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[This corrects the article DOI: 10.1371/journal.pone.0071093.].
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The purpose of this retrospective study was to identify risks of postoperative facial nerve injury (FNI) in mandibular condylar fractures. A total of 59 consecutive cases of condyle fracture or plate removal with a retromandibular transparotid approach (RMTA) were divided into FNI and non-FNI groups that were evaluated for associations with age, sex, laterality, fracture type, height, weight, body mass index (BMI), and maxillofacial bone height and width diameters on computed tomography (CT). FNI occurred in 11 of 59 patients (18.64%), all of them female (p = 0.0011). Other statistically significant factors on univariate analysis for FNI included a short height (156.95 ± 8.16 cm vs. 164.29 ± 9.89 cm, p = 0.04), low weight (46.08 ± 8.03 kg vs. 58.94 ± 11.79 kg, p = 0.003), low BMI (18.64 ± 2.63 kg/m2 21.68 ± 3.02 kg/m2, p = 0.007), short condylion-anterior fracture distance (19.34 ± 3.15 mm vs. 22.26 ± 3.96 mm, p = 0.04) and short condylion-posterior fracture distance (20.12 ± 3.98 mm vs. 25.45 ± 5.02 mm, p = 0.009). Our retrospective study suggested that FNI with RMTA surgery occurs particularly in female patients and may occur more frequently in patients who are short, lean or have high condyle fractures.
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Oral and maxillofacial trauma is influenced by various factors, including regional characteristics and social background. Due to the coronavirus disease 2019 (COVID-19) pandemic, a state of emergency was declared in Japan in March 2020. In this study, we aimed to examine the dynamics of patients with oral and maxillofacial trauma over a 12-years period using interrupted time-series (ITS) analysis. Patients were examined at the Shimane University Hospital, Maxillofacial Trauma Center from April 2012 to April 2023. In addition to general patient characteristics, data regarding the type of trauma and its treatment were obtained from 1203 patients (770 men and 433 women). Group comparisons showed significant differences in age, trauma status, method of treatment, referral source, route, and injury occasion. ITS analysis indicated significant changes in combined nasal fractures, non-invasive reduction, and sports injuries (P < 0.05), suggesting COVID-19 significantly impacted oral and maxillofacial trauma dynamics. A pandemic of an infectious disease may decrease the number of minor trauma cases but increase the number of injuries from outdoor activities, resulting in no overall change in the dynamics of the number of trauma patients. Medical systems for oral and maxillofacial trauma should be in place at all times, independent of infectious disease pandemics.
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COVID-19 , Análisis de Series de Tiempo Interrumpido , Traumatismos Maxilofaciales , Humanos , COVID-19/epidemiología , Femenino , Masculino , Traumatismos Maxilofaciales/epidemiología , Adulto , Persona de Mediana Edad , Anciano , Japón/epidemiología , Pandemias , Adulto Joven , Adolescente , SARS-CoV-2/aislamiento & purificación , Centros Traumatológicos/estadística & datos numéricos , Niño , Anciano de 80 o más AñosRESUMEN
Numb chin syndrome (NCS) is hypesthesia of the mandible and lower lip caused by damage to the inferior alveolar or mandibular nerves, commonly due to dental treatment or osteomyelitis, but occasionally caused by malignant tumors. We report the case of a male in his 60s. He came to our hospital with a chief complaint of mandibular pain and paresthesia in the right side of the mental region. He had noticed swelling of the left mandible one month before the initial visit and strong hypesthesia of the right side of the mental region one week before the initial visit. Panoramic radiographs showed slight osteosclerosis of the left side mandible at the initial visit. Blood tests showed only a slight inflammatory reaction. The diagnosis of mandibular osteomyelitis and numb chin syndrome was made, and a contrast-enhanced CT scan was performed to investigate the possibility of neoplastic lesions, but no obvious cause was found. Osteosclerosis was minimal. A tissue biopsy was recommended, but the patient did not consent. Considering the possibility of NCS due to a hematologic disorder, the patient was referred to a hematologist, but no cause could be identified at the initial visit. With time, the markedly severe pain worsened, and the possibility of a neoplastic lesion was again suspected. Blood tests were performed, which revealed abnormally high levels of CA19 and CEA. He consulted a gastroenterologist, who found a tumor in the ileocecal region on contrast-enhanced CT, and multiple systemic metastases were found on a PET-CT scan the next day. Systemic chemotherapy was administered for multiple metastatic unresectable colorectal cancer (cT4N1aMc2 stage IVc).
