Radical (chemo)radiotherapy in oropharyngeal squamous cell carcinoma: Comparison of TNM 7th and 8th staging systems.

PURPOSE: To evaluate whether the 8th staging system is a better discriminator of overall survival (OS) than the 7th edition for oropharyngeal cancer patients after definitive (chemo)radiotherapy (CRT). MATERIAL AND METHODS: Data from oropharyngeal cancer patients treated with CRT with curative intent between 2010 and 2016 at Guy's and St Thomas' Hospitals were reviewed. Human papillomavirus (HPV) status was ascertained in all cases. Patients were staged using the 7th edition and the 8th edition TNM staging system. Demographics, tumor characteristics and treatment response data were included in univariate and multivariate analysis for OS. OS and disease-free survival (DFS) were estimated using the Kaplan-Meier method. In addition, a multivariate survival Cox regression analysis of several clinical variables was performed. RESULTS: A total of 273 patients were included. The median follow-up was 4.7 years. Overall 63 patients died. In multivariate analysis, HPV status, complete response at 3 months and ≤21 units/week alcohol were prognostic for OS. For the entire cohort, the 5-year OS and DFS rates were 78.1% (95% confidence interval CI 0.719-0.831) and 73.9% (95% CI 0.677-0.792), respectively. Better stratification of OS and DFS was recorded by 8th edition for the entire cohort. In HPV-positive cases, risk stratification based on tobacco smoking and nodal stage resulted in statistically higher discrimination in OS rates (5-year OS 90.7% in low risk patients and 84.6% in intermediate risk, p = 0.05) and DFS rates (5-year DFS 91.5% in low risk and 76.1% in intermediate risk, p = 0.001). CONCLUSION: The 8th edition TNM staging system provides better OS stratification in oropharyngeal cancer after definitive CRT compared with the 7th edition. Other clinical variables, such as complete response at 3 months, alcohol and tobacco smoking, should also be considered in future classifications as they provide additional risk stratification information in both HPV-positive and HPV-negative disease.

Real-time optical vascular imaging: a method to assess the microvascular circulation of myofascial free flaps used in the head and neck region.

Microvascular free flaps are considered the gold standard in head and neck reconstructive surgery. Myofascial flaps, in particular, are useful in certain oral and maxillofacial reconstruction cases, where mucosal regeneration over the transplanted tissue is planned. Despite high success rates, 1-6% of free flaps fail. A plethora of methods are available to assess transplanted tissue viability after reconstruction, including clinical observational monitoring, surface Doppler, implantable Doppler probe, colour Doppler sonography, laser Doppler flowmeter, surface temperature and indocyanine green angiography. However, no method has demonstrated adequate reliability or has proven to be cost-effective. The authors tested a technique called real-time optical vascular imaging to evaluate the microvascular circulation of myofascial free flaps. This technique was develop at Guy's Hospital, London to observe the microvascular anatomy of the oral cavity in vivo, non-invasively and without the need for patient preparation, with the aim of detecting and monitoring oral diseases. This technology detects the red blood cells flowing inside the microvasculature at a depth of approximately 2mm, allowing the microvascular architecture and blood flow to be determined. This study showed that RTOVI may prove to be beneficial for the early detection of vascular compromise due to its immediacy and the feasibility of assessing multiple graft tissue regions.

Comparing disciplines: outcomes of non melanoma cutaneous malignant lesions in oral and maxillofacial surgery and dermatology.

300 cases of non-melanoma cutaneous lesion procedures carried out by the Oral and Maxillofacial Surgery and Dermatology departments in a North West London hospital over a 6 month period between September 2011 and February 2012 were included in a retrospective case control study. The results from each speciality were compared. The mean age of the OMFS group was 75.8 years compared to 69.9 years in the dermatology group. There was no statistically significant difference in gender between the 2 groups. The OMFS group treated a higher proportion of atypical (17%) and malignant (64.9%) cases compared to the dermatology group (11.3% and 50.5% respectively). This could also account for the fact that the OMFS group carried out a higher number of full excisions compared to dermatology. Both groups had a similar number of false positives (a benign lesion initially diagnosed as malignant) and a similar proportion of false negatives (a malignant lesion initially diagnosed as benign). Overall, the results show that both specialities had similar outcomes when managing non-melanoma cutaneous lesions. Both groups adhere to the guidelines set out by the British Association of Dermatologists and the National Institute of Clinical Excellence when managing such lesions.

Guidelines for management of sodium hypochlorite extrusion injuries.

Sodium hypochlorite (NaOCl) is the most common irrigant used in modern endodontics. It is highly effective at dissolving organic debris and disinfecting the root canal system due to the high pH. Extravasation of NaOCl into intra-oral and extra-oral tissues can lead to devastating outcomes leading to long-term functional and aesthetic deficits. Currently no clear guidelines are available which has caused confusion among the dental and oral and maxillofacial (OMFS) surgical community how best to manage these patients. Following a literature review and considering our own experience we have formulated clear and precise guidelines to manage patients with NaOCl injury.

Advances in imaging of obstructed salivary glands can improve diagnostic outcomes.

