Prognostic implications of mucosal and deep margin distances according to T-status in oral tongue squamous cell carcinoma: A single-center retrospective study.

OBJECTIVE: To elucidate the prognostic implications of mucosal and deep margin distances in oral tongue squamous cell carcinoma (OTSCC), and to assess a different margin cut-off value in T1-T2 versus T3-T4 tumors. METHODS: This single-center retrospective study included 223 patients who received surgery for a primary OTSCC between January 2017 and December 2021. RESULTS: Multivariable analysis showed that deep margin distance ≥3 mm in T1-T2 tumors and ≥5 mm in T3-T4 tumors was significantly associated with better RFS and OS. Mucosal and deep margin distances were globally clinically useful for 2-year RFS prediction of T1-T2 tumors, for which deep margins seemed to have more clinical utility than mucosal margins. The influence of margin distances on 2-year RFS seemed greater for T1-T2 tumors than T3-T4 tumors. CONCLUSION: Mucosal and deep margin distances were associated with OS and RFS in OTSCC. Shorter deep margin distances may be aimed for in T1-T2 versus T3-T4 tumors.

[Some scientific highlights: A selection by the students of the Master Biology-Health of Montpellier University]. / L'actualité scientifique vue par les étudiants du Master Biologie-Santé de l'université de Montpellier.

Title: L'actualité scientifique vue par les étudiants du Master Biologie-Santé de l'université de Montpellier. Abstract: L'unité d'enseignement « Immunopathologie ¼ qui propose les brèves présentées dans ce numéro est suivie par des étudiants de divers parcours du Master Biologie Santé de l'université de Montpellier. Ce Master rassemble des étudiants issus du domaine des sciences et technologies et de domaines de la santé. On y étudie les bases physiopathologiques des maladies immunologiques, les cibles thérapeutiques et les mécanismes d'échappement des microorganismes et des tumeurs Les articles présentés ont été choisis par les étudiants selon leur domaine de prédilection.

Outpatient orthognathic surgery: a prospective study of predictive factors for the length of hospital stays.

OBJECTIVES: Transitioning from non-outpatient orthognathic surgery to outpatient surgery is a new challenge, and it is essential to target the eligible population as precisely as possible. Several authors describe series of outpatient orthognathic surgery but do not include the reasons for their success or failure. The main aim of this study was to identify the factors significantly associated with "successful" outpatient orthognathic treatment. The secondary objective was to determine the factors significantly associated with prolonged hospital stays (≥ 2 nights). MATERIALS AND METHODS: A prospective cohort study including patients undergoing orthognathic surgery was conducted over a period of 1 year. We recorded the prognostic factors that contributed to successful outpatient treatment and prolonged hospital stays. These factors were evaluated by bivariate and multivariate analysis. RESULTS: A total of 102 patients were included, and the success rate of treatment was 65%. The variables that were isolated by multivariate analysis were: patients over the age of 22, procedures ending before 1 pm, brief operations, the absence of both postoperative vomiting and the administration of morphine. CONCLUSION: Patient selection, organisation of outpatient facilities and anaesthetic protocols contribute to the development of outpatient orthognathic surgery. These initial considerations provide a framework for our practice, but the considerations that predict the failure of outpatient surgery will need to be clarified. CLINICAL RELEVANCE: Orthognathic surgery can be performed on outpatient basis in selected cases. Age, the operative time, procedure end time, postoperative vomiting and the administration of morphine are associated with the success of outpatient care.

Characterization of labiomandibular movements induced after isolated LeFort I osteotomy in the surgical management of class III malocclusion.

INTRODUCTION: Maxillary surgery alone can be proposed for the surgical management of class III malocclusion, but anticipating outcomes for the labiomental muscle complex is challenging due to the mandibular autorotation phenomenon. The objective of this study was to quantify the mandibular and labiomental movements induced by maxillary osteotomy alone in the management of class III malocclusion according to different clinical and surgical variables. METHODS: The post-operative changes in mandibular and labiomental shapes were studied by geometric morphometry from the pre- and post-operative lateral cephalometric radiograph of 25 patients. The explanatory variables tested were maxillary advancement, maxillary rotation, and divergence. RESULTS: Soft tissues repositioning are different from postoperative mandibular repositioning after maxillary osteotomy. Neuromuscular adjustments of mandible depend on divergence and the maxillary rotation. Labiomental response only depends on divergence. CONCLUSION: The surgical procedure does not have the same bone-related and musculocutaneous effects on patients with the same class III malocclusion. It is therefore essential for surgeons to understand the effects of their procedure on musculocutaneous tissues in order to best anticipate post-operative outcomes.