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Immune checkpoint inhibitors are known to produce immune-related adverse events(irAE)that require medical management. Herein, we report a case of a patient treated with pembrolizumab who experienced a Grade 3 interrupted skin disorder. The patient is a 67-year-old female diagnosed with right maxillary gingival squamous cell carcinoma(cT4aN0M0, Stage â £A)and underwent partial right maxillectomy, right extended supra-omohyoid neck dissection, and maxillary reconstruction using a forearm flap. Six months postoperatively, late lymph node metastases with extracapsular spread was found in the right buccal lymph node and the left neck, and the patient underwent right buccal lymphadenectomy and left modified radical neck dissection. After postoperative combined chemoradiotherapy(cisplatin plus IMRT)followed by 13 courses of cetuximab plus paclitaxel, a recurrent lesion was found in the right buccal region. After 8 courses of pembrolizumab, a skin rash appeared on the forearm, chest, and back, which was diagnosed as Grade 3 irAE, requiring hospitalization. The patient was re-instituted after waiting for improvement of the skin disorder. The pembrolizumab at 75% reduction dose was re-administrated, and the patient has been followed up so far.
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Neoplasias Gingivales , Neoplasias de Cabeza y Cuello , Anciano , Femenino , Humanos , Anticuerpos Monoclonales Humanizados/efectos adversos , Cetuximab , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , PaclitaxelRESUMEN
BACKGROUND: Cisplatin (CDDP) plays a central role in chemotherapy for head and neck squamous cell carcinoma (HNSCC), but drug resistance in HNSCC chemotherapy remains a problem, and the mechanism of CDDP resistance is unclear. We investigated CDDP-resistance mechanisms mediated by extracellular vesicles (EVs) and ATPase copper transporting beta (ATP7B) in HNSCC. METHODS: We established CDDP-resistant sublines of HNSCC cells and verified their ATP7B expression. We used an EV secretion inhibitor (GW4869) and ATP7B short hairpin (sh)RNA transfection to examine the correlation between EV secretion and ATP7B expression. RESULTS: The CDDP-resistant HNSCC sublines showed decreased CDDP sensitivity and increased ATP7B expression. GW4869 suppressed ATP7B expression, and ATP7B shRNA transfection suppressed EV secretion. The suppressions of EV secretion and ATP7B expression both enhanced CDDP's cell-killing effect. CONCLUSIONS: EVs were involved in the ATP7B-mediated mechanism underlying CDDP resistance. Further clarification of the EV-induced CDDP-resistance mechanism may lead to novel therapeutic strategies for HNSCC.
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Compuestos de Anilina , Antineoplásicos , Compuestos de Bencilideno , Vesículas Extracelulares , Neoplasias de Cabeza y Cuello , Humanos , Cisplatino/farmacología , Cisplatino/uso terapéutico , Carcinoma de Células Escamosas de Cabeza y Cuello/tratamiento farmacológico , Antineoplásicos/farmacología , Antineoplásicos/uso terapéutico , Proteínas Transportadoras de Cobre , Resistencia a Antineoplásicos , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/genética , Vesículas Extracelulares/metabolismo , Línea Celular Tumoral , Cobre/metabolismo , Cobre/farmacologíaRESUMEN
Bone stabilization using osteosynthesis devices is essential in maxillofacial surgery. Owing to numerous disadvantages, bioresorbable materials are preferred over titanium for osteofixation in certain procedures. The biomaterials used for osteosynthesis in maxillofacial surgery have been subdivided into four generations. No study has compared the tissue responses generated by four generations of biomaterials and the feasibility of using these biomaterials in different maxillofacial surgeries. We conducted an in vivo animal study to evaluate host tissue response to four generations of implanted biomaterial sheets, namely, PLLA, PLLA/PGA, u-HA/PLLA, and u-HA/PLLA/PGA. New bone volume and pertinent biomarkers for bone regeneration, such as Runx2, osteocalcin (OCN), and the inflammatory marker CD68, were analyzed, and the expression of each biomarker was correlated with soft tissues outside the biomaterial and toward the host bone at the end of week 2 and week 10. The use of first-generation biomaterials for maxillofacial osteosynthesis is not advantageous over the use of other updated biomaterials. Second-generation biomaterials degrade faster and can be potentially used in non-stress regions, such as the midface. Third and fourth-generation biomaterials possess bioactive/osteoconductivity improved strength. Application of third-generation biomaterials can be considered panfacially. Fourth-generation biomaterials can be worth considering applying at midface due to the shorter degradation period.
