Perioperative management of maxillofacial tumor and reconstruction patients.

Patients who undergo maxillofacial tumor surgery and reconstruction present many perioperative management challenges. This patient population commonly presents with significant medical comorbidities in addition to the site-specific challenges of these tumors and the complexity of the reconstructive surgeries. This article combines a review of the relevant literature and the experience of a busy regional maxillofacial tumor and reconstruction referral center to provide a concise reference for management of patients. In addition to the valuable system-specific information presented, the article outlines a daily clinical pathway, which is easily adapted to any clinical practice performing complex maxillofacial surgery.

Surgical management of cutaneous melanoma of the head and neck.

Surgical management of cutaneous malignant melanoma of the head and neck requires careful assessment of the primary lesion, use of appropriate biopsy and excision technique, and assessment of the regional lymphatics in all but the thinnest of lesions. Sustained disease-free survival can be achieved with appropriate initial intervention and serial follow-up. The major significant differences between current and past management are the advent and acceptance (or not) of sentinel node biopsy technique for intermediate thickness lesions without evidence of lymphadenopathy and an improved, validated, staging system. Early diagnosis and management are crucial to improving patient survival. They are best achieved through education of patients and clinicians.

Mandibulotomy fixation: a laboratory analysis.

PURPOSE: Mandibulotomy is an access osteotomy technique associated with significant complications. Critical evaluation of available fixation systems is required to aid in the selection of the most stable fixation method. This study was designed to provide data on the stability of traditionally used plating configurations and a low-profile 2.0-mm locking plate (mandibular locking plate, Synthes MLP; Synthes Maxillofacial, Paoli, PA). MATERIALS AND METHODS: An in vitro red oak model was used to evaluate the stability provided by the study fixation devices. Five groups were studied as follows: group 1, two 4-hole 2.0-mm nonlocking miniplates; group 2, two 4-hole 2.0-mm mandibular locking plates; group 3, one 6-hole 2.0-mm mandibular locking plate; group 4, one 6-hole 2.4-mm nonlocking rigid plate; and group 5, control (uncut red oak blocks). Each specimen was tested with vertical loads applied over the osteotomy site. The force-versus-displacement behavior was recorded for each specimen and analyzed statistically. RESULTS: Plate type and configuration affected the resistance to vertical peak load (kilogram/force [kgf]) and the fixation stiffness (kgf/mm). The greatest peak load (58.92 kgf) and stiffness (7.07 kgf/mm) was found with group 2 specimens. The differences in system stiffness were statistically significant (P <.05), as were the peak loads for groups 1, 2, and 3. The control group (nonosteotomized red oak) had markedly higher values of peak load and stiffness (484 kg and 83 kg/mm, respectively). Group 2 specimens exhibited increased resistance to flexion. CONCLUSIONS: Two 2.0-mm locking plates provided the greatest resistance to vertical load.

Oral leiomyosarcoma: review of the literature and report of two cases with assessment of the prognostic and diagnostic significance of immunohistochemical and molecular markers.

Leiomyosarcoma of the oral cavity is a very rare tumor that is associated with aggressive clinical behavior and low survival. In this paper, we report two new cases of leiomyosarcoma affecting the mandibular gingiva and mandible of a 35-year-old male and the mandible of a 51-year-old female. Given the difficulty in the histopathologic discrimination between benign and malignant smooth muscle tumors and the absence of reliable histologic parameters for prognostication of leiomyosarcomas, we evaluated the diagnostic and prognostic value of various immunohistochemical and molecular markers. By means of immunohistochemistry and quantitative real-time PCR analysis, we detected protein expression of PCNA, bcl-2, CDK4, p53 and MDM2 in both our cases and MDM2 amplification in our second case. The literature, pertinent to oral leiomyosarcoma and to molecular analysis of smooth muscle tumors, is reviewed.

Oral and oral pharyngeal cancer: an update on incidence and epidemiology, identification, advances in treatment, and outcomes.

Dental health care providers offer a primary means by which improvements in outcome in oral and oral pharyngeal cancer can be realized. Early detection of mucosal abnormalities (e.g., leukoplakia, erythroplakia), which may represent the earliest identifiable premalignant change, requires only thorough oral-examination skills. Patient education and efforts to decrease the use of tobacco products are a critical means of decreasing incidence. Changes in cancer incidence related to tobacco cessation will take many years to affect statistical rates of oral and oral pharyngeal cancer.