RESUMEN
PURPOSE: To assess clinical behavior, response to treatment, and factors affecting survival in maxillofacial osteosarcoma treated at a tertiary referral center. PATIENTS AND METHODS: Ethics-approved retrospective review of clinical and pathological records was undertaken for 15 patients managed by the Royal Melbourne Hospital Head and Neck Oncology Tumor Stream. RESULTS: Treatment was a combination of surgery and chemotherapy. Chemotherapy was given as adjuvant, neoadjuvant, or in combination. The overall 2-, 5-, and 15-year disease-free survival rates in this study were 92%, 74%, and 74%, respectively. Using Kaplan-Meier analysis with log rank tests, increasing T stage (P = .01) and positive margins (P = .003) were found to affect survival significantly. Neoadjuvant chemotherapy was not significantly associated with tumor necrosis or improved survival. CONCLUSIONS: Tumor size and adequacy of local control were found to be the most important predictors of outcome.
Asunto(s)
Neoplasias de Cabeza y Cuello/cirugía , Neoplasias Mandibulares/cirugía , Neoplasias Maxilares/cirugía , Osteosarcoma/cirugía , Adulto , Anciano , Supervivencia sin Enfermedad , Femenino , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/mortalidad , Humanos , Masculino , Neoplasias Mandibulares/tratamiento farmacológico , Neoplasias Mandibulares/mortalidad , Neoplasias Maxilares/tratamiento farmacológico , Neoplasias Maxilares/mortalidad , Persona de Mediana Edad , Osteosarcoma/tratamiento farmacológico , Osteosarcoma/mortalidad , Evaluación de Resultado en la Atención de Salud , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Adulto JovenRESUMEN
To examine differences in survival and clinical outcomes of elderly patients without traditional risk factors presenting with oral squamous cell carcinoma. Retrospective review of 287 consecutive patients divided into 2 treatment period cohorts treated for oral SCC between the 1st Jan 2007 and 31st Dec 2012. Patients were classified as either smoker-drinkers (SD) or non-smoking, non-drinking (NSND). Only patients with oral sub-site primaries according to ICD-10 were included. Carcinomas of the lip, tonsil, base of tongue and oro-pharyngeal subsites were excluded. Of the study population (Nâ¯=â¯287), 24.4% were NSND and 9.75% were NSND elderly (older than 70â¯years) females. >50% of tumours arose from the oral tongue in NSND patients (pâ¯=â¯0.022) and there was a higher rate of recurrent and persistent disease (42.9% vs 27.6%, pâ¯=â¯0.005). Disease specific survival at 5â¯years was significantly reduced when NSND elderly females were compared to all other patients (pâ¯<â¯0.001) as well as age matched controls (pâ¯=â¯0.006). This effect was verified independently in each cohort.The results of this study suggest that NSND elderly females are a distinct patient population with poorer disease specific survival outcomes.
Asunto(s)
Neoplasias de la Boca/mortalidad , Recurrencia Local de Neoplasia/epidemiología , Carcinoma de Células Escamosas de Cabeza y Cuello/mortalidad , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Abstinencia de Alcohol/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/terapia , Disección del Cuello , No Fumadores/estadística & datos numéricos , Radioterapia Adyuvante/métodos , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Carcinoma de Células Escamosas de Cabeza y Cuello/terapia , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Oral pain and odontogenic infections are common reasons for patients to present to EDs and general medical practice in Australia. Although most odontogenic infections can be managed on an outpatient basis, because of their proximity to the airway, infections in this region can be life threatening, requiring urgent surgical intervention and ICU management. This article focuses on the emergency assessment, triage and non-specialist management of oral pain and odontogenic infections.
Asunto(s)
Servicios Médicos de Urgencia , Manejo del Dolor/métodos , Enfermedades Dentales , Australia , Humanos , Enfermedades Maxilares/diagnóstico , Enfermedades Maxilares/etiología , Enfermedades Maxilares/terapia , Enfermedades Dentales/diagnóstico , Enfermedades Dentales/etiología , Enfermedades Dentales/terapia , Odontalgia/diagnóstico , Odontalgia/terapiaRESUMEN
Dentoalveolar trauma and dislocations of the temporomandibular joint are common reasons for patients to present to EDs in Australia. The majority of medical practitioners receive very little formal training in the management of these injuries and might not have ready access to dental services out of hours for advice. This article focuses on the emergency assessment, triage and non-specialist management of dentoalveolar trauma and injuries to the temporomandibular joint.
Asunto(s)
Servicio de Urgencia en Hospital , Traumatismos Faciales , Articulación Temporomandibular/lesiones , Traumatismos de los Dientes , Urgencias Médicas , Traumatismos Faciales/diagnóstico , Traumatismos Faciales/terapia , Humanos , Traumatismos de los Tejidos Blandos/diagnóstico , Traumatismos de los Tejidos Blandos/terapia , Avulsión de Diente/diagnóstico , Avulsión de Diente/terapia , Traumatismos de los Dientes/diagnóstico , Traumatismos de los Dientes/terapia , TriajeRESUMEN
Fractures of the facial skeleton are a common reason for patients to present to EDs and general medical practice in Australia. Trauma to the maxillofacial region can lead to airway obstruction, intracranial injuries, loss of vision or long term cosmetic and functional deficits. This article focuses on the emergency assessment, triage and non-specialist management of traumatic injuries of the orbit and facial skeleton.