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The submental island flap is an axial pattern pedicle flap widely used in head and neck surgery because of its ease and success. Indications of the submental island flap range from reconstruction for the malignant tumor resection to loss of temporal bone and facial skin due to trauma. Whereas, intraoperative facial nerve injury is not uncommon. We verified whether it was possible to localize the nerve to the mylohyoid muscle and reanimate the facial nerve during submental island flap procedures by preserving the mylohyoid muscle using human fresh cadaveric specimens. Six cadaveric heads were dissected and the position of the nerve to the mylohyoid muscle identified to the mylohyoid triangle documented. We identified the nerve to the mylohyoid muscle on all sides within the mylohyoid triangle and were able to separate the nerve from the submental island flap completely. Our results suggest that facial nerve reanimation using the nerve to the mylohyoid muscle can be used while reconstructing with a submental island flap in cases of intraoperative facial nerve injury.
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Cancers showing excessive innervation of sensory neurons (SN) in their microenvironments are associated with poor outcomes due to promoted growth, increased tumor recurrence, metastasis, and cancer pain, suggesting SNs play a regulatory role in cancer aggressiveness. Using a preclinical model in which mouse 4T1 breast cancer (BC) cells were injected into the bone marrow of tibiae, we found 4T1 BC cells aggressively colonized bone with bone destruction and subsequently spread to the lung. Of note, 4T1 BC colonization induced the acidic tumor microenvironment in bone in which SNs showed increased innervation and excitation with elevated expression of the acid-sensing nociceptor transient receptor potential vanilloid-1 (TRPV1), eliciting bone pain (BP) assessed by mechanical hypersensitivity. Further, these excited SNs produced increased hepatocyte growth factor (HGF). Importantly, the administration of synthetic and natural TRPV1 antagonists and genetic deletion of TRPV1 decreased HGF production in SNs and inhibited 4T1 BC colonization in bone, pulmonary metastasis from bone, and BP induction. Our results suggest the TRPV1 of SNs promotes BC colonization in bone and lung metastasis via up-regulating HGF production in SNs. The SN TRPV1 may be a novel therapeutic target for BC growing in the acidic bone microenvironment and for BP.
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Key Clinical Message: A case of dentinogenic ghost cell tumor occurring simultaneously with a clinically diagnosed odontoma. The occurrence of epithelial and mesenchymal tumors at the same site is very rare, but should be kept in mind during pathological diagnosis. Abstract: Dentinogenic ghost cell tumor (DGCT) is a rare and benign odontogenic tumor composed of ghost cells, calcified tissue, and dentin. We present an extremely rare case of a 32-year-old female who was clinically diagnosed with an odontoma presenting with a painless swelling in her maxilla. Radiographic examination showed a well-defined radiolucent lesion with tooth-like calcified areas. The tumor was resected under general anesthesia. No recurrence was noted at the 12-month follow-up. Histopathological examination of the surgically resected tumor yielded a diagnosis of DGCT with odontoma.
