Free Flap Outcomes of Microvascular Reconstruction after Repeated Segmental Mandibulectomy in Head and Neck Cancer Patients.

This is the first study to investigate the impact of a second fibula flap or a soft tissue flap combined with bridging plate for a repeated segmental mandibulectomy reconstruction on flap outcomes in head and neck cancer patients. A retrospective comparative analysis (2007-2016) of 61 patients who underwent a second segmental mandibulectomy was performed. 20 patients underwent a fibula flap reconstruction whereas 41 had a soft tissue flap and plate reconstruction. No significant difference was seen in the operative time, total hospital stay, flap loss, re-exploration rates, plate exposure rate, or recipient site infection rate. On multivariate analysis, patients reconstructed with a soft tissue flap and bridging plate (odds ratio (OR) 3.997; 95% confidence interval (CI), 1.046-15.280, p = 0.043) and complications developed in previous surgery (OR 4.792; 95% CI, 1.120-20.493, p = 0.035) were shown to be independent predictors of a prolonged nasogastric tube dependence. The utilization of a soft tissue flap with plate is associated with comparative results of acute complication rate within 1 week, recipient site infection rate, and plate exposure rate to free fibula flaps alone. Free fibula flaps may result in a decreased risk for prolonged tube dependence compared to free soft tissue flap reconstructions.

Vascularized mandibular anterior ameloblastoma - an entity still unresolved.

Vascularized ameloblastoma is a bewildering entity whose existence is questionable from its origin to nosology and its very characterization as a distinct variant of ameloblastoma. This uncertainty is largely because of a fewer number of documented cases and loss of long-term follow-up. The current paper describes two cases of ameloblastoma in the mandibular anterior region, which had features of so-called "hemangiomatous ameloblastoma" as it was originally described. Understanding its pathophysiology based on various views and clinical implications in terms of its biologic behavior are brought to light in this paper.

Contemporary reconstruction of the mandible.

Reconstruction of the mandible has evolved significantly over the last 40years. Early attempts were often disfiguring and wrought with complications but with the introduction of free tissue transfer of well vascularized bone in the 1970's there was a significant improvement in outcomes. In recent years the harvest, inset, and microvascular anatomosis have been refined to the point that success rates are reported as high as 99% throughout the literature. Focus has now shifted to optimizing functional and aesthetic outcomes after mandible reconstruction. This paper will be a review defect classification, goals of reconstruction, the various donor sites, dental rehabilitation, new advances, and persistent problems. Reconstruction of segmental mandibular defects after ablative surgery is best accomplished using free tissue transfer to restore mandibular continuity and function. Reestablishing occlusion and optimizing tongue mobility are important to post-operative oral function. Persistent problems in oro-mandibular reconstruction relate to the effects of radiation treatment on the native tissue and include xerostomia, dysgeusia, osteoradionecrosis and trismus. These problems continue to plague the oral cancer patient despite the significant advances that allow a far more complete functional restoration than could be accomplished a mere two decades ago.

Hemangioma of the mandible: case report with special emphasis on bone degradation.

PURPOSE: Intraosseous hemangioma of the mandible is a rare tumor. In this report, we present a case with a particularly prominent osteolysis and discuss the histological features of bone degradation. MATERIALS AND METHODS: We describe a 64-year-old female patient with a cystic tumor mass of the mandible leading to pathologic bone fracture. X-ray analysis was suggestive for aneurysmatic bone cyst. A segment resection was performed. RESULTS: The histological examination revealed a mesenchymal tumor with numerous capillaries and dilated vessels immunohistochemically being positive for CD31, but not for D2-40. In addition, there was a remarkable increase of osteoclasts that sometimes exhibited Howship's lacunae. The tumor was diagnosed as intraosseous hemangioma with prominent bone degradation. CONCLUSIONS: Based on our histological findings, it should be further investigated whether there could be an association between angiogenesis and osteoclastogenesis as a central pathway leading to bone destruction in the case of intraosseous hemangiomas.

Ultrasonographic evaluation of mandibular ameloblastoma: a preliminary observation.