Oncological outcomes and prognostic factors of squamous cell carcinoma of the upper gingiva and hard palate: a retrospective study.

PURPOSE: Despite sharing the same staging system as oral cavity cancers, upper gingiva and hard palate (UGHP) squamous cell carcinoma (SCC) have several features that make them a different entity. We aimed to analyze oncological outcomes and adverse prognostic factors of UGHP SCC, and assess an alternate T classification specific to UGHP SCC. METHODS: Retrospective bicentric study including all patients treated by surgery for a UGHP SCC between 2006 and 2021. RESULTS: We included 123 patients with a median age of 75 years. After a median follow-up of 45 months, the 5-year overall survival (OS), disease-free survival (DFS) and local control (LC) were 57.3%, 52.7% and 74.7%, respectively. Perineural invasion, tumor size, bone invasion, pT classification and pN classification were statistically associated with poorer OS, DFS and LC on univariate analysis. On multivariable analysis, the following variable were statistically associated with a poorer OS: past history of HN radiotherapy (p = 0.018), age > 70 years (p = 0.005), perineural invasions (p = 0.019) and bone invasion (p = 0.030). Median survivals after isolated local recurrence were 17.7 and 3 months in case of surgical and non-surgical treatment, respectively (p = 0.066). The alternate classification allowed better patient distribution among T-categories, however without improving prognostication. CONCLUSION: There is a broad variety of clinical and pathological factors influencing prognosis of SCC of the UGHP. A comprehensive knowledge of their prognostic factors may pave the way towards a specific and more appropriate classification for these tumors.

Fibula free flap perforasomes: vascular anatomical study and clinical applications.

PURPOSE: This study assesses the anatomical features of the cutaneous fibular perforators and perforasomes of fibular free flap to determine the clinical implications therein. METHODS: This anatomical study was performed with 16 fresh cadavers after selective arterial injections of inked serum. The numbers of perforators, diameter, location of the perforasome center, perforator course, the distance between perforator origin and tibiofibular division, and the perforasome area were all documented. RESULTS: Thirty-one lower legs were dissected. Eighty-eight cutaneous perforators were found, averaging 2.8 per leg (1-4). The mean diameter was 1.7 mm and decreased from proximal to distal (p < 0.001). The centers of the perforasomes were aligned on an oblique projection from proximal to distal and anterior to posterior. Seventeen perforators (19%) were musculocutaneous, all in the proximal half of the leg, whereas 71 perforators were septocutaneous (81%), including 18 in the proximal half of the leg. Six of the uppermost perforators originated from the fibular artery less than 10 mm from the tibiofibular division. The mean area perforasome was 37.2 cm2 (7.9-106 cm2) and decreased from proximal to distal (p < 0.01). CONCLUSION: Distal and proximal fibular flap perforasomes sported different features. Large skin paddles supplied by large and often intramuscular perforators were found in the proximal half of the leg. Distal skin paddles were smaller, more posterior, and featured septocutaneous perforators. These factors should be considered in the skin paddle choice during the fibular free flap harvest.

Adjuvant brachytherapy for oral squamous cell carcinomas: a single-center experience comparing low-dose and pulsed-dose-rate techniques.

