Sentinel lymph node biopsy versus selective neck dissection in patients with early oral squamous cell carcinoma: A cost analysis.

OBJECTIVE: Sentinel lymph node biopsy (SLNB) has been proved to be as efficient as selective neck dissection (SND) for the treatment of occult metastases in T1-T2cN0 oral squamous cell carcinoma (OSCC). The aim of our study was to assess and compare the cost of these two surgical procedures. PATIENTS AND METHODS: This retrospective cost analysis includes consecutive patients treated between 2012 and 2017 in two French hospitals either by SLNB or SND. Hospital cost (hospital stay for initial surgery and re-hospitalizations over a period of 60 days after the initial surgery), the length of hospital stay for the initial surgery and the perioperative management were described and compared between the two techniques. The propensity score regression adjustment method was used to address selection bias. RESULTS: Ninety-four patients underwent SLNB procedure and seventy-seven patients underwent SND. The length of hospital stay for initial surgery was lower in SLNB group: 5.8 days (SD: 3.8) versus 9.2 days (SD: 5) in the SND group. Hospital costs were lower in SLNB group: €7 489 (standard deviation: €3 691) versus €8 886 (standard deviation: €4 381) but this difference was not significant after propensity score regression adjustment. The rate of complication, the delay of full oral feeding and postoperative drainage were lower in SLNB group. CONCLUSION: SLNB in T1-T2cN0 OSCC is less invasive than SND with fewer complications, a shorter length of hospital stay and favorable perioperative management. This study shows that this technique could be also less expensive than SND.

Vestibuloplasty for immediate dental implantation in fibular free flap for oral cancer patients undergoing mandibulectomy reconstruction: A technical note.

Vestibuloplasty is fundamental to restore an oral vestibule for immediate dental implantation in fibular free flap (FFF) for oral cancer patients undergoing mandibulectomy reconstruction. Double surgical team including reconstructive head and neck surgeon and a dental surgeon is fundamental. The first step of the vestibuloplasty is to identify the skin perforator. The second step is to thin the FFF skin island as much as necessary to facilitate: i-the reinset into the gingivobuccal sulcus while creating enough space in the oral vestibule for the future dental prosthesis and ii-the exposition of dental implants. The third step is to create a percutaneous access to the implants through the FFF skin paddle using a dermatologic punch while preserving a large oral vestibule. The fourth step is the skin reinsertion into the gingivobuccal sulcus and closure. Realizing vestibuloplasty before radiotherapy allows prevention of soft tissue contraction and osteoradionecrosis while reducing the necessary time for a complete dental rehabilitation and improving patient quality of life.