Resultados oncológicos del tratamiento de rescate en pacientes con carcinomas de orofaringe tratados con radioterapia / Oncological results of salvage treatment in patients with oropharynx carcinoma treated with radiotherapy

Objetivo Evaluar las posibilidades de rescate tras la recidiva local en pacientes con carcinomas de orofaringe tratados con radioterapia y analizar los factores pronósticos relacionados con el control final de la enfermedad. Métodos Estudio retrospectivo de 596 con carcinomas de orofaringe pacientes tratados con radioterapia durante el periodo 1991-2018. Resultados Ciento ochenta y un pacientes (30,4%) tuvieron una recidiva local. De los pacientes con una recidiva local, 51 (28,2%) fueron tratados con una cirugía de rescate. Las variables que se relacionaron con que el paciente no recibiese una cirugía de rescate fueron una edad superior a los 75 años, la localización del tumor en la pared posterior de la hipofaringe, una extensión inicial del tumor cT4 y un intervalo libre de recidiva inferior a los 6 meses. La supervivencia específica a los 5 años de los pacientes tratados con una cirugía de rescate fue del 19,1% (IC del 95%: 7,3-30,9%). Las variables que se relacionaron con la supervivencia específica fueron la extensión de la recidiva y el estatus de los márgenes de resección. No se consiguió el control final del tumor en ninguno de los pacientes con una recidiva extensa (rpT3-4, n=25) o con unos márgenes de resección positivos (n=22). Conclusión Los pacientes con carcinomas de orofaringe tratados con radioterapia con una recidiva local del tumor cuentan con un pronóstico limitado. Una mayoría de los pacientes (71,8%) no fueron considerados candidatos a cirugía de rescate. La supervivencia específica a los 5 años de los pacientes tratados con una cirugía de rescate fue del 19,1%. (AU)

Objective To evaluate the possibilities of salvage after local recurrence in patients with oropharyngeal carcinomas treated with radiotherapy, and to analyze the prognostic factors related to the final control of the disease. Methods Retrospective study of 596 patients with oropharyngeal carcinoma treated with radiotherapy during the period 1991–2018. Results One hundred and eighty-one patients (30.4%) had a local recurrence. Of the patients with a local recurrence, 51 (28.2%) were treated with salvage surgery. Variables that were associated with the patient not receiving salvage surgery were age greater than 75 years, tumor location in the posterior hypopharyngeal wall, an initial tumor extent cT4, and a recurrence-free interval of less than 6 months. Five-year specific survival of patients treated with salvage surgery was 19.1% (95% CI: 7.3%–30.9%). Variables that were related to specific survival were extent of recurrence and status of resection margins. Final tumor control was not achieved in any of the patients with extensive recurrence (rpT3-4, n=25) or positive resection margins (n=22). Conclusion Patients with oropharyngeal carcinomas treated with radiotherapy with local tumor recurrence have a limited prognosis. Most patients (71.8%) were not considered candidates for salvage surgery. The 5-year specific survival of patients treated with salvage surgery was 19.1%. (AU)

Pruebas predictoras de vía aérea difícil y clasificación cormack-lehane en adultos. ¿mito o realidad? / Predictive tests of difficult airway and cormack- lehane classification in adults. ¿myth or reality?

El manejo de la vía aérea es de preocupación del anestesiólogo y es su deber anticipar las dificultades al realizar una intubación. Existen múltiples pruebas para predecir la vía aérea difícil. Objetivo: Describir los resultados de las escalas de Mallampati, distancia interincisivos, distancia esternomentoniana y circunferencia de cuello y la clasificación de Cormack-Lehane en pacientes adultos sometidos a cirugía electiva bajo anestesia general. Pacientes y Métodos: Estudio cuantitativo, descriptivo, de corte transversal; método de recolección de datos fue: cuestionario; en el Hospital Nacional Doctor Mario Catarino Rivas. Un total de 50 pacientes mayores de 18 años. Resultados: En la escala de Mallampati 4 (44%) de los pacientes fueron intubación difícil coincidiendo conlos resultados de la escala de Cormack-Lehane. En la apertura mayor de 3 cm el 32 (94%) fueron intubación fácil. De los pacientes con distancia esternomentoniana mayor de 13 cm el 41 (89.1%) fueron intubación fácil. En el grosor del cuello menor o igual a 36 cm, 32 (94%) fueron intubación fácil. Conclusión: Al comparar los resultados de pruebas predictoras de via aérea difícil y la clasificación de Cormack-Lehane se encontró que la clasificación de Mallampati y apertura bucal fueron similares a la clasificación Cormack-Lehane...(AU)