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OBJECTIVES: Cetuximab (Cmab) is a molecularly targeted monoclonal antibody drug for head and neck squamous cell carcinoma (HNSC), although cetuximab resistance is a serious challenge. Epithelial cell adhesion molecule (EpCAM) is an established marker for many epithelial tumors, while the soluble EpCAM extracellular domain (EpEX) functions as a ligand for epidermal growth factor receptor (EGFR). We investigated the expression of EpCAM in HNSC, its involvement in Cmab action, and the mechanism by which soluble EpEX activated EGFR and played key roles in Cmab resistance. MATERIALS AND METHODS: We first examined EPCAM expression in HNSCs and its clinical significance by searching gene expression array databases. We then examined the effects of soluble EpEX and Cmab on intracellular signaling and Cmab efficacy in HNSC cell lines (HSC-3 and SAS). RESULTS: EPCAM expression was found to be enhanced in HNSC tumor tissues compared to normal tissues, and the enhancement was correlated with stage progression and prognosis. Soluble EpEX activated the EGFR-ERK signaling pathway and nuclear translocation of EpCAM intracellular domains (EpICDs) in HNSC cells. EpEX resisted the antitumor effect of Cmab in an EGFR expression-dependent manner. CONCLUSION: Soluble EpEX activates EGFR to increase Cmab resistance in HNSC cells. The EpEX-activated Cmab resistance in HNSC is potentially mediated by the EGFR-ERK signaling pathway and the EpCAM cleavage-induced nuclear translocation of EpICD. High expression and cleavage of EpCAM are potential biomarkers for predicting the clinical efficacy and resistance to Cmab.
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Receptores ErbB , Neoplasias de Cabeza y Cuello , Humanos , Molécula de Adhesión Celular Epitelial/genética , Cetuximab/farmacología , Cetuximab/uso terapéutico , Carcinoma de Células Escamosas de Cabeza y Cuello/tratamiento farmacológico , Receptores ErbB/metabolismo , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Línea Celular TumoralRESUMEN
A crucial regulator in melanoma progression and treatment resistance is tumor microenvironments, and Hedgehog (Hh) signals activated in a tumor bone microenvironment are a potential new therapeutic target. The mechanism of bone destruction by melanomas involving Hh/Gli signaling in such a tumor microenvironment is unknown. Here, we analyzed surgically resected oral malignant melanoma specimens and observed that Sonic Hedgehog, Gli1, and Gli2 were highly expressed in tumor cells, vasculatures, and osteoclasts. We established a tumor bone destruction mouse model by inoculating B16 cells into the bone marrow space of the right tibial metaphysis of 5-week-old female C57BL mice. An intraperitoneal administration of GANT61 (40 mg/kg), a small-molecule inhibitor of Gli1 and Gli2, resulted in significant inhibition of cortical bone destruction, TRAP-positive osteoclasts within the cortical bone, and endomucin-positive tumor vessels. The gene set enrichment analysis suggested that genes involved in apoptosis, angiogenesis, and the PD-L1 expression pathway in cancer were significantly altered by the GANT61 treatment. A flow cytometry analysis revealed that PD-L1 expression was significantly decreased in cells in which late apoptosis was induced by the GANT61 treatment. These results suggest that molecular targeting of Gli1 and Gli2 may release immunosuppression of the tumor bone microenvironment through normalization of abnormal angiogenesis and bone remodeling in advanced melanoma with jaw bone invasion.
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Proteínas Hedgehog , Melanoma , Femenino , Animales , Ratones , Proteínas Hedgehog/metabolismo , Proteína Gli2 con Dedos de Zinc/metabolismo , Microambiente Tumoral , Antígeno B7-H1 , Proteína con Dedos de Zinc GLI1/metabolismo , Ratones Endogámicos C57BL , Melanoma/tratamiento farmacológico , Melanoma/metabolismo , Línea Celular TumoralRESUMEN
The high perimandibular approach is a feasible surgical technique for treating mandibular condylar fractures with open reduction and internal fixation, followed by fewer complications. Temporary trismus is the only postoperative complication that may occur. This study evaluated postoperative complications following open reduction and rigid internal fixation (OR-IF) of mandibular condylar fractures using the high perimandibular approach. Twenty consecutive patients undergoing OR-IF were included in this study. They included 11 male and 9 female patients, of an average age of 58.5 years, all of whom responded to a follow-up call at least 12 months after the surgery. All patients were evaluated for range of mouth opening, postoperative complications, and radiological findings. A statistical analysis of the relationship between range of mouth opening and related clinical parameters at 6 months postoperative evaluation was conducted. The fracture of the condylar neck was associated with a limited range of mouth opening and longer operation time. However, longer operation time was not associated with a limited range of mouth opening. The high perimandibular approach with OR-IF in mandibular condylar fractures is a feasible and safe technique; however, prolonged surgery and mandibular condylar neck fractures could affect the postoperative range of mouth opening.
