Perineural and lymphovascular invasion in squamous cell carcinoma of the tongue.

BACKGROUND: Perineural invasion (PNI) and lymphovascular invasion (LVI) may be adverse prognostic indicators in squamous cell carcinoma (SCC) of the tongue. METHODS: The percentages of histological PNI and LVI were determined in 335 patients with tongue SCC. Sixty tumours originally reported as negative for these features were tested to determine how many more were positive with "immunohistochemical enhancement." RESULTS: PNI was found in 141 (42.1%) and LVI in 51 (15.2%) patients. 79.4% of the 141 patients who had PNI and 72.6% of the 51 with LVI had a T3 or T4 tumour. Lymph node metastasis was identified in 145 (51.2%) of the 280 patients who had undergone neck dissection; 58.2% of the 141 patients with PNI and 80.4% of the 51 patients with LVI had lymph node metastasis. There was a highly statistically significant correlation between PNI with increasing pT (P < .00001) and pN (P < .0001) stage, and a statistically significant correlation between LVI and pT stage (P < .001), the association of LVI with pN status could not be reliably tested statistically. Immunohistochemistry for S100 identified five further cases of PNI, but review of the original H&E showed the feature was present in four and had been missed at original reporting. CD31 identified three further possible cases of LVI and D2-40 none. The endothelium of some vascular channels was positive for both CD31 and D2-40 and cross-reactivity with other cells compromised interpretation. CONCLUSIONS: Histological identification of PNI and LVI per se remains of uncertain prognostic significance. "Immunohistochemical enhancement" offered little benefit.

PDBe: Protein Data Bank in Europe.

The Protein Data Bank in Europe (PDBe; pdbe.org) is actively involved in managing the international archive of biomacromolecular structure data as one of the partners in the Worldwide Protein Data Bank (wwPDB; wwpdb.org). PDBe also develops new tools to make structural data more widely and more easily available to the biomedical community. PDBe has developed a browser to access and analyze the structural archive using classification systems that are familiar to chemists and biologists. The PDBe web pages that describe individual PDB entries have been enhanced through the introduction of plain-English summary pages and iconic representations of the contents of an entry (PDBprints). In addition, the information available for structures determined by means of NMR spectroscopy has been expanded. Finally, the entire web site has been redesigned to make it substantially easier to use for expert and novice users alike. PDBe works closely with other teams at the European Bioinformatics Institute (EBI) and in the international scientific community to develop new resources with value-added information. The SIFTS initiative is an example of such a collaboration--it provides extensive mapping data between proteins whose structures are available from the PDB and a host of other biomedical databases. SIFTS is widely used by major bioinformatics resources.

A retrospective study of the influence of telemedicine in the management of pediatric facial lacerations.

A study was carried out to determine the influence of telemedicine on management of facial lacerations in children. Proforma was designed, and information was collected retrospectively over a 4-month period. Of the 2524 telemedicine referrals, 27% (693/2524) were pediatric referrals. One hundred forty-five of these were children with facial lacerations, of which only 98 were admitted for possible surgical management. During the same period, a further 45 children were admitted to the pediatric ward through verbal referral. The average age of the children admitted was 4.85 years and male-to-female ratio was 2:1. Lacerations to the lips (42%) were the most common site of injury, and the majority sustained the injury as a result of a mechanical fall (42%). Among the telemedicine group, 86% had surgery, whereas in the nontelemedicine group it was 82%. On average, 2 to 3 photographs accompanied the referrals, and none of the patients who were treated conservatively by the referring centers following telemedicine referral and discussion with Queen Victoria Hospital required a re-referral. The results from this study confirm that clinical findings together with images from telemedicine provide adequate information to make clinical decisions in children with facial lacerations.

Can we do it better? Consent in dentoalveolar surgery.

Obtaining informed consent is essential for any medical or dental procedure. Dentoalveolar surgery poses numerous risks due to the complex environment and anatomy of the oral cavity. Failure to seek and correctly document consent may lead to claims in negligence, as demonstrated by the increasing litigation in OMFS. We audited dentoalveolar surgery consent forms at two different UK OMFS units and found that many forms failed to document important material risks associated with procedures. In an attempt to improve the consent process, we developed a standardised form containing a list of risks for dentoalveolar surgery that can be affixed to the consent form. We suggest other OMFS units adopt this form to standardise the consent process and optimise patient care while protecting clinicians from medico-legal claims.

Head and neck oncological ablation and reconstruction in the COVID-19 era - our experience to date.