OBJECTIVE: The purpose of this study was to demonstrate ultrasonographic characteristics of mandibular ameloblastoma and assess the value of ultrasonography in diagnosis of the tumor. STUDY DESIGN: Nineteen subjects with ameloblastomas in the mandibles were examined with ultrasonography. Locations, sizes, internal echoes, boundaries, and blood flow of the tumors were observed and documented. Ultrasonographic appearances of the tumors were compared with histopathological findings. Sensitivity and specificity of Doppler flow signals for prediction of active tumor proliferations were calculated. RESULTS: The main sonographic features of the tumor appeared as a complex cystic mass with solid contents. Most tumors (15/19, 79%) showed no or minimal flow signals on color Doppler flow imaging (CDFI), whereas the remaining 4 lesions demonstrated abundant flow signals. The sensitivity and specificity of the Doppler flow signals for prediction of active tumor proliferations were 100% and 94%, respectively. The ultrasonographic appearances could be classified into 4 types: multilocular (10/19, 53%), honeycomb (4/19, 21%), unilocular (3/19, 16%), and local severe destructive (2/19, 10%). CONCLUSION: Ultrasonography can be used as an effective supplementary diagnostic method for mandibular ameloblastomas. CDFI of tumor vascularity could be used to predict active tumor proliferations.

[Interest of PET/CT scan fusion to assess mandible involvement in oral cavity and oro pharyngeal carcinomas]. / Intérêt de la fusion TEP/TDM dans l'exploration de l'envahissement mandibulaire des cancers de la cavité orale et de l'oropharynx.

UNLABELLED: The aim of the study is to assess mandible involvement in oral cavity and oropharyngeal carcinomas. OBJECTIVE: To evaluate interest of fusion of Positron Emission Tomography (PET) with Computed Tomography scan (CT scan). METHOD: Eight patients were included in this prospective study. Each patient underwent PET and CT scan of the head and neck before surgery including tumorectomy and mandibulectomy. We compared results of PET- CT fusion with histologic examinations. RESULTS: Oral cavity (6), oropharyngeal (2) carcinoma: Mandibular invasion was suspected by PET-CT in 3 cases, but was confirmed in histological examination in only 2 cases. In 5 cases, PET-CT did not find mandibular invasion; this was confirmed in histological examination in all cases. Sensibility of PET-CT fusion was 100%, specificity was 83%. Positive predictive value was 66% and negative predictive value was 100%. DISCUSSION: PET-CT fusion provided maximal sensitivity. Specificity was better than for MRI but less than CT-scan. There were no false negatives and the false positive rate was 33%. CONCLUSION: PET-CT fusion is interesting to predict mandible involvement. Further studies are necessary to confirm these preliminary results.

Evaluation of an ossifying fibroma using three-dimensional computed tomography.

We describe the appearance of a mandibular ossifying fibroma in spiral computed tomography-based multiplanar (MPR) and three-dimensional (3D) reconstruction using computer graphics. The usefulness of the interactive reconstructed images, especially using a vascular protocol, for qualitative and quantitative analyses is demonstrated. This technique is an important adjunct to evaluation with conventional axial CT.

Curative treatment of central hemangioma in the mandible by direct puncture and embolisation with n-butyl-cyanoacrylate (NBCA).

Management of central hemangioma in the mandible is difficult because of the abundant vascular network in this region. One of the most common signs of these patients, especially in the mixed dentition period, is hypermobility of the teeth with spontaneous hemorrhage from the surrounding gingival sulcus. Various therapeutic modalities have been considered, but surgery is the most frequently used. In cases of a large extensive lesion, however, intralesional injections of sclerosing agents have often been successful. A case of central hemangioma of the mandible with arteriovenous malformations in a 10-year-old girl is reported. She was treated with direct injection of an embolic material, n-butyl-cyanoacrylate, which brought satisfactory results. Preoperative embolisation of feeder vessels with Gelfoam and Avitene soaked in thrombin together with this direct injection is a safe treatment modality that is as effective as surgery.

Hemangiomatous ameloblastoma: Clinical, radiologic, and pathologic features.

