6 ± 63 N/mm; heavy animals mean 358.1 ± 34.64 N/mm; light animals mean 280.8 ± 59.85 N/mm). The correlation of densitometric techniques and failure loads was high (DXA R2 = 0.89 and pQCT R2 = 0.88). In comparison to femurs tested with a fix span, individual adaptation of biomechanical testing homogenized our data significantly. Most notably, the standard deviation of failure loads (221 ± 18.95 N individualized setting vs. 205.5 ± 30.36 N fixed) and stiffness (358.1 ± 34.64 N/mm individualized setting vs. 498.5 ± 104.8 N/mm fixed) was reduced by at least one third. CONCLUSIONS: Total variation observed in any trait reflects biological and methodological variation. Precision of the method hence affects the statistical power of the study. By simply adapting the setting of the biomechanical testing, interindividual variation could be reduced, which improves the precision of the method significantly.

Malignant Peripheral Nerve Sheath Tumor in the Course of the Mandibular Nerve.

OBJECTIVE: Malignant peripheral nerve sheath tumors are infiltrating, aggressive tumors that are soft tissue sarcomas. This article describes 3 patients with a tumorous swelling in the entire inferior alveolar nerve suspicious for malignant peripheral nerve sheath tumor, which is particularly rare in the trigeminal nerve. Diagnostic tools, surgical proceedings, and reconstructive procedures are presented. METHODS: Three male patients (age range, 58-68 years) with numbness, pain, and mild swelling in the sensory area served by the mental nerve presented to the Department of Oral and Maxillofacial Surgery and underwent diagnostic work-up including computed tomography, magnetic resonance imaging, fluorodeoxyglucose-positron emission tomography/computed tomography, and biopsy of the clinically visible tumor mass with histopathologic and molecular pathologic analysis. RESULTS: Magnetic resonance imaging revealed the full extent of the tumor comprising the course of the entire mandibular nerve (1 case bilateral) starting in the trigeminal ganglion through the inferior alveolar nerve and ending in the mental foramen. Both a neurosurgical and a maxillofacial intervention with jaw replacement were necessary. Adjuvant radiation of intracranial closed resection margins and, in 1 case, of parts of the mandible was required. CONCLUSIONS: To reveal the full extent of tumor spread of malignant peripheral nerve sheath tumors, sufficient preoperative imaging is crucial, as it is an important step in therapy planning. Magnetic resonance imaging and positron emission tomography/computed tomography have the best prospect of success in depicting the full extent of disease. Radical surgical management is the treatment of choice, whereas radiochemotherapy has an ancillary part.

Whole bone testing in small animals: systematic characterization of the mechanical properties of different rodent bones available for rat fracture models.

OBJECTIVES: Rat fracture models are extensively used to characterize normal and pathological bone healing. Despite, systematic research on inter- and intra-individual differences of common rat bones examined is surprisingly not available. Thus, we studied the biomechanical behaviour and radiological characteristics of the humerus, the tibia and the femur of the male Wistar rat-all of which are potentially available in the experimental situation-to identify useful or detrimental biomechanical properties of each bone and to facilitate sample size calculations. METHODS: 40 paired femura, tibiae and humeri of male Wistar rats (10-38 weeks, weight between 240 and 720 g) were analysed by DXA, pQCT scan and three-point-bending. Bearing and loading bars of the biomechanical setup were adapted percentually to the bone's length. Subgroups of light (skeletal immature) rats under 400 g (N = 11, 22 specimens of each bone) and heavy (mature) rats over 400 g (N = 9, 18 specimens of each bone) were formed and evaluated separately. RESULTS: Radiologically, neither significant differences between left and right bones, nor a specific side preference was evident. Mean side differences of the BMC were relatively small (1-3% measured by DXA and 2.5-5% by pQCT). Over all, bone mineral content (BMC) assessed by DXA and pQCT (TOT CNT, CORT CNT) showed high correlations between each other (BMC vs. TOT and CORT CNT: R2 = 0.94-0.99). The load-displacement diagram showed a typical, reproducible curve for each type of bone. Tibiae were the longest bones (mean 41.8 ± 4.12 mm) followed by femurs (mean 38.9 ± 4.12 mm) and humeri (mean 29.88 ± 3.33 mm). Failure loads and stiffness ranged from 175.4 ± 45.23 N / 315.6 ± 63.00 N/mm for the femurs, 124.6 ± 41.13 N / 260.5 ± 59.97 N/mm for the humeri to 117.1 ± 33.94 N / 143.8 ± 36.99 N/mm for the tibiae. Smallest interindividual differences were observed in failure loads of the femurs (CV% 8.6) and tibiae (CV% 10.7) of heavy animals, light animals showed good consistency in failure loads of the humeri (CV% 7.7). Most consistent results of both sides (left vs. right) in failure loads were provided by the femurs of light animals (mean difference 4.0 ± 2.8%); concerning stiffness, humeri of heavy animals were most consistent (mean difference of 6.2 ± 5%). In general, the failure loads showed strong correlations to the BMC (R2 = 0.85-0.88) whereas stiffness correlated only moderate, except for the humerus (BMC vs. stiffness: R2 = 0.79). DISCUSSION: Altogether, the rat's femur of mature specimens showed the most accurate and consistent radiological and biomechanical results. In synopsis with the common experimental use enabling comparison among different studies, this bone offers ideal biomechanical conditions for three point bending experiments. This can be explained by the combination of a superior aspect ratio and a round and long, straight morphology, which satisfies the beam criteria more than other bones tested.

