ABSTRACT
Free tissue transfer is a reliable surgical technique that enables primary reconstruction following ablative surgery. Widely practised in many European units, acceptance into mainstream oral and maxillofacial surgery in the USA has been slow. The authors reviewed free flap practice patterns and outcomes in a US oral and maxillofacial surgery training program with specific emphasis on failures and complications to illustrate obstacles encountered during the initial phase of practice implementation. The demographic and clinical data of 71 consecutive patients who underwent microvascular reconstruction over 3 years (2002-2005) were reviewed. The study group included 48 males and 23 females who underwent 72 free tissue transfer procedures. Fourteen patients required operative exploration in the perioperative period. Six patients were explored for clinically compromised flaps. Thrombotic events occurred in 4 patients; 1 flap was successfully salvaged. There were 4 flap failures and 9 complications related to the donor site. Two perioperative deaths occurred from non-flap-related complications. Prolonged hospital stay and ICU utilization was observed in patients with surgical complications. Complications in this study did not affect the overall success rates of free-flaps. Salvage rates from thrombotic events were unaffected despite rigid flap monitoring protocols.
Subject(s)
Head and Neck Neoplasms/surgery , Oral Surgical Procedures/adverse effects , Plastic Surgery Procedures/adverse effects , Surgery Department, Hospital/statistics & numerical data , Surgical Flaps , Adult , Aged , Anastomosis, Surgical , Female , Head and Neck Neoplasms/rehabilitation , Humans , Length of Stay , Male , Microvessels/surgery , Middle Aged , Postoperative Hemorrhage/etiology , Retrospective Studies , Surgical Flaps/blood supply , Thrombosis/etiology , Treatment Failure , United States , Young AdultABSTRACT
Although liposarcoma is one of the most common soft tissue sarcomas, its location in the oral cavity is very rare. To our knowledge, only 43 cases of liposarcoma originating in the oral tissues have been reported in the English-language literature. In this article, we report a case of well-differentiated liposarcoma affecting the cheek of a 28-year-old man and review the oral liposarcoma literature. Immunohistochemical analysis of the tumor revealed an MDM2+/CDK4+/p53+ immunophenotype that is consistent with the immunohistochemical profile of well-differentiated liposarcoma originating in other areas of the body. Quantitative polymerase chain reaction analysis of the DNA levels of the MDM2 (human homologue of the murine double-minute type 2), CDK4 (cyclin-dependent kinase 4), and SAS (sarcoma amplified sequence), genes was performed, revealing only SAS gene amplification. The possibility of misdiagnosis of oral liposarcoma because of its sometimes inconspicuous clinical and microscopic features is emphasized. Careful pathologic examination of liposarcoma is essential for discrimination from benign adipose tissue neoplasms and for precise histologic classification, both of major prognostic significance. Possible implications of molecular and cytogenetic analysis for unraveling the pathogenesis and determining the prognosis of liposarcoma are discussed.
Subject(s)
Cyclin-Dependent Kinases/genetics , Genes, p53/genetics , Liposarcoma/genetics , Mouth Neoplasms/genetics , Neoplasm Proteins/genetics , Nuclear Proteins/genetics , Proto-Oncogene Proteins/genetics , Adult , Cyclin-Dependent Kinase 4 , DNA, Neoplasm/genetics , Diagnosis, Differential , Gene Expression Regulation, Neoplastic/genetics , Humans , Immunohistochemistry , Immunophenotyping , Liposarcoma/pathology , Male , Membrane Proteins/genetics , Mouth Neoplasms/pathology , Polymerase Chain Reaction , Prognosis , Proto-Oncogene Proteins c-mdm2 , TetraspaninsABSTRACT
Proliferative verrucous leukoplakia (PVL) is a particularly aggressive form of oral leukoplakia that is resistant to treatment and presents a high risk of recurrence and malignant transformation. This article describes the microscopic and clinical characteristics of one case of PVL, which initially presented as hyperkeratosis with mild dysplasia and posteriorly developed multifocal areas and verrucous carcinoma despite treatment.