A hemangiomatous ameloblastoma was present in the third molar region of the left mandible of a 26-year-old woman. The histology and radiologic features of this tumor differed from those of a conventional ameloblastoma. Its histologic features were consistent with those of a hemangiomatous ameloblastoma, and its standard radiologic features and computed tomography mimicked that of fibro-osseous lesions, whereas magnetic resonance imaging suggested a vascular lesion. The behavior and prognosis of the hemangiomatous ameloblastoma are uncertain because of the small number of documented cases and lack of long-term follow-up, but are thought to be similar to those of the conventional type. The relevant clinical, radiologic, and pathologic features of this case are presented.

Large cell, epithelioid, telangiectatic osteoblastoma: a unique pseudosarcomatous variant of osteoblastoma.

A previously undescribed large-cell, epithelioid, and aneurysmal variant of osteoblastoma with minimal osteoid-production--simulating telangiectatic osteosarcoma, epithelioid angiosarcoma, and metastatic carcinoma is reported. The tumor occurred in the mandible of a 14-year-old girl. The light microscopic, immunohistochemical, ultrastructural, cell proliferation, and DNA-ploidy studies, as well as the 7-year disease-free follow-up period all indicate a benign osteoblastic tumor. Cytogenetically, the tumor had a pseudodiploid karyotype, distinguished by a complex t(1;5;17;22) and a terminal 1q deletion. Recognition of this unique, pseudomalignant variant of osteoblastoma is important to avoid an erroneous diagnosis of malignancy.

[Vascular structure of malignant tumours of the mandible shown by specimen arteriography].

OBJECTIVE: To investigate the vascular structure of different kinds of malignant tumours of the mandible. METHODS: Specimen arteriography was performed on 11 cases of malignant tumours of the mandible. RESULTS: Malignant tumours could be divided into two groups: 1. the hypervascular tumours, the arteries are dilated, distributed evenly and arranged in a bush-like pattern. 2. hypovascular tumours, the scanty arteries are distributed unevenly without dilation, in some areas, the shape of arteries are irregular and arranged in a network pattern. CONCLUSION: Variation in vascular structure of malignant tumours in the mandible may be related to the outcome of regional chemotherapy.

Observations on the vascular structure of malignant tumours of the mandible using specimen arteriography.

OBJECTIVES: To investigate the vascular structure of different malignant tumours of the mandible. METHODS: Specimen arteriography was performed on seven cases of squamous cell carcinoma of gingiva and four sarcomas. RESULTS: Malignant tumours could be divided into two groups: (1) the hypervascular sarcomas in in which the arteries were dilated, distributed evenly and arranged in a bush-like pattern; and (2) hypovascular squamous cell carcinoma with scanty arteries distributed unevenly without dilatation; in some areas, the shape of arteries was irregular and arranged in a network pattern. CONCLUSIONS: The variation in vascular structure of malignant tumours of the mandible may be related to the outcome of regional chemotherapy.

The role of angiogenesis in the spread of oral squamous cell carcinoma.

Microvessels were counted in 41 primary oral squamous cell carcinomas using JC70 antibody to PECAM (CD31). The counts were compared with clinical and pathological indicators of tumour behaviour including lymph node status, tumour stage, type of histological differentiation, size and velocity of tumour growth. Tumour microvessel counts correlated with lymph node metastasis (p < 0.001). This association was independent of tumour size, velocity and type of histological differentiation and when all the variables were analysed by multivariate analysis only vascular count showed a significant association with lymph node metastasis.

[Angiographic study of osteosarcoma and fibrosarcoma of the jaw].

It has been well known that the sarcomas of jaw are very vascularized, but reports on the angiography of jaw sarcomas were very few. Based on the preoperative angiography of 3 cases of jaw bone sarcomas and arteriography of their specimens, it has been noticed that the supplying arteries of the mandible ramus sarcoma can be directly from the external carotid arteries; and the supplying arteries can be from inferior alveolar artery in sarcomas of the body of mandible. The tumors are more vascularized than the surrounding normal tissues, and the direction of the arteries can be from central to peripheral in the tumors, which are different from the long bone sarcomas. The vascularization and the retarded blood flow in the tumor are the significant anatomic bases for local perfusion chemotherapy of jaw sarcomas.