Experiencia inicial en Buenos Aires con la cirugía transoral robótica (TORS) / Initial experience with transoral robotic surgery (TORS) in Buenos Aires

Antecedentes: la cirugía robótica es una alternativa a la cirugía abierta, microcirugía láser CO2, o quimiorradioterapia en vía aerodigestiva superior. El robot permite trasladar la técnica quirúrgica abierta a un abordaje mínimamente invasivo, con acceso por boca, para patología benigna y maligna. Actualmente se emplean diferentes terapéuticas con similares resultados oncológicos. Objetivo: introducir una herramienta quirúrgica para abordaje bucal. Comunicar la experiencia inicial con el uso del robot. Evaluar la preservación de respiración y deglución. Analizar variables que determinaron una disminución en la hospitalización. Material y métodos: 13 mujeres y 11 hombres. Edad entre 16 y 82 años, media de 55,08. Total 24 pacientes con enfermedad inflamatoria crónica (8), tumores benignos (4) y malignos (12). Variables consideradas en cirugía robótica: tiempo y lugar de internación, complicaciones, estado respiratorio y deglutorio, uso de técnicas reconstructivas. Se realizó videoendoscopia de deglución para objetivar la seguridad del método. Resultados: tiempo medio de internación: 1,92 días. El 83,3% internado 1 día. El 79,9% en internación general. Unidad cerrada: 20,1%. Ninguna traqueostomía. Cicatrización del lecho por segunda. Sin complicaciones. Edema de lengua: 2 pacientes. Conclusiones: la cirugía robótica favorece la exéresis con baja morbilidady máxima preservación de tejidos sanos. Disminuye: edema posoperatorio, uso colgajos para reparar el lecho, traqueotomía temporaria, tiempo de internación. La videoendoscopia de deglución demuestra utilidad para determinar la deglución segura. Limitante del presente trabajo es el tamaño de la muestra. Es importante incrementar el número de pacientes para valorizar supervivencia y calidad de vida.

Background: robotic surgery is an alternative to open surgery, CO2 laser microsurgery, or chemoradiation for the upper aero-digestive tract. This system allows surgeons to use the open surgical technique in a minimally invasive approach through the mouth to treat benign and malignant disorders. Different treatments are currently used with similar oncologic outcomes. Objective: the aim of this study was to introduce a surgical tool through transoral approach, report the initial experience with the use of the robotic system, evaluate respiratory and digestive functional preservation and analyze the variables associated with shorter hospital length of stay. Material and methods: A total of 24 patients (13 women and 11 men, mean age 55.08 years [16-82]) were included. Eight patients had chronic inflammatory disease, four had benign tumors and 12 had cancer. The variables considered in robotic surgery were hospital length of stay, place of postoperative care, complications, respiratory and swallowing function and use of reconstructive techniques. Flexible endoscopic evaluation of swallowing was performed to document safe function. Results: mean length of stay was 1.92 days; 83.3% stayed for one day; 79.9% were admitted to the general ward and 20.1% stayed in intensive or intermediate care units. None of the patients required tracheostomy. Healing of the surgical bed occurred by secondary intention. There were no complications. Tongue edema occurred in two patients. Conclusions: robotic surgery favors tumor removal with low morbidity and maximum preservation of healthy tissues while reducing postoperative edema, use of flaps for reconstruction, temporary tracheostomy and hospital length of stay. Flexible endoscopic evaluation of swallowing is useful to determine safe swallowing function. The main limitation of our study is the sample size. It is important to increase the number of patients to evaluate survival and quality of life.