Comparison of contact radiographed and stained histological sections for osseointegration analysis of dental implants: an in vivo study.

OBJECTIVES: Histology is still regarded as the gold-standard to determine bone implant contact (BIC) as a parameter representing implant stability. As the further processing of cut slices for contact radiography (CR) to stained and polished histological sections is time consuming and error prone, our aim was to assess agreement between CR and Giemsa-eosin (GE) stained sections with regard to dental implants. STUDY DESIGN: Threaded dental titanium implants (n = 54) from the maxillae of Goettingen minipigs were evaluated. After 28 and 56 days, BIC and the ratio of bone volume to total volume (BV/TV; 1000 µm) were determined on the same sections by using CR and GE staining, and the results were compared. RESULTS: Moderate differences for BIC (0.6%; P = .53) and BV/TV (1.3%; P = .01) between the methods were determined, in which CR overestimated BIC and BV/TV. A strong correlation was seen between the modalities concerning BIC (28 days: r = 0.84; 56 days: r = 0.85; total: r = 0.85) and BV/TV (r = 0.96; r = 0.94; r = 0.96; all: P < .0001). CONCLUSIONS: CR enabled determination of the bone-to-implant interface in comparison with GE-stained sections. BIC and BV/TV were slightly overestimated but correlated strongly between the methods. Therefore, if BIC and BV/TV are sufficient endpoints, CR is adequate and no further preparation and staining are necessary.

EGFR and Cortactin: Markers for potential double target therapy in oral squamous cell carcinoma.

Survival periods of patients following surgical therapy of oral squamous cell carcinoma (OSCC) have previously been demonstrated to decrease over recent decades. Epidermal growth factor receptor (EGFR) and Cortactin are molecular markers that are important in tumour progression and development, and interact within the EGF pathway. Although EGFR antibody therapy exists, sufficient efforts for increased survival are still lacking due to the present limited response rates. The aim of the present study was to examine the association between EGFR and Cortactin expression on survival rates of OSCC patients and to determine whether EGFR and Cortactin expression levels are associated with advanced tumor sizes and lymphnode-metastases. In total, 222 OSCC patients were included in the study. EGFR and Cortactin expression in tumor tissue was evaluated by immunohistochemistry. Cox regression was used for survival analysis. Categories were tested for associations by using cross tabs (Chi-square test). Groups were compared by the non-parametric Mann Whitney U-test. Probabilities of less than 0.05 were considered significant and significant expression of Cortactin was observed in Advanced Union Internationale Contre le Cancer stage (P=0.032), including advanced tumour stage (P=0.021) and lymph node metastasis (P=0.049). High Cortactin expression was significantly associated with poorer survival rates (P=0.037). Further Cortactin expression was not associated with extracapsular spread, however EGFR exhibited a significant association (P=0.034). Neither EGFR nor Cortactin expression was correlated to grading. EGFR and Cortactin co-expression was demonstrated to be significantly associated with poorer survival rates in OSCC patients, suggesting that identification of predictive biomarkers for adjuvant therapies are of primary concern in OSCC. In particular, efficient dual-target therapy may act as an appropriate therapy to improve survival time for patients at advanced OSCC tumor stages.

Mammary analogue secretory carcinoma of salivary glands: diagnostic pitfall with distinct immunohistochemical profile and molecular features.

Mammary analogue secretory carcinoma (MASC) is a newly defined entity among salivary gland malignancies which has just been established in the 4th edition of the WHO classification of head and neck tumors. MASC (synonym: secretory carcinoma) are characterized by a specific rearangement of the ETV6 gene locus. Here, we present a series of 3 MASC cases including clinical data with follow-up for up to 26 months. All tumours immunhistochemically displayed strong positivity for cytokeratin 7, and mammaglobin, focal positivity for S100, cytokeratin 5/6 and muc-4. In contrast, immunhistochemical stainings against cytokeratin 14, hormon receptors, Her2/neu, androgen receptor and prostate-specific antigen were consistently negative. FISH analysis showed translocation of the ETV6 gene locus in the majority of tumour cell nuclei. During clinical follow-up, no local relapse or metastasis was detected. As these carcinomas are clinically and radiologically indistinguishable from other salivary gland tumours and as therapeutic approaches and prognosis might differ, we need to be able to diagnose MASC correctly.

Fully automated segmentation of callus by micro-CT compared to biomechanics.

