Intra-arterial preoperative cytostatic treatment versus preoperative irradiation: A prospective, randomized study of lingual and sublingual carcinomas.

BACKGROUND: For several decades, both preoperative intra-arterial chemotherapy and preoperative irradiation have been accepted treatments for patients with tumors of the head and neck. Unfortunately, arguments have often been put forward in favor of one or other of the two methods, but without the performance of an objective, randomized investigation. To resolve this situation, the authors have carried out a multicenter, randomized prospective study of selected patients with a view to deciding which method affords better results in complex tumor therapy from the aspects of survival and postoperative quality of life. METHODS: One hundred thirty-one patients with operable sublingual or lingual squamous cell carcinoma in stages T2NXM0 to T4MXM0 were randomized into 2 groups: 1 group participated in preoperative chemotherapy with cisplatin and epirubicin (total doses: 200 mg cisplatin, 120 mg epirubicin) via the external carotid artery, whereas the other group received preoperative radiation therapy (46 grays). Following subsequent radical surgery, the patients received regular follow-up for 5 years. RESULTS: By the end of the 5 years, 95 of the 131 patients had conformed to the protocol. Of those 95, 47 had received preoperative chemotherapy and 48 preoperative irradiation. After 5 years, 18 of the 47 patients who received chemotherapy and 15 of the 48 patients who received irradiation were still alive and tumor free. A few more patients had died of recurrence or regional metastasis in the chemotherapy group (23 patients) than in the irradiation group (20 patients). Occurrence of a second carcinoma was 3 times as frequent in the irradiation group (9 patients) as in the chemotherapy group (3 patients). Overall, the survival rates were by-and-large the same for the two groups. Regarding postoperative quality of life, the chemotherapy group presented a more favorable picture. CONCLUSIONS: The long term survival results subsequent to preoperative intra-arterial chemotherapy or preoperative radiotherapy were practically the same. Regarding postoperative quality of life, patients who underwent intra-arterial chemotherapy appeared to be in a slightly more favorable situation. The authors consider it important to stress these findings, as they are not aware of a similar randomized study of patients with tumors of the oral cavity.

Extensive facial vascular malformations and haemangiomas: a review of the literature and case reports.

We present 6 selected cases of extensive facial vascular anomalies extending to the skull base or actually involving it. These patients are compared with other cases in the literature. The spontaneous course of these vascular lesions is different and so variable treatment modalities are suggested depending on the age of the patient and the type of lesion. In young children, haemangiomas are common and spontaneous involution is characteristic. Conservative treatment in the sense of a wait-and-see approach is thereby favoured if there is no urgent indication such as involvement of essential structures, e.g. blockage of an orifice as demonstrated in one case or complications such as excessive bleeding. Vascular malformations most commonly appear in adults, there is no tendency to spontaneous involution and resection is usually necessary, especially in arteriovenous malformations. Nowadays, preoperative superselective embolization is recommended to minimize intraoperative blood loss. Superselective embolization is the treatment of choice in cases of a-v fistulae. Proximal ligation of the supplying arteries should be avoided because this may make embolization more difficult, and may be responsible for the common occurrence of rapid revascularization.

Treatment of intraosseous high flow arteriovenous malformation of the mandible by temporary segmental ostectomy for extracorporal tumour resection: a case report.

We present a case of intraosseous arteriovenous malformation of the mandible with temporary segmental resection, extracorporal removal of the vascular malformation from the osteotomized mandibular bone and intraoperative osteosynthetic replantation of the avascular bony remnant. In a follow-up after 1 year, when removing the titanium miniplates used for osteosynthesis, the mandibular bone was found to have remodelled completely. There is no recurrence of the lesion in a follow-up after 2 years.

Pedicled calvarial bone flap for reconstruction of the anterior skull base following tumor resection.

According to our experience in five patients, the calvarial bone flap pedicled on the temporalis muscle in combination with a galeal-pericranial flap can be recommended for one-stage reconstruction of the anterior skull base following tumor resection. It gives good support to the brain, prevents CSF leakage and ascending infection, and can be used for closure of defects exceeding the midline.

[Reconstruction of the orbital roof after tumor resection with a pedicled muscle calvarial flap--the calvaria temporalis flap]. / Die Rekonstruktion des Orbitadaches nach Tumorresektion mit einem muskelgestielten Kalottendeckel--der Calvaria-temporalis-Lappen.

The reconstruction after radical orbital exenteration and tumor resection in the anterior skull base may be difficult. To cover these particular perforations we introduce a calvarial bone flap vascularized by a pedicle of the temporal muscle. Technique and experience in 6 cases are reported.

Ankylosis of the temporomandibular joint. Follow-up of thirteen patients.

We undertook a postoperative clinical study of 13 patients with ankylosis of the temporomandibular joints. The study consisted of an evaluation of the surgical concepts of resection and subsequent surgical reconstruction by osteotomy in previous height of the joint space and lining of the glenoid fossa with lyophilized dura. Early mobilization and aggressive physiotherapy are mandatory postoperative measures. According to the theory of mandibular growth as a result of functional matrix, early surgical intervention to correct ankylosis should be performed, regardless of the age of the patient, to prevent recurrence and later asymmetry or distoclusion.

[Intra- and extra-capsular condyle fractures in the growth period. Therapy, clinical course, complications]. / Intra- und extrakapsuläre Kondylusfrakturen im Wachstumsalter. Therapie, Verlauf, Komplikationen.