Implicancias pronósticas de los márgenes quirúrgicos en el carcinoma oral / Prognostic implications of surgical margins in carcinoma of the oral cavity

Antecedentes: sobre la base de la bibliografía revisada y los resultados de supervivencia global y libre de enfermedad con diferentes márgenes de resección, se plantea la hipótesis de que márgenes < 5mm son suficientes para lograr una tasa de supervivencia global y comparables a las obtenidas con márgenes mayores. Objetivo: evaluar la supervivencia global y la supervivencia específica a 3 y 5 años de los pacientes con carcinomas escamosos de cavidad oral, en función de los márgenes quirúrgicos obtenidos. Material y métodos: se reclutaron entre enero de 2010 y diciembre de 2017 81 pacientes operados, 57,1%hombres, con una edad media de 60,49 años. Resultados: en el análisis multivariado en función de la supervivencia global y libre de enfermedad, resultaron variables pronósticas significativas el grado de diferenciación tumoral (p = 0,033), la invasión ganglionar extracapsular (p = 0,001) y la infiltración perineural (p = 0,000). Se pudo observar que no hay diferencias en la supervivencia libre de enfermedad de los diferentes grupos evaluados sobre la base de los márgenes quirúrgicos, pero se cree que la radioterapia posoperatoria estaría confundiendo la importancia real de los márgenes, debido a que la mayoría de los pacientes que presentaban márgenes cercanos fueron sometidos a radioterapia posoperatoria. Conclusiones: las variables analizadas concuerdan con la bibliografía en el sentido de que los únicos factores pronósticos resultan las características histológicas. Si bien existen muchos trabajos que analizan los márgenes en el carcinoma escamoso de cavidad oral, todavía no hay consenso en cuanto al valor pronóstico de los márgenes cercanos (1-5 mm).

Background: Based on the literature reviewed and the results of overall and disease-free survival with different surgical margins, we hypothesized that margins < 5mm are sufficient to achieve and overall survival rate and are comparable to those obtained with larger margins. Objective: The primary outcome of the present study was to evaluate overall survival and specific survival at 3 and 5 years of patients with squamous cell carcinoma of the oral cavity according to the surgical margins obtained. Material and methods: Between January 2010 and December 2017, 81 patients underwent surgery; 57.1% were men and mean age was 60.49 years. Results: At multivariate analysis, tumor differentiation (p = 0.033), extracapsular lymph node invasion (p = 0.001) and perineural invasion (p = 0.000) were identified as significant predictors of overall survival and disease-free survival. There were no differences in disease-free survival in the different groups evaluated based on the surgical margins. Yet, postoperative radiotherapy may actually obscure the importance of margins since most patients with close margins underwent postoperative radiotherapy. Conclusions: The variables analyzed in this paper are consistent with the literature in that only histological characteristics are prognostic factors. Although there are many studies analyzing the surgical margins in squamous carcinoma of the oral cavity, there is still no consensus regarding the prognostic value of close margins (1-5 mm).

Current surgical practices of robotic-assisted tissue repair and reconstruction / 中华创伤杂志(英文版)

This paper systematically reviewed and analyzed the recent publications of robotic-assisted surgeries in the field of tissue repair and reconstruction. Surgical robots can elevate skin flap more accurately and shorten the time of tissue harvest. In addition, robotic-assisted surgery has the advantage of minimal tissue trauma and thus forms minimal scar. The utilization of surgical robots reduces the occurrence of complications after oral radical tumor resection while achieving cosmetic sutures. Robotic-assisted radical mastectomy could radically remove invasive breast cancer lesions and achieve breast reconstruction in the first stage through the small incisions in the operation areas. Surgical robots enable precise microvascular anastomosis and reduce tissue edema in the surgical field. Robotic-assisted technology can help appropriately locate the target tissues at different angles during sinus and skull base surgeries and accurately place tissues during urethroplasty. The robotic-assisted technology provides a new platform for surgical innovation in the field of tissue repair and reconstruction. However, the uncertainty in the survival rate after tumor radical surgery, the increase of operating time, and the high costs are barriers for its clinical application in tissue repair and reconstructive surgery. Nevertheless, robotic-assisted technology has already demonstrated an impact on the field of tissue repair and reconstruction in a meaningful way.