The COVID-19 pandemic has caused unprecedented disruption to the routine operations of healthcare services across the world. As the potential duration of the pandemic remains uncertain, the need to develop strategies to continue urgent elective services has received increasing attention. A solution adopted in the Kent, Sussex and Surrey area of England has been to create COVID-19-protected cancer hubs. The Queen Victoria Hospital is the designated hub for head and neck cancer services in the area. We report on the evolution of the head and neck cancer care pathway and standard operating protocols put in place and how these have combined both national guidelines and local problem solving. It is hoped that our experience can help guide other centres as they re-establish head and neck cancer services during the ongoing pandemic.

Nasal obstruction as the first symptom in a patient with a calcifying epithelial odontogenic tumour (CEOT).

UNLABELLED: Calcifying epithelial odontogenic tumour (CEOT), also known as Pindborg tumour, is a rare, benign odontogenic neoplasm. A case of an intra-osseous CEOT in the maxilla is presented in which unilateral nasal obstruction and progressive difficulty in breathing were the first clinical symptoms. Dental practitioners might be the first clinicians to come across such tumours, during investigation of missing or non-erupted maxillary teeth, ie canines, and they should be alerted by any unilateral nasal obstruction symptoms. Diagnostic features and treatment options of the tumour are discussed in relation to its histological typing. CLINICAL RELEVANCE: This manuscript highlights the importance of accurate clinical and radiographic investigation for the dental practitioner when assessing missing maxillary teeth.

Head and neck sarcomas: A single institute series.

BACKGROUND: Sarcomas are tumours of mesenchymal origin, accounting for 1% of all malignancies. METHODS: This is a retrospective analysis of 107 head and neck sarcoma cases, treated over a period of thirteen years. RESULTS: Fifty-four patients had with craniofacial bone sarcomas (BSs) (male: 33; female: 21) with high grade osteosarcoma being the most predominant type. The soft tissue sarcomas (STS) (53 patients; male: 28, female: 25) were histologically diverse with rhabdomyosarcomas and myxofibrosarcomas being the predominant types. The majority of BSs were managed with neoadjuvant chemotherapy followed by surgery, whereas in STSs treatment included predominantly surgery followed by radiotherapy. Overall survival estimates were 79% at 2years and 64% at 5years (mean follow-up period was 48months). CONCLUSIONS: The mesenchymal origin of sarcomas, the pattern of disease spread and the different extent of cancellous bone infiltration in contrast to epithelial tumours, dictate distinct principles for surgical clearance.

Mucosal melanoma of the upper airways tract mucosal melanoma: A systematic review with meta-analyses of treatment.

BACKGROUND: Mucosal melanoma of the upper aerodigestive tract (MM-UADT) occurs in a complex anatomic region. It represents a small number of tumors of the head and neck and a small number of melanoma cases. METHODS: Search strategies initially identified 600, 11 of which were included in this study. RESULTS: All studies involved surgery and radiotherapy. None were randomized, and all were assessed as having a high risk of selection and performance bias. No studies reported quality of life, treatment-related mortality, or morbidity. The results indicate that the addition of radiotherapy to surgery reduces the rate of locoregional recurrence (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.42-0.87). There was no statistically significant difference in overall survival (HR, 1.16; 95% CI, 0.98-1.37). CONCLUSION: Surgical resection with postoperative radiotherapy remains the optimal treatment strategy for locoregional control. More robust studies and the use of molecular targeted therapies need to be undertaken to improve overall survival. © 2016 Wiley Periodicals, Inc. Head Neck 39: 819-825, 2017.

Dentigerous Cyst and Ameloblastoma of the Jaws.

AIM: To determine how many ameloblastomas were misdiagnosed as dentigerous cysts (DCs) by correlating the radiological and histopathological features of a series of both entities. METHODS AND RESULTS: Histopathology reports and radiological imaging of 135 DCs and 43 ameloblastomas were reviewed. Any clinical or radiological feature that suggested that the diagnosis of DC was wrong-for example, absence of an unerupted tooth-prompted review of the original histology. A total of 34 cases coded as DC at diagnosis were excluded; in the remaining 101 patients, the clinicoradiological and histopathological features were consistent with DC in 96 (95.0%). Review of the histology revealed that 4 patients had actually had odontogenic keratocysts (OKCs) and one a luminal/simple unicystic ameloblastoma (UA). One other OKC and 3 other ameloblastomas (1 luminal UA, 2 solid/multicystic) had originally been diagnosed as DC; these had been identified prior to the study. Of the 9 misdiagnosed patients, 6 were ≤20 years old. Clinically, DC had been the only, or one of the differential, diagnoses in 7 patients; in the other 2, the clinical diagnosis was radicular cyst. In none of the 4 misdiagnosed ameloblastomas was the radiology compatible with a diagnosis of DC. Incorrect terminology had been used on the histopathology request form in 5 of the 34 excluded cases where the clinical diagnosis was DC, despite the cyst being periapical to an erupted carious or root-filled tooth. CONCLUSIONS: The entire clinical team must ensure that a histopathological diagnosis of DC is consistent with the clinicoradiological scenario, particularly in younger patients.