OBJECTIVE: This study aims to assess the outcomes of adjuvant interstitial brachytherapy (BT) to the tumor bed for oral cavity squamous cell carcinoma (SCC), and to compare the oncological outcomes and toxicity profile of low-dose-rate (LDR) and pulsed-dose-rate (PDR) BT. DESIGN: This retrospective single-center study included all patients who underwent postoperative LDR- or PDR-BT to the tumor bed as the sole adjuvant treatment for an oral tongue or floor of the mouth SCC between January 2000 and December 2020. RESULTS: A total of 79 patients were eligible for this study. The cohort was divided into an LDR group (n = 38) and a PDR group (n = 41). The median time interval between surgery and brachytherapy was 55 days. Median delivered total dose was 55 Gy and median hospital stay was 5 days. Five patients (8.3%) experienced grade 3-4 early toxicity, 2 in the LDR group and 3 in the PDR group. Late toxicities were present in 28 patients (44.4%) and were dominated by grade 1-2 residual pain and dysesthesia, without a statistical difference between the groups. After a median follow-up of 65.1 months, 5­year local control (LC), disease-free survival (DFS), and overall survival (OS) for the whole cohort were 76.3% (95% CI = 63.4-85.1), 61.6% (95% CI = 49.0-72.0), and 71.4% (95% CI = 58.6-80.8), respectively. CONCLUSION: Adjuvant BT after excision of oral cavity SCC provides satisfactory oncological outcomes along with good tolerance. In our study, PDR-BT showed similar oncological and functional results to LDR-BT in this indication.

Surgical benefit of mandibular morphometric analysis: A new tool to standardize mandibular reconstruction.

PURPOSE: The gold-standard for reconstruction of large mandibular defects is the use of free flaps of vascularized autologous bone with the fibula as the preferred donor site. The use of "custom cutting guides" for this indication is becoming increasingly prevalent. But cost of the procedure averages around 2,500 dollars per patient excluding treatment and entails selection criteria. We think it is possible to standardize mandibular reconstructions from an anatomical mean. The objective of this study was to perform a mandibular morphometric analysis in order to obtain a set of "mean" measurements, which can be used by all surgeons interested in mandibular reconstruction. METHODS: We performed a morphometric analysis consisting of three-dimensional mandibular reconstructions of 30 men and 30 women. Several reference points were set and defined to evaluate specific lengths and angles of interest. We conducted an intra and inter-sexual descriptive analysis of measurements obtained. RESULTS: We did not identify any major intra-sexual differences within each group. The gonial angle is more open in women and the measurements characterizing the basilar contour are more prominent in men. We did not identify any differences in alveolar region parameters. CONCLUSION: The results of this study constitute a morphological tool for surgeons, from bone graft to free flap. These results also confirm us that the use of «custom cutting guides¼ for mandibular reconstruction may be excessive. It is pertinent to examine the value of "custom made" mandibular reconstructions since the differences observed are of the order of millimeters.

Ultrasound-Guided Proximal and Distal Suprascapular Nerve Blocks: A Comparative Cadaveric Study.

OBJECTIVES: The primary aim of our study was to evaluate and compare the accuracy of ultrasound (US)-guided distal suprascapular nerve (dSSN) and proximal SSN (pSSN) blocks. Secondary aims were to compare the phrenic nerve involvement between groups and to describe the anatomical features of the sensory branches of the dSSN. METHODS: pSSN and dSSN blocks were performed in 14 cadavers (28 shoulders). Ten mL of 0.2% ropivacaine colored with methylene blue was injected under US guidance. Accuracy was determined using SSN staining and the distance between predefined anatomical landmarks and the targeted SSN. The phrenic nerve (PN) was judged to be colored or not. The distribution of the sensory branches that originate from the 14 dSSNs is described. Quantitative data are expressed as median (range). RESULTS: The pSSN was dyed more frequently than the dSSN (13 vs 11, P = 0.59). The targeted SSN was close to the suprascapular notch (1.3 [0-5.2] cm) and the origin of the SSN (1.4 [0.2-4.5] cm) for dSSN and pSSN blocks, respectively (P = 0.62). For dSSN blocks, the most frequent injection site was the supraspinous fossa. Three PNs were marked in pSSN blocks, compared with none in dSSN blocks (P = 0.22). Three sensory branches were identified for all 14 dSSNs: the medial subacromial branch, the lateral subacromial branch, and the posterior glenohumeral branch. CONCLUSIONS: US-guided pSSN and dSSN blocks can be realized with accuracy. A distal approach to the SSN could be an alternative to interscalene brachial plexus block for the management of postoperative pain after shoulder surgery in high-respiratory risk patients.

Cutaneous Squamous Cell Carcinoma Tumour Size is Associated with Sentinel Lymph Node Metastasis in a Cohort of 69 Patients.