Carcinoma de Lengua Móvil / Mobile Tongue Carcinoma

Introducción: El Carcinoma de lengua móvil es uno de los tumores malignos más frecuentes de la cavidad bucal. Generalmente, los pacientes son diagnosticados después de los 40 años de edad. La detección temprana de estas lesiones, evita su desarrollo hacia fases avanzadas de la enfermedad, que oscurecen su pronóstico, por medio de una atención rápida y adecuada, biopsia oportuna, y tratamiento precoz, evitando que los pacientes sean mutilados, sufran o mueran por esta causa. El objetivo del presente estudio es reportar un grupo de pacientes con esta neoplasia, su tratamiento y supervivencia. Métodos: En el presente estudio descriptivo, longitudinal y retrospectivo fueron evaluados los pacientes con diagnóstico de carcinoma de lengua móvil, tratados en el Instituto Nacional de Oncología de la Habana, entre los años 2007 y 2011. Se reporta edad, tabaquismo, alcoholismo, estadiaje, tipo de tratamiento y supervivencia. Resultados: Se registraron 68 casos, se observó un predominio del grupo de edad entre los años 55-69, con el 41.18% de los pacientes, siendo el sexo predominante el masculino, con un 79.41% del total. En la clasificación TNM, se observó que predominó de los tumores estadiados como T3 con el 35.29 %, seguidos de los T2 con el 30.88 %, la invasión ganglionar estuvo más representada por la categoría N0 con el 58.82% de los casos. El 64.71% de los pacientes estaban vivos a los 60 meses. Conclusión: El carcinoma de lengua móvil fue más frecuente en las edades entre 55-69 años y en el sexo masculino, más del 50% de los pacientes practicaban hábitos tóxicos, hubo un predominio de etapas avanzadas, la cirugía con adyuvancia postoperatoria fue la terapéutica más común.

Introduction: Carcinoma of the mobile tongue is one of the most frequent malignant tumors of the oral cavity. Generally, patients are diagnosed after 40 years of age. The early detection of these lesions prevents their development towards advanced stages of the disease, which obscure their prognosis, through rapid and adequate care, timely biopsy, and early treatment, preventing patients from being mutilated, suffering or dying from it cause. The objective of the present study is to report a group of patients with this neoplasia, its treatment and survival. Methods: In the present descriptive, longitudinal and retrospective study, patients diagnosed with mobile tongue carcinoma, treated at the National Institute of Oncology of Havana, between 2007 and 2011, were evaluated. Age, smoking, alcoholism, staging are reported, type of treatment and survival. Results: There were 68 cases, a predominance of the age group between the years 55-69 was observed, with 41.18% of the patients, being the predominant sex the masculine, with 79.41% of the total. In the TNM classification, it was observed that tumors predominated as T3 with 35.29%, followed by T2 with 30.88%, the lymph node invasion was more represented by the N0 category with 58.82% of the cases. 64.71% of the patients were alive at 60 months. Conclusion: The mobile tongue carcinoma was more frequent in the ages between 55-69 years and in the male sex, more than 50% of the patients practiced toxic habits, there was a predominance of advanced stages, the surgery with postoperative adjuvant was the therapeutic more common.

Estrechez de uretra bulbopeneana de 16 centímetros, ¿es posible resolverla en un sólo tiempo? / 16-centimeter Penile Bulbar Urethral Stricture: Can it be Solved in Only One Stage?