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Multidisciplinary treatment, combining ablative surgery and reconstruction, radiotherapy, and chemotherapy, is used to treat advanced oral cancers. In this study, we report a case of extensive osteoradionecrosis of the mandible following multidisciplinary treatment for tongue cancer, in which a computer-assisted, patient-specific custom-made cutting guide and reconstruction plate(TruMatch® )were used to improve the patient's facial morphology and oral-maxillofacial functioning. A 70-year-old man received multidisciplinary treatment for squamous cell carcinoma of the left side of the tongue (cT3N2bM0, cStage â £A)at a previous hospital. Seven years postoperatively, bilateral osteoradionecrosis of the mandible developed, and the patient was referred to our department for further treatment. Since the lesions were extensive, we planned reconstructive surgery using the TruMatch® system in collaboration with the plastic surgery department of our hospital. Surgery was performed precisely and accurately according to the preoperative simulation. Postoperatively, the patient's recovery was uneventful. The TruMatch® system enables us to achieve good morphological and comprehensive functional oral-maxillofacial reconstruction.
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Carcinoma de Células Escamosas , Reconstrucción Mandibular , Osteorradionecrosis , Procedimientos de Cirugía Plástica , Masculino , Humanos , Anciano , Osteorradionecrosis/etiología , Osteorradionecrosis/cirugía , Osteorradionecrosis/patología , Mandíbula/cirugía , Mandíbula/patología , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Escamosas/patologíaRESUMEN
Breast cancer (BC) bone metastasis causes bone pain (BP), which detrimentally damages the quality of life and outcome of patients with BC. However, the mechanism of BCBP is poorly understood, and effective treatments are limited. The present study demonstrated a novel mechanism of BCBP using a mouse model of bone pain, in which mouse (EO771) and human (MDAMB231) BC cells were injected in the bone marrow cavity of tibiae. Western blot analysis using sensory nerves, in vivo assessment of cancer pain and in vitro calcium flux analysis were performed. These mice developed progressive BCBP in tibiae in conjunction with an upregulation of phosphorylated pERK1/2 and cAMPresponse elementbinding protein (pCREB), which are molecular indicators of neuron excitation, in the dorsal root ganglia (DRG) of sensory nerves. Importantly, mice injected with BC cells, in which the expression of the lactic acid transporter monocarboxylate transporter 4 (MCT4) was silenced, exhibited decreased BCBP with downregulated expression of pERK1/2 and pCREB in the DRG and reduced circulating levels of lactate compared with mice injected with parental BC cells. Further, silencing of the cellsurface orphan receptor for lactate, G proteincoupled receptor 81 (GPR81), in the F11 sensory neuron cells decreased lactatepromoted upregulation of pERK1/2 and Ca2+ influx, suggesting that the sensory neuron excitation was inhibited. These results suggested that lactate released from BC cells via MCT4 induced BCBP through the activation of GPR81 of sensory neurons. In conclusion, the activation of GPR81 of sensory neurons by lactate released via MCT4 from BC was demonstrated to contribute to the induction of BCBP, and disruption of the interactions among lactate, MCT4 and GPR81 may be a novel approach to control BCBP.
