Osteonecrosis of the jaw induced by arsenic trioxide therapy in a leukemia patient: A rare case report and literature review.

A patient suffering from acute promyelocytic leukemia (APL) was referred to the dental department before introduction of chemotherapy by all-trans retinoic acid and arsenic trioxide (ATO). A panoramic radiography showed his third upper maxillary left tooth included into the maxillary bone. The patient presented with a febrile episode. Consequently, the infectious gateway was researched. A left maxillary sinus migration of his third upper left tooth together with a bony sequestrum has been observed on a CT-scan. A surgery was then performed to remove the bony sequestrum and the tooth. The first hypothesis of tooth migration could be that the patient had an infection prior to introduction of chemotherapy. However, neither clinical or radiographic signs were observed during the initial check-up. The second hypothesis is that ATO caused osteonecrosis of the jaw (ONJ) induced the formation of a bony sequestrum associated to the tooth migration into the sinus. ONJ could be a potential adverse of ATO chemotherapy.

Plasmablastic lymphoma: oral presentation in patient suffering from osteradionecrosis of the jaw.

INTRODUCTION: We describe here an unusual presentation of a plasmablastic lymphoma in a patient suffering from an osteoradionecrosis of the jaw. PRESENTATION OF CASE: We report the case of a 64-year-old patient who was followed up on oncology because of an oropharyngeal cancer treated by a combined procedure of both surgery and radio-chemotherapy procedure. This patient developed an osteoradionecrosis of the jaw. In the vicinity of this necrotic area appeared an ulceration which could evoke a new necrotic area. Given the persistence of this ulceration, a biopsy was performed which highlighted a plasmablastic lymphoma oral localization. DISCUSSION: The plasmablastic lymphoma, belonging to the diffuse large B-cell lymphoma family, is a very aggressive and unusual form of cancer with poor prognosis. If it is found mainly in patients with positive HIV, in whom it was first described, it is also found in immunosuppressed patients such as transplanted patients or patients suffering from leukaemia. CONCLUSION: Plasmablastic lymphoma is a rare and an aggressive pathology in immunocompetent patients.

Detection of disseminated tumor cells in aspirative drains after neck dissection.

The dissemination of individual tumor cells is a common phenomenon in solid cancers. Detection of tumor cells in bone marrow disseminated tumor cells (DTC) and in peripheral blood circulating tumor cells (CTC) in nonmetastatic situation is of high prognostic significance. Compared to breast, colon and prostate cancers, the studies on CTC and DTC in head and neck cancers are sparse. The objective of our study was to detect DTC in drains after neck dissection. Fourteen patients undergoing surgery for stages III and IV head and neck cancers were enrolled in this study--twelve presenting with squamous cell carcinoma and two with adenocarcinoma. Redon drain analysis was performed by the Cellsearch method using immunomagnetic and fluorescence approaches. A positivity threshold value was set at 2DTC/7.5 ml of the sample. Tumor cells were detected in drains of 69 % of patients a few days after surgery. The range of quantification was 3-2,094 DTC/5 ml and we showed morphological differences between the two types of carcinoma cells. DTC were detected after neck dissection both in squamous cell carcinoma and in adenocarcinoma. Potential clinical significance of tumor cells needs to be further investigated as their presence could affect pre-surgical and post-operative treatments.

Value of the preservation of an osseous mandibular rim with a fibula free flap reconstruction.

BACKGROUND: Reconstruction of the mandible with microvascularized fibula transplants is actually a well-established procedure, yet the major component is the limited diameter of the diaphysis that can induce oral rehabilitation's failure, especially in dentate patients. In this paper, we report our surgical procedure allowing preservation of the mandibular height. The primary objective was to assess aesthetic and functional improvements of preservation of an osseous mandibular rim with a fibula free flap reconstruction. PATIENTS AND METHODS: Five patients (all males, mean age of 60 years) were treated with this method. Aetiologies were tumour in 3 cases, and osteoradionecrosis in the two others cases. We described all step of our surgical procedure and the functional, aesthetic and carcinologic results were evaluated. The follow up varies from 6 to 30 months. RESULTS: One patient died at 12 days from unrelated affection. For the other patients, both the aesthetics and functional outcomes were better than in case of mandibular interruption surgery. In fact, the mandibular contour of the mandibule was preserved and the height of mandible was restored. One patient is in progress of dental rehabilitation with osseous implants. Carcinologically, no local recurrence was observed. CONCLUSION: This technique is reliable and enables to optimize oral rehabilitation with endosteal implants. Nevertheless, we consider that the 3D scanner is essential before the intervention to evaluate the osseous reach. Moreover, if necessarily the procedure can be modified intraoperatively.

Guidelines of the French Society of Otorhinolaryngology (SFORL), short version. Extension assessment and principles of resection in cutaneous head and neck tumors.

Cutaneous head and neck tumors mainly comprise malignant melanoma, squamous cell carcinoma, trichoblastic carcinoma, Merkel cell carcinoma, adnexal carcinoma, dermatofibrosarcoma protuberans, sclerodermiform basalioma and angiosarcoma. Adapted management requires an experienced team with good knowledge of the various parameters relating to health status, histology, location and extension: risk factors for aggression, extension assessment, resection margin requirements, indications for specific procedures, such as lateral temporal bone resection, orbital exenteration, resection of the calvarium and meningeal envelopes, neck dissection and muscle resection.

Development of an osteosarcoma following dental extraction after allogeneic stem cell transplantation.