Ten to fifty percent of high-risk cutaneous squamous cell carcinoma may potentially metastasize. However, the concept of sentinel lymph node biopsy remains controversial for cutaneous squamous cell carcinoma. The aim of this study was to identify prognostic factors associated with sentinel lymph node positivity. A bicentric retrospective analysis was conducted between January 2006 and January 2018. All patients undergoing sentinel lymph node biopsy for high-risk cutaneous squamous cell carcinoma were included, based on the criteria of the prognostic classification of the French Society of Dermatology. Seventy-four patients were included. Five (6.8%) procedures failed. Of the 69 patients assessed, the positive sentinel lymph node biopsy rate was 11.6% (n = 8) with a false negative rate of 5.7% (n = 4). The positivity of sentinel lymph node biopsy was associated with tumour size (p = 0.0194). Sentinel lymph node biopsy is an effective staging procedure for clinically N0 high-risk cutaneous squamous cell carcinoma, with an acceptable morbidity. To date, 2 risk factors of sentinel lymph node positivity have been identified with statistical significance: tumour size and poor tumour differentiation.

Definitive radiochemotherapy or initial surgery for oropharyngeal cancer : To what extent can p16 expression be used in the decision process?

BACKGROUND: The decision between definitive radio(chemo)therapy (RCT) or a surgical strategy, i. e. surgery ± adjuvant radio(chemo)therapy for optimal treatment of oropharyngeal cancer is highly debated. Human papillomavirus(HPV)-related tumours are a distinct entity associated with p16 overexpression. While this represents a major prognostic factor, its predictive significance remains unknown. RESULTS: Among 183 consecutive unselected patients treated between 2009 and 2013 with a state-of-the-art surgical procedure ± adjuvant radio(chemo)therapy or definitive RCT including intensity-modulated radiotherapy, 3­year disease-free survival (DFS) was 74 vs. 57%, respectively (p = 0.007). When focusing on p16+ patients (49%), there was no significant difference in tumour control rate between surgery ± radio(chemo)therapy and the definitive RCT group (3-year DFS 83 vs. 82%, respectively; p = 0.48). However, delayed severe dysphagia was significantly lower in favour of definitive RCT: 35 vs. 4%, respectively; p = 0.0002. CONCLUSION: Our results highlight distinct outcomes after definitive RCT or initial surgical treatment according to p16 status, which should thus be considered during the decision process.

Prospective comparison of 18F-NaF PET/CT versus 18F-FDG PET/CT imaging in mandibular extension of head and neck squamous cell carcinoma with dedicated analysis software and validation with surgical specimen. A preliminary study.

BACKGROUND: The aim of this study is to propose a new method to quantify radioactivity with PET/CT imaging in mandibular extension in head and neck squamous cell carcinoma (HNSCC), using innovative software, and to compare results with microscopic surgical specimens. PATIENTS AND METHODS: This prospective study enrolled 15 patients who underwent 18F-NaF and 18F-FDG PET/CT. We compared the delineations of bone invasions obtained with 18F-NaF PET/CT and 18F-FDG PET/CT with the results of histopathological analysis of mandibular resections (from right and left bone borders). A method for visualization and quantification of PET images was developed. RESULTS: For all patients, a significant difference (p = 0.032 for right limits and p = 0.011 for left limits) was observed between 18F-FDG PET/CT imaging and histopathology results, and no significant difference (p = 0.88 for right limits and p = 0.55 for left limits) was observed between 18F-NaF PET/CT imaging and histopathology results. The right limits were less than 10 mm in 93% of patients, and the left limits were less than 10 mm in 86% of patients. CONCLUSIONS: The dedicated software enabled the objective delineation of radioactivity within the bone. We can confirm that 18F-NaF is a precise and specific bone marker for the assessment of intraosseous mandibular extensions of head and neck cancers. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Tomographic osteometry of the zygomatic bone applied to traumatology of facial bones: Preliminary retrospective study of zygomatic summit in 28 patients.