INTRODUCTION: Obstruction of the major salivary glands is a relatively common condition defined as the blockage of the salivary outflow in the glandular ductal system. It can however mimic more aggressive pathology. METHODS: The most common cause of salivary obstruction is sialolithiasis, followed by ductal strictures. Salivary obstruction is clinically characterized by a food-related painful swelling of the affected gland, known as 'mealtime syndrome'. RESULTS: When obstruction is clinically suspected, the role of imaging consists of confirming the obstruction, identifying its cause, evaluating the position and extent of the obstruction and evaluating for associated complications. However, if imaging shows up signs of a tumour or other pathology which can mimic an obstructed gland clinically instead, the radiologist can alert the clinician accordingly to change the course and plan of treatment. Several imaging techniques are available for investigating the obstructed salivary glands. CONCLUSIONS: This review looks at the causes of obstruction and the use, diagnostic performance and practicality of the various imaging modalities. Importantly, an imaging approach algorithm for the evaluation of the obstructed salivary gland is also proposed.

A synopsis of technical notes published in the British Journal of Oral and Maxillofacial Surgery in 2009/2010.

Technical notes form an important part of the British Journal of Oral and Maxillofacial Surgery (BJOMS). Many ideas are novel and some change practice. During 2009-2010, 39 technical notes were published in the journal, and they covered the whole remit of the specialty. In this article we briefly review and summarise these articles, and highlight the salient points.

Serum testosterone levels in surgeons during major head and neck cancer surgery: a suppositional study.

Serum testosterone levels are known to have diurnal variation and to decrease by up to 2% per year after the age of 40. They can also be affected by stress and aggressive behaviour as well as various medical conditions. Although studies have investigated the role of mood and stress, none has specifically evaluated the effect of operative procedures on surgeons testosterone levels, particularly those in our own specialty, one that has historically been associated with perceived 'high testosterone' levels. We devised a suppositional study, particularly pertinent for publication at the beginning of April. This was a prospective randomised study of five male consultant maxillofacial surgeons (including two with male pattern baldness) and assayed serum testosterone levels at rest, during, and after a series of major ablative and reconstructive procedures. The resting testosterone levels were found to be similar in all surgeons (220 ± 120.9 mcg/ml). During major head and neck procedures, a statistically significant increase in serum testosterone was found (up to a maximum concentration of 1062.50 mcg/ml). Multivariate analysis revealed that the likely predictors of increasing serum testosterone were: size and extent of tumour and complexity, and type of microvascular reconstruction (all P<0.001). The long-term effects of chronically raised serum testosterone warrant further investigation but recent evidence has found that it may be cerebro-protective against conditions including Alzheimer's syndrome.

Short communication articles published in BJOMS during 2008-2009--an analysis of types of submission and subject material.

The British Journal of Oral and Maxillofacial Surgery (BJOMS) accepts many types of papers that include leading articles, reviews, full length articles, and short communications. Many of the latter are isolated case reports of rare or interesting pathology, or personal experience of a difficult or unexpected complication. Case reports are considered to have a relatively low value in the advancement of medical knowledge, and with increasing pressure for space in paper publications, many journals now limit them to online publication only. We evaluated all 142 short communications published in BJOMS during 2008/2009. Most (87%) were single case reports, and they covered virtually the whole remit of the specialty. There were also 14 formal studies that included two laboratory-based research projects; these were excluded from the analysis. We used established criteria to assess the possible educational value of each publication, and found that 61/128 papers (48%), while interesting and informative, probably added little to existing knowledge. The remaining papers described new or unreported cases, rare or unexpected outcomes, and adverse effects or complications of treatment. We discuss the possible implications of this study for readers of BJOMS and for the journal itself.

Orthognathic surgery and related papers published in the British Journal of Oral and Maxillofacial Surgery 2008-2009.

This paper provides a review of articles relating to deformity, orthognathic surgery, and distraction osteogenesis published in the British Journal of Oral and Maxillofacial Surgery during 2008 and 2009. A total of 42 papers (26 full length articles, 5 technical notes, and 11 short communications or letters to the editor) were published. It was pleasing that 62% were full length articles; this is encouraging as such papers have a high educational value and are likely to be cited in future publications.

A synopsis of oncology and oncology-related papers published in the British Journal of Oral and Maxillofacial Surgery 2007-2008.

This paper provides a summary of the 95 papers related to oncology that were published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) during 2007-2008. They include full length articles on clinical studies, radiology, basic science, and reconstruction in oral, and head and neck cancer. The journal also publishes technical notes and short communications. It encompasses the whole remit of the specialty and it is encouraging that authors choose to submit their work to BJOMS, but to improve the quality and status of the journal, we need to increase the ratio of full length articles to other submissions. Reviews of other subspecialties will be published in due course.

Dog bite- fracture of the mandible in a 9 month old infant: a case report.

BACKGROUND: We present the case of a fractured mandible due to a dog bite in a 9 month old female. Dog bites in this age group are rare as are fractured mandibles. There are only two reported cases of fractured mandibles due to dog bites in the literature. This is the youngest. The other reported cases were in a 1 year old and also in a 4 year old. CASE PRESENTATION: A 9 month old female was brought by her parents to the Emergency Department after sustaining a dog bit to the face. This was assessed by the emergency physicians and deemed to be superficial. The patients wounds were irrigated, and she was given oral antibiotics. She was transferred to our department were she was assessed under anaesthetic. A fracture of her mandible was discovered and treated with open reduction and internal fixation. CONCLUSION: The case presentation highlights the important of proper assessment of facial lacerations for not only neurovascular status and the parotid duct, but also the hard tissues. The case also highlights the difficulty of treating children and infants with fractures of the mandible and the importance of follow-up to monitor growth.

Maxillary etymologies.

Our vocabulary grows as undergraduates, and continues to develop as we continue to grow as dental professionals. For many of us not learned in Latin or Greek, we are too busy learning what words mean rather than appreciating why a word means what it does. This article aims to clarify where words relating to the maxilla are derived from, why they are used and how they are related to other similar words in everyday use.