OBJECTIVES: Radio-induced sarcoma is known to occur several years following bone irradiation especially when this treatment is combined to high dose chemotherapy regimens prior to allogeneic haematopoietic stem cell transplantation (HSCT) in very young children. However, little is known about the stimulus of aggressive bony surgery in the development of these tumours. MATERIAL AND METHODS: We report the case of a young girl in whom dental extraction was rapidly followed by the occurrence of a localized tumour 11 years after allogeneic haematopoietic stem cell transplantation using total body irradiation (TBI) for a haemophagocytic lymphophistiocytosis (HLH). RESULTS: This tumour involved tooth socket and all the right side of the mandible and was diagnosed as an osteogenic osteosarcoma of the zygomatic bone. CONCLUSION: This tumour had the characteristics of a radio-induced sarcoma. Thanks to the very short time between the dental extraction and the occurrence of the osteosarcoma at the same location, we discuss the role of the dental extraction as a trigger of osteosarcoma development.

Combined transoral and suprahyoid approach for oropharyngeal cancers: an alternative to mandibulotomy.

UNLABELLED: Surgical treatment of oropharyngeal tumours usually requires mandibular osteotomy. Using this technique allows a better exposure and an easier excision, but this approach often generates complications. Since 1995, we used a less aggressive surgical technique, with a suprahyoid pharyngotomy when the oral approach was not sufficient, thus sparing the mandible. OBJECTIVE: The purpose of this study is to evaluate this technical evolution, ensuring that mandibular preservation doesn't affect quality of exeresis, local control and survival, while allowing a lower complication rate. MATERIAL AND METHODS: All patients who have had a surgical treatment for an oropharyngeal carcinoma between 1995 and 2001 in our center were included in this study. RESULTS: Mandibular sparing was used for 55 patients; 19 patients underwent mandibulotomy. The surgical procedure's quality was classified as clear, close, or insufficient margins. All adjuvant treatments were noted, functional and carcinologic results were evaluated. No significant differences are found for exeresis quality and local control. There are less complications (p = 0.045) and less surgical revisions (p = 0.023) in the preservation group. Survival and functional results are better in the preservation group, but without significant difference. For oropharyngeal tumours, survival is dependent on tumoural aggressivity, on general condition and co-morbidity and on the development of a second tumour. Results in local control rate (83.7% at 1 year) are satisfying compared to literature. CONCLUSION: Mandibular preservation is an efficient and safe procedure, even for T3/T4 tumours. Most of oropharyngeal tumours can be removed without mandibulotomy. The suprahyoid approach provides a good exposure when oral approach is insufficient, thus avoiding mandibulotomy and its complications.

Navigation in head and neck oncological surgery: an emerging concept.

Navigation surgery, initially applied in rhinology, neurosurgery and orthopaedic cases, has been developed over the last twenty years. Surgery based on computed tomography data has become increasingly important in the head and neck region. The technique for hardware fusion between RMI and computed tomography is also becoming more useful. We use such device since 2006 in head and neck carcinologic situation. Navigation allows control of the resection in order to avoid and protect the precise anatomical structures (vessels and nerves). It also guides biopsy and radiofrequency. Therefore, quality of life is much more increased and morbidity is decreased for these patients who undergo major and mutilating head and neck surgery. Here we report the results of 33 navigation procedures performed for 31 patients in our institution.

[Microsurgical reconstruction and full management of patients with head and neck cancer: importance of a quality approach and a patient care team]. / Reconstruction microchirurgicale et prise en charge globale des patients porteurs de cancer ORL: l'importance d'une approche qualité et d'un circuit protocolisé.

UNLABELLED: MAIN OF STUDY: Management and surgical reconstruction of head and neck cancers remain a challenge. From the first consultation to surgery and radiotherapy it is necessary to gain time to ensure optimum treatment and better survival rates. OBJECTIVE: To establish a kind of quality approach to the management of patients with head and neck cancers. 54 patients who received microsurgical reconstruction after head and neck cancer were included in this study between 1997 and 2006. RESULTS: Multiple data were considered: body mass index (BMI), ASA stage, age, existence of a pre-or postoperative radiotherapy, the surgeon's experience and the number of drainage veins. The success rate is superior when more than one draining vein is sutured to the flap for patients with a BMI >20. Radiotherapy does not seem to affect the survival of the flap. CONCLUSION: According to current literature, the survival rate of these patients is better when the overall time care is less than 100 days. That period is possible with a perfect organization of the medical and paramedical team. Therefore, we propose to include these patients in a circuit protocolisation care, which saves time, to better inform patients and improve survival rates.

Use of the infra hyoid musculo-cutaneous flap in soft palate reconstruction.

AIMS: To review a series of 23 consecutive patients with squamous cell carcinomas arising from oropharynx who underwent infra hyoid musculo-cutaneous flap reconstruction including soft palate in alternative to free radial forearm flap or maxillofacial prosthesis. Post operative radiotherapy was performed for all patients. RESULTS: Every reconstruction healed quickly without major wound complications. The functional results evaluated by speech and swallowing capacities, were good for 17 patients, fair for 4 patients and bad for 2. CONCLUSIONS: The infra hyoid musculo-cutaneous flap is a versatile, reliable and convenient flap suitable for repairing small and medium sized defects; it can be used in combination with other flaps, and in selected cases obviates the need for a microvascular free radial forearm flap or maxillofacial prosthesis.