BACKGROUND: The available referential measures defining the zygomatic bone morphology are adequate enough for full determination of the zygoma positioning, especially for trauma surgery, but osteometric analysis of the zygoma positioning based on tomographic examinations could be useful in peroperative and postoperative imaging. In this study, we propose referential measures, taking into account the morphology and the symmetry of the zygoma. In addition, the reliability and reproducibility are considered. METHODS: Thirty normal computed tomography (CT) scans were used to establish the referential measures. The study involved preoperative imaging (27 CT and 1 cone beam CT [CBCT] scan), and postoperative imaging (6 CT and 22 CBCT scans) pertaining to 28 patients, showing a unilateral zygomatic fracture. In a precisely chosen axial cut in the orbito-meatal plane, 3 referential data were defined: namely, S, denoting the distance of the zygoma summit; αS, representing the angle between the summit and the symmetry axis passing through the clivus; and αZ, corresponding to the morphologic angle. RESULTS: The 3 referential measures S, αS, and αZ are reliable and reproducible by CT and CBCT examination. Those parameters can be used to evaluate the zygomatic symmetry. The postoperative asymmetries arise from an erroneous recovery of S, which was statistically significant at p = 0.0216. CONCLUSION: On a single optimized axial cut, the new referential measures are useful and effective in preoperative and postoperative assessment of the residual bone asymmetries. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Surgical Treatment of Facial Basal Cell Carcinoma: Patient-Based Assessment of Clinical Outcome in a Prospective Cohort Study.

BACKGROUND: There are limited data on the esthetic, functional, and morphological outcomes of surgical treatment of facial basal cell carcinoma (BCC). OBJECTIVE: The aim of our study was to assess the determinants of the evaluation of both the patients and the investigator of the esthetic, functional, and morphological impact of the surgical treatment of facial BCC. METHODS: A prospective observational study evaluated 111 patients treated surgically for facial BCCs (n = 135 BCCs), using the Patient and Observer Scar Assessment Scale (POSAS), a validated and reliable scale designed for the evaluation of all types of scars by professionals and patients. RESULTS: Scar assessment rated by the patients was very good. Skin aging was associated with a better surgical outcome as evaluated by POSAS (OR = 0.30, 95% CI: 0.09-0.98; p = 0.04). Conversely, histologically infiltrative or sclerosing BCC (OR = 2.33, 95% CI: 0.95-5.71; p = 0.06) was independently associated with poorer POSAS. In terms of the investigator's evaluation, aging signs (protective factor: OR = 0.17, 95% CI: 0.04-0.73; p = 0.01), location on the H-zone of the face (risk factor: OR = 2.95, 95% CI: 1.07-8.15; p = 0.03), and histologically infiltrative or sclerosing BCC (risk factor: OR = 2.89, 95% CI: 1.01-8.29; p = 0.04) were independently associated with POSAS. CONCLUSION: Esthetic, functional, and morphological outcomes of facial BCC surgery provide high patient satisfaction overall. Taking wider margins requires specific measures to improve the surgical outcome.

Improvement of Microstomia in Scleroderma after Carbon Dioxide Laser Treatment.

Limited mouth opening (LMO) is a frequent complication of systemic sclerosis (SS). Its management is complex and there are limited treatment options. We report four patients with SS and severe LMO [interincisal distance (IID) <30 mm] treated with pulsed carbon dioxide (CO2) laser. Pulsed CO2 laser treatment of the white lips was performed after all patients had signed a written informed consent in the absence of alternative treatment. Treatment was carried out under locoregional anaesthesia using a Sharplan 30C CO2 laser in the Silk Touch® resurfacing mode. One to three laser sessions were performed at intervals of 8-12 months between sessions. Assessments were performed at 3 and 12 months with measurement of the IID using a ruler, calculation of the Mouth Handicap in Systemic Sclerosis (MHISS) scale and global evaluation by the patients. Adverse events were also reported. In all four patients, an improvement in IID occurred 3 months after the first session with a mean gain of +5 mm (range: 2-7). At 12 months, a mean gain of +8.5 mm (range: 7-10) in IID was observed. The MHISS score decreased by a mean of •14 (range: 11-17). All patients showed improvement of lip flexibility or mouth opening, allowing better phonation and mastication and easier dental care. Adverse effects were transient erythema and/or dyschromia. CO2 laser appears to be effective and well tolerated in the improvement of LMO in SS.

A Systematic Review and Meta-Analysis of Double Venous Anastomosis in Free Flaps.