37 patients had been reviewed after surgical (n = 25) or conservative (n = 12) treatment of condylar fractures. Morphologic and functional outcomes were equal in spite of the poorer starting position of the patients that had been operated on. Injuries and complications due to the operation, such as facial nerve palsy, growth inhibition or obvious scars have never been found. Conservatively treated and operated patients alike showed a moderate limitation of opening and mediotrusion on the fracture side, and both groups showed a flattening of the protrusion path.

[Midfacial and mandibular fractures during the growth period]. / Mittelgesichts- und Unterkieferfrakturen im Wachstumsalter.

This study investigated the occurrence of primary and secondary complications following conservative versus surgical intervention in the treatment of midface and lower jaw fractures. Follow-up studies were undertaken on 81 patients who had been admitted to the above clinic with such fractures during their adolescence. It was found that more complications developed after surgical intervention.

Regional chemotherapy of inoperable maxillofacial tumours combined with radiotherapy. Long-term results.

At the Department of Oral Maxillo-Facial Surgery, University of Vienna, we have from January 1973 to September 1985, subjected 117 patients with inoperable malignant tumours in the maxillo-facial area to intra-arterial chemotherapy consisting of methotrexate and bleomycin. In this group 103 patients have also been given radiotherapy. In this report only 68 patients of the group of 103 patients who have undergone combined treatment have been considered eligible for evaluation on the basis of their post-therapeutic survival time, which ranged from 2 to 11 years. 10 cases with complete remission and 34 cases with partial remission were observed, indicating that 65% responded to combined treatment.

[Causation of stomatitis during cytostatic chemotherapy for head and neck tumors]. / Zur Ursache der Stmoatitis bei der Chemotherapie von Kopf-Hals-Tumoren.

In a prospective trial involving 17 patients with head and neck tumors an attempt was made to relate the occurrence of stomatitis during cytostatic chemotherapy to changes in the resident microbial population, if any. Of the 17 patients who received the same cytostatic regimen, 10 developed stomatitis after a mean interval of 12 days. Smears were taken of the 2 patient subgroups (with and without stomatitis) at the onset of treatment and after comparable intervals during treatment and compared to those of a normal control group. Pretreatment smears did not show any quantitative or qualitative differences in the aerobic and anaerobic microbial spectrum between the 3 subgroups examined. During treatment patients developing mucositis were found to show a statistically significant multiplication of pathogens, while the other 2 groups still did not differ from one another. Together with the direct cytostatic effect of chemotherapy, proliferation of pathogens in the oral cavity appears to contribute to the development of stomatitis.

Experience with radical surgical treatment of maxillofacial tumours invading the base of the skull. Long term results.

A review of patient data of maxillofacial tumours invading the base of the skull shows a relatively high fatality rate as a result of surgical intervention but also an unexpectedly high life expectancy. Surgical intervention seems to be the right choice whenever clinical examination suggest tumour removal is possible even if a tumour cannot be extirpated in one operation and a further operation from a second access is needed.

Paranasal incision as an access for maxillary osteotomy.

A new approach for osteotomy of the maxilla through a paranasal incision is described. Advantages and indications are discussed.

Traumatic lesion of the optic nerve.

The problems of therapy are described by comparing a retrospective (17 cases) to a prospective (12 cases) study of cases of traumatic lesions of the optic nerve. Intensive cooperation between specialists and a quick diagnosis facilitate the decision regarding treatment and lead to better results. Indication for surgical treatment-transcranial or transethmoidal approach-should be confined to posttraumatic deterioration of optic nerve function in combination with fractures of the optic canal, and to its deterioration in spite of proper conservative treatment-shock treatment and cortisone infusions-.

[Histopathology and prognosis of thymomas. Statistical analysis of 200 cases]. / Histopathologie et pronostic des thymomes. Analyse statistique de 200 cas.

200 cases of thymoma operated on at the surgical centre of Marie-Lannelongue between 1955 and 1982 were reviewed and analysed statistically; their histology was compared and their evolutionary potential. Based on their degree of differentiation of the epithelial tumour component and on the proportion of non tumour associated lymphocytes, 4 histological types were defined: 1) Spindle-or-oval-cell thymomas where tumour cells reminiscent of normal involutive thymic cells were of small size with a tendency to form clusters, whorls or a glandular appearance; 2) Lymphocyte-rich thymomas where normal epithelial cells, few in number, reproduce the appearance of normal thymic cells; 3) Differentiated epithelial thymomas, comprised of large epithelial cells with abundant cytoplasm and clearly demarcated and often less numerous lymphocytes; 4) Undifferentiated epithelial thymomas, characterised by a poverty of lymphocytes and anaplastic epithelial cells with a raised nuclear cytoplasmic ratio, nuclear irregularity and mitosis. Statistically, there was a significant correlation between the degree of differentiation of the tumor and prognosis. Spindle-or-oval cell thymomas (type 1) and lymphocyte-rich thymomas (type 2) have an 80% survival at 5 years and a 75% survival at 10 years. Well differentiated epithelial thymomas of type 3 have a 75% survival at 5 years and a 50% survival at 10 years, finally undifferentiated epithelial thymomas (type 4); the survival rate was nil at 5 years.(ABSTRACT TRUNCATED AT 250 WORDS)

[Results of surgically and conservatively treated cases of traumatic optic nerve lesions]. / Ergebnisse von operativ und konservativ behandelten Fällen mit traumatischen Optikusläsionen.

The problems of therapy are demonstrated by comparing a retrospective study and a prospective study of 29 cases with lesion of the optic nerve. Intensive cooperation between specialists and a quick diagnostic procedure facilitate therapeutic decision-making and lead to better results.