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Neoplasias Óseas , Neoplasias de la Mama , Femenino , Humanos , Neoplasias Óseas/genética , Neoplasias de la Mama/genética , Ácido Láctico/metabolismo , Transportadores de Ácidos Monocarboxílicos , Dolor/metabolismo , Calidad de Vida , Receptores Acoplados a Proteínas G/genética , Receptores Acoplados a Proteínas G/metabolismo , Células Receptoras Sensoriales/metabolismo , Animales , Ratones , Células MDA-MB-231RESUMEN
INTRODUCTION: Cancer-induced bone pain (CIBP) is one of the most common and debilitating complications associated with bone metastasis. Although our understanding of the precise mechanism is limited, it has been known that bone is densely innervated, and that CIBP is elicited as a consequence of increased neurogenesis, reprogramming, and axonogenesis in conjunction with sensitization and excitation of sensory nerves (SNs) in response to the noxious stimuli that are derived from the tumor microenvironment developed in bone. Recent studies have shown that the sensitized and excited nerves innervating the tumor establish intimate communications with cancer cells by releasing various tumor-stimulating factors for tumor progression. APPROACHES: In this review, the role of the interactions of cancer cells and SNs in bone in the pathophysiology of CIBP will be discussed with a special focus on the role of the noxious acidic tumor microenvironment, considering that bone is in nature hypoxic, which facilitates the generation of acidic conditions by cancer. Subsequently, the role of SNs in the regulation of cancer progression in the bone will be discussed together with our recent experimental findings. CONCLUSION: It is suggested that SNs may be a newly-recognized important component of the bone microenvironment that contribute to not only in the pathophysiology of CIBP but also cancer progression in bone and dissemination from bone. Suppression of the activity of bone-innervating SNs, thus, may provide unique opportunities in the treatment of cancer progression and dissemination, as well as CIBP.
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Neoplasias Óseas , Huesos , Dolor en Cáncer , Nervios Periféricos , Dolor en Cáncer/etiología , Dolor en Cáncer/fisiopatología , Neoplasias Óseas/complicaciones , Neoplasias Óseas/secundario , Huesos/inervación , Humanos , Nervios Periféricos/patología , Nervios Periféricos/fisiopatología , Progresión de la Enfermedad , Nociceptores/fisiología , Microambiente Tumoral , Familia-src Quinasas/metabolismo , Proteína HMGB1/metabolismoRESUMEN
Patients with oral cancer have poor nutritional status before treatment. However, there have been no reports of the detailed evaluation of preoperative oral function in patients with oral squamous cell carcinoma (OSCC). Therefore, this study aimed to evaluate the preoperative oral function of patients with OSCC and examine the relationship with nutritional status. Oral function measurements (microorganisms, oral dryness, occlusal force, tongue pressure, masticatory function, Eating Assessment Tool, and Postoperative Oral Dysfunction Scale) and Mini Nutritional Assessment-Short Form (MNA-SF) data were collected from 51 patients with OSCC (men: 37, women: 14, mean age: 72.1 years) who visited the Shimane University Hospital, Department of Oral and Maxillofacial Surgery, from September 2019 to September 2021. The tongue was the most prevalent primary gingiva site [22 patients (43.1%)], and 36 patients (70.6%) had advanced cancer. Comparisons between nutritional status and each related factor revealed significant differences in the number of individuals in the household, cancer stage, presence of pulmonary disease, number of teeth, microorganisms (grade), and masticatory function (mg/dL) (p < 0.05). Multiple regression analysis using the total MNA-SF score as the dependent variable with adjustment for confounding factors showed significant association between oral dryness and tongue pressure (p < 0.05). No significant association was found for the Eating Assessment Tool or Postoperative Oral Dysfunction scale. Patients with OSCC may have decreased oral function because of the tumor at the time of diagnosis, which causes a decline in nutritional status. Preoperative interventions are necessary to improve nutrition based on the state of oral function.
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Carcinoma de Células Escamosas , Desnutrición , Neoplasias de la Boca , Masculino , Humanos , Femenino , Anciano , Estudios Transversales , Lengua/fisiología , Neoplasias de la Boca/complicaciones , Neoplasias de la Boca/cirugía , Presión , Estado Nutricional , Evaluación NutricionalRESUMEN
Bone metastasis and bone destruction are common occurrences in human malignancies, including breast, prostate, and lung cancer, and are associated with a high morbidity rate because of intractable bone pain, pathological fractures, hypercalcemia, and nerve compression. Animal models of bone metastasis and bone destruction are important tools to investigate the pathogenesis and develop treatment strategies. However, there are few models of spontaneous bone metastasis despite the fact that animals often spontaneously develop cancer. Here, we describe methods for developing a mouse model of breast cancer bone metastasis achieved by injection of MDA-MB-231 breast cancer cells into the left cardiac ventricle. In addition, we introduce mouse model of the bone destruction by injection of SAS oral squamous cell carcinoma cells into the bone marrow space of the right tibial metaphysis. These assays can be applied to studies on roles of cellular communication network factor/connective tissue growth factor (CTGF/CCN2) protein in tumor metastasis and development of treatment strategies targeting CCN proteins.