BACKGROUND: Venous problems are the most frequent causes of flap failure and surgical revision in free flap surgery. Double venous anastomosis can be used to improve flap drainage, but this procedure has not been adopted universally and remains controversial. The authors evaluated the benefits of double venous anastomosis in terms of venous thrombosis rate, surgical revision of flaps, and flap failure rate. METHODS: A systematic literature review was conducted searching the MEDLINE, PubMed Central, Cochrane, and Embase databases for articles published between 1996 and July of 2014. Data analysis consisted of evaluating the pooled relative risks of single and double venous anastomoses in fixed and random-effects models. RESULTS: The final analysis included 27 articles involving 6842 flaps. The overall success rate was 97.48 percent. Single venous anastomosis was performed in 4591 flaps versus two anastomoses in 2251 flaps. The failure rate was 3.1 percent for single anastomosis versus 1.3 percent for double anastomosis (OR, 0.511; 95 percent CI, 0.349 to 0.747; p = 0.001). The respective thrombosis rates were 3.1 percent versus 2.3 percent (OR, 0.586; 95 percent CI, 0.390 to 0.880; p = 0.010). In addition, more single venous anastomoses were revised: 7.7 percent versus 6 percent (OR, 0.601; 95 percent CI, 0.469 to 0.770; p < 0.0001). Stratified analysis by flap type did not show any significant differences. CONCLUSIONS: Although the physiologic mechanisms remain poorly understood, the data strongly support double venous anastomosis, considering the reduction in flap failure, microsurgical venous thrombosis, and surgical revision. The authors recommend double anastomosis whenever it is feasible in free flap surgery.

Interest of Mineralized Plasmatic Matrix in Secondary Autogenous Bone Graft for the Treatment of Alveolar Clefts.

The authors describe a new material termed mineralized plasmatic matrix (MPM), a combination of platelets, fibrin concentrate, and autogenous bone to repair alveolar cleft defects. Autogenous cancellous bone is widely used to this end because such bone affords the functionalities (osteogenesis, osteoinduction, and osteoconduction) required for successful outcomes. To optimize these features, autologous blood products high in platelet concentrations have recently been developed. On the basis of our experience with PRP (platelet-rich plasma) and PRF (platelet-rich fibrin), we developed MPM, which contains platelets and fibrin concentrate in a liquid state; these materials can become bound to bone particles. The filling material is easy to shape and a PRF-type membrane is also generated. Ten patients with cleft lips and alveoli, with or without cleft palates (median, or uni- or bilateral) benefited from secondary bone grafts placed using our new material. We transferred autogenous bone from the iliac crest, an abundant source of cancellous bone associated with a high success rate. The 6-month outcomes of all patients were excellent in terms of both bone graft stability and closure of the oronasal fistulae. The preparation procedure is simple and the technical requirements minimal. Upon further optimization, MPM may serve as a third-generation platelet concentrate with potential applications in various fields.

Radiolabelling rituximab with (99m)Tc in three steps procedure.

Lymphomas are the most frequent haematological malignancy. In non-Hodgkin's lymphomas (NHL), more than 90% of tumor cells express the cluster of differentiation (CD) 20 antigen. At the end of frontline therapy, the evaluation of remission is based on computed tomography (CT) and positron emission tomography coupled with computer tomography (PET/CT) with [(18)F]-fluorodeoxyglucose ([(18)F]FDG). Unfortunately, these techniques are not specific and cannot distinguish residual active tumor from inflammation. The aim of this study was to develop a specific radiotracer of NHL CD 20+ cells for clinical applications. The radiolabelling technique presented, based on the use of tricarbonyl compound, does not include an antibody reduction because this step could damage the protein. Actually, rituximab, an anti-CD 20 chimeric antibody used for the treatment of these NHL, was radiolabelled with Isolink® (99m)Tc-tricarbonyl compound in a three-step procedure without using a specific antibody reducer. Radiolabelling yield was greater than 97%. In vitro experiments showed a conservation of antibody integrity. In vivo experiments using Single-photon emission computed tomography/CT showed significant tumor targeting 24 h after injection of the radiotracer. It was consequently possible to develop an immunoradiolabelling method to specifically detect the residual disease. As this procedure is fast, reproducible and gentle, it will be possible to comply with Good Manufacturing Practices.