BACKGROUND: A high percentage of closed femur fractures have slight comminution. Using micro-CT (µCT), multiple fragment segmentation is much more difficult than segmentation of unfractured or osteotomied bone. Manual or semi-automated segmentation has been performed to date. However, such segmentation is extremely laborious, time-consuming and error-prone. Our aim was to therefore apply a fully automated segmentation algorithm to determine µCT parameters and examine their association with biomechanics. METHODS: The femura of 64 rats taken after randomised inhibitory or neutral medication, in terms of the effect on fracture healing, and controls were closed fractured after a Kirschner wire was inserted. After 21 days, µCT and biomechanical parameters were determined by a fully automated method and correlated (Pearson's correlation). RESULTS: The fully automated segmentation algorithm automatically detected bone and simultaneously separated cortical bone from callus without requiring ROI selection for each single bony structure. We found an association of structural callus parameters obtained by µCT to the biomechanical properties. However, results were only explicable by additionally considering the callus location. CONCLUSIONS: A large number of slightly comminuted fractures in combination with therapies that influence the callus qualitatively and/or quantitatively considerably affects the association between µCT and biomechanics. In the future, contrast-enhanced µCT imaging of the callus cartilage might provide more information to improve the non-destructive and non-invasive prediction of callus mechanical properties. As studies evaluating such important drugs increase, fully automated segmentation appears to be clinically important.

Ectopic meningioma of the mandible in a 20-year-old woman: a case report and literature review.

Ectopic meningiomas are a very rare tumor entity. We present a case of a meningioma arising in the mandible of a young woman and initially supposed to be a radicular cyst. Histopathological and immunhistochemical evaluation showed typical cell characteristics of a meningioma. Only six cases of ectopic meningiomas in the mandible have been described in the literature until now, mainly in women at an advanced age and with surgical removal of all tumors. For the first time, no surgical excision has been performed in this case and follow-up control after 12 months showed no significant progression or increasing clinical complaints. Hence, surgical removal seems non-urgent. In conclusion, unclear lesions of the jaws, even if they seem to be clear following diagnostics, should be evaluated by incisional biopsy and histopathological evaluation.

Functional analysis of bioactivated and antiinfective PDLLA - coated surfaces.

Common scaffold surfaces such as titanium can have side effects; for example, infections, cytotoxicity, impaired osseointegration, or low regeneration rates for bone tissue. These effects lead to poor implant integration or even implant loss. Therefore, bioactive implants are promising instruments in tissue regeneration. Osteoinductive elements-such as growth factors and anti-infectives-support wound healing and bone growth and thereby enable faster osseointegration, even in elderly patients. In this study, titanium surfaces were coated with a poly-(d,l-lactide) (PDLLA) layer containing different concentrations of copolymer-protected gene vectors (COPROGs) to locally provide bone morphogenetic protein-2 (BMP-2) or activated anti-infective agents, such as chlorhexidine gluconate, triclosan, and metronidazole, to prevent peri-implantitis. The coated titanium implants were then loaded with osteoblasts, NIH 3T3 fibroblasts, and human mesenchymal stem cells in 96-well plates. When shielded by COPROGs as a protective layer and resuspended in PDLLA, BMP-2-encoding pDNA at relatively low doses (5.63 µg/implant) induced the local expression of BMP-2. A linear dose dependence, which is common for recombinant growth factors, was not found, probably due to the retention property of the PDLLA surface. PDLLA, in general, successfully retains additional elements, such as osteoconductive growth factors (BMP-2) and anti-infective agents, which was demonstrated using metronidazole, and thus prevents the systemic application of excessive doses. These bioactive implant surfaces that provide the local release of therapeutic gene vectors or anti-infective agents allow the controlled stimulation of the implant and scaffold osseointegration. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 1672-1683, 2017.

Evaluating tumour after care in oral squamous cell carcinoma: Insights into patients' health related quality of life.

INTRODUCTION: Tumour aftercare (tac) is an essential tool in oncology. The main aim of these follow ups is to diagnose recurrence and second tumours from the beginning. Tac appointments can create a special environment for patients' further concerns. The purpose of the current study was to evaluate tac of patients diagnosed with OSCC and to investigate their health related quality of life (hrql). MATERIAL AND METHODS: A German questionnaire was created by two maxillo-facial surgeons with several years of tac experience. It was handed out to 100 German-speaking OSCC patients during tac. Results were statistically evaluated with SPSS (SPSS version 21.0; SPSS, IBM; Chicago, IL, USA). The inclusion criterion was that diagnosis and surgery were performed at our department and that the patients attended our tac regularly. RESULTS: Side effects such as difficulties in speaking and swallowing were evaluated as being significantly higher in cases who were administered adjuvant radiochemotherapy (art) compared with the surgical therapy group (stg) (p = 0.03). Anxiety occurred in 80% of all female patients (p = 0.02), 90% of them with a high psychological strain because of the cancer diagnosis (p = 0.04). DISCUSSION: To date, tac is a rare topic in literature. Moreover, only a few trials have focused on hrql in OSCC. A main result of the current study is that during tac, OSCC patients should be regularly questioned about their symptoms and mental state. Further, the need of the majority of OSCC patients for coping therapies can concomitantly be evaluated. CONCLUSION: The evaluation of tac is of high relevance. The results of the current study have encouraged us to establish this questionnaire as a routine tool in our tac.