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Neoplasias Óseas , Neoplasias de la Mama , Carcinoma de Células Escamosas , Neoplasias de la Boca , Ratones , Masculino , Animales , Humanos , Carcinoma de Células Escamosas/patología , Neoplasias de la Boca/patología , Neoplasias Óseas/patología , Factor de Crecimiento del Tejido Conjuntivo/metabolismo , Huesos/metabolismo , Proteínas , Modelos Animales de Enfermedad , Neoplasias de la Mama/patología , Línea Celular TumoralRESUMEN
Radical tumor resection for oral cancer can cause morphological and esthetic disorders and oral and maxillofacial dysfunction and maintaining a social life could become challenging, especially in the adolescents and young adults(AYA)generation. Conversely, chemoradiotherapy for young patients may cause adverse reactions such as impaired fertility and late side effects of radiation. Therefore, treatment should be performed cautiously. We report a case of AYA generation patient who underwent salvage surgery and maxillofacial reconstruction for recurrent tongue cancer after super-selective intra-arterial chemoradiotherapy. The patient was a 30-year-old woman who was 20 weeks pregnant. She was diagnosed with Stage â ¢ squamous cell carcinoma of the right tongue, cT3N0M0. After abortion, the patient underwent super-selective intra-arterial chemoradiotherapy and achieved a complete response. However, 13 years later, a recurrence of Stage â £A tongue cancer, r- cT4aN2bM0, was reported. Additionally, the patient had osteoradionecrosis. We performed radical tumor resection(bilateral neck dissection plus subtotal glossectomy plus segmental mandibulectomy)and maxillofacial reconstruction with a fibula flap. Subsequently, we performed occlusal reconstruction treatment using dental implants. Three years postoperatively, no tumor recurrence was observed, and the patient was satisfied with the restored morpho-aesthetic and maxillo-oral functions.
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Neoplasias de la Boca , Neoplasias de la Lengua , Adulto , Femenino , Humanos , Quimioradioterapia , Colgajos Quirúrgicos/patología , Lengua/patología , Neoplasias de la Lengua/cirugía , Neoplasias de la Lengua/patología , EmbarazoRESUMEN
The treatment of advanced lower gingival carcinoma requires postoperative chemoradiotherapy; therefore, simultaneous hard-tissue reconstruction may not be indicated. In these cases, mandibular reconstruction is performed using a temporal reconstruction plate and various skin flaps. Herein, we reported 2 cases of advanced lower gingival carcinoma treated with a novel computer-assisted patient-specific, fully custom-made mandibular reconstruction plate system(Cosmofix®)in combination with a pedicle/free flap. In case 1, an 80-year-old female patient was diagnosed with right lower gingival carcinoma( cT4aN3bM0, Stage â £B). Under general anesthesia, she underwent tracheostomy, bilateral neck dissection, segmental mandibulectomy, and mandibular reconstruction using Cosmofix® in combination with an ulnar forearm free flap. In case 2, an 81-year-old male patient was diagnosed with right lower gingival carcinoma(cT4aN2bM0, Stage â £A). The patient underwent maintenance dialysis and required minimally invasive surgery using a pedicle flap. Under general anesthesia, the patient underwent tracheostomy, right modified radical neck dissection, segmental mandibulectomy, and mandibular reconstruction using Cosmofix® in combination with a pectoralis major myocutaneous flap. Postoperative facial morphology, occlusion, eating, swallowing, articulation, and other dysfunctions were minimal in both the cases. Adjuvant chemoradiotherapy was recommended. In conclusion, the utilization of the Cosmofix® system enabled both esthetic and functional reconstruction following segmental mandibulectomy for advanced lower gingival carcinoma.