The role of the dental team in preventing and diagnosing cancer: 3. oral cancer diagnosis and screening.

UNLABELLED: Oral cancer is among the ten most common cancers world-wide, and is especially seen in disadvantaged elderly males. Members of the dental profession have a duty to detect both potentially malignant and malignant oral lesions. Early detection and prompt treatment offer the best hope to the patient with oral cancer, providing the best chance of a cure. As patient awareness regarding the danger of oral cancer increases, the demand for oral cancer 'screening' is also expected to increase significantly. The signs and symptoms of cancer often resemble less serious conditions more commonly found in the mouth and similarly presenting as a lump, red or white patch or ulcer. If any such lesion does not heal normally within 3 weeks, a malignancy or some other serious disorder must be excluded. A biopsy is indicated. Prompt referral to an appropriate specialist usually allows for the best management but, if this is not feasible, the dental practitioner should take the biopsy which should be sent to a specialist oral pathologist for histological evaluation. CLINICAL RELEVANCE: Early detection and prompt treatment offer the best hope to the patient with oral cancer, providing the best chance of a cure. As patient awareness regarding the danger of oral cancer increases, the demand for oral cancer'screening' is expected to increase significantly as well.

The role of the dental team in preventing and diagnosing cancer: 2. Oral cancer risk factors.

UNLABELLED: Oral cancer is among the ten most common cancers world-wide, and is especially seen in disadvantaged older males. Cancer arises as a consequence of DNA mutations causing multiple molecular genetic events in many chromosomes and genes, leading to cell dysregulation. Tobacco and alcohol use are extremely important in oral mutagenesis. Environmental factors such as infective agents and genetic factors are implicated in a minority of patients. CLINICAL RELEVANCE: Dental staff can advise on lifestyle changes for the prevention of potentially malignant oral disease and thereby protect their patients, staff, colleagues, families and acquaintances, having the opportunity to make an impact on improving the survival rate and morbidity of oral cancer by detecting both potentially malignant and malignant oral lesions.

How serious are oral infections?

Life-threatening conditions following dental infections have been rare since antibiotics were introduced into the world of medicine. However, infections spreading through the soft tissues of the head and neck are encountered occasionally and mortality is still reported as a result of sepsis or airway embarrassment. A case of Ludwig's angina from odontogenic infection that progressed into mediastinitis and pericarditis is presented. The steps adopted in the management of this case highlight the significance of early recognition and diagnosis of the source of deep cervical infections, the importance of securing the airway, effecting surgical drainage and aggressive intravenous antibiotic therapy.

Practical free flap monitoring techniques in head and neck surgery.

A myriad of techniques varying in complexity and sophistication for monitoring flaps have been described but systematic clinical assessment is regarded as the most reliable monitoring tool. This article reviews the contemporary clinical methods in monitoring free flaps.

Post operative maxillary cyst: report of an unusual presentation.

A postoperative maxillary cyst is a rare, delayed complication of operations on the maxillary sinus, trauma. or infection, particularly in Japan. As far as we know this is the first reported case in a patient of African origin. The cyst presented as a midline palatal swelling that arose from the nasal, rather than the antral, mucosa. Awareness of this condition will expedite its correct diagnosis and management. In most cases, enuclcation is the treatment of choice.

Oral squamous cell carcinoma associated with khat chewing.

The incidence of oral squamous cell carcinoma has been long associated with smoking, alcohol, and betel quid/areca nut chewing. This article presents a case of a 42-year-old female patient with squamous cell carcinoma of the floor of the mouth, associated with khat chewing. This relatively early presentation of oral squamous cell carcinoma may be linked to the synergistic effect of khat chewing and other known carcinogens such as polycyclic aromatic hydrocarbons and nitrosamines such as 4-(N-methyl-N-nitrosamino)-1-(3-pyridyl)-1-butanone, 4-(N-methyl-N-nitrosamino)-4-(3-pyridyl)-1-butanal. With the changing demographic structure and migration between countries, khat chewing is of increasing significance as it may contribute to the etiology of squamous cell carcinoma in developed countries.