La panestenosis de la uretra anterior tradicionalmente se ha resuelto mediante la uretroplastía en etapas. Esto implica un grave deterioro en la calidad de vida del paciente, ya que debe permanecer con la uretra expuesta y orinando sentado por unos 2 a 6 meses, entre las cirugías. Nuestro objetivo es detallar una técnica alternativa. Materiales y métodos: Presentamos un paciente de 60 años, con antecedentes de uropatía obstructiva baja de larga data, sin estudio previo. Durante una hospitalización para recambio valvular aórtico, presenta una retención aguda de orina. El sondeo uretral resulta frustro y debe instalarse una cistostomía. Posteriormente, se estudia con cistouretroscopía retrógrada y anterógrada flexible, encontrándose estrecheces en uretras peneana y bulbar, además de extensa espongiofibrosis. La uretrocistografía confirma una panestenosis anterior y muestra una uretra posterior indemne. Se decide resolver mediante uretroplastía con técnica de Asopa, utilizando un abordaje ventral, con injerto doble de mucosa oral, dispuesto en inlay dorsal, en un solo tiempo. Con bisturí oftálmico, se realiza una amplia y profunda uretrotomía dorsal, donde se fijarán los injertos más adelante. Simultáneamente, otro equipo cosecha la mucosa oral de ambas mejillas y prepara los injertos. Estos se fijan con sutura corrida en todos sus extremos y, mediante puntos interrumpidos, a la línea media sobre la albugínea dorsal. Una vez que los injertos están fijos, se instala una sonda foley siliconada de 16Fr y se procede a realizar la uretrorrafia del abordaje ventral, sobre la sonda. Finalmente se procede al cierre del cuerpo esponjoso, músculo bulboesponjoso, fascia de Colles, tejido subcutáneo y piel. Resultados: No hubo complicaciones intraoperatorias ni postoperatorias. El paciente se dio de alta a sudomicilio a los 4 días postoperatorios. La sonda se mantuvo por 34 días en total y se retiró previa realización de una pericateterografía. A los 6 meses de seguimiento, tiene un IPSS=5 y un Qmax de 17ml/seg. Conclusiones: Es factible y seguro resolver una panestenosis de uretra anterior, de 16 centímetros, mediante la técnica de Asopa, en un solo tiempo.

The pananterior urethral strictures has traditionally been solved by urethroplasty in stages. This implies serious deterioration in the life quality of patients, since the patient's urethra must remain exposed and urination must take place in a sitting position for 2 to 6 months between surgeries. Our goal is to detail an alternative technique. Materials and methods: We present a 60-year old patient with a history of long-standing lower obstructive uropathy with no previous study. During hospitalization for aortic valve replacement, he exhibits acute urinary retention. Urethral sounding is unsuccessful and cystotomy must performed. Later, he is subject to a flexible retrograde and antegrade cystourethroscopy study, finding a strictured penile and bulbar urethra, plus extensive spongiofibrosis. Urethrocystography confirms pananterior stenosis and shows an unscathed posterior urethra. It was decided to resolve the condition by urethroplasty with Asopa technique, using a ventral approach, with oral mucosa double graft, placed in a one-stage dorsal inlay. An ophthalmic scalpel is used to perform a broad and deep dorsal urethrotomy, where the grafts will be later placed. Simultaneously, another team harvest the oral mucosa from both cheeks and prepares the grafts. The latter are fastened with running suture in all ends and by interrupted stitches to the midline on the dorsal tunica albuginea. Once the grafts are fastened, a 16Fr silicone Foley catheter is installed and uretrorraphy is performed by ventral approach over the catheter. Finally, the spongy body, bulbospongiosus muscle, Colles' fascia, subcutaneous tissue and skin are closed. Results: There were no intraoperative or postoperative complications. The patient was discharged 4 days after surgery. The catheter was maintained for 34 days in total and removed after pericatheterogram. On the 6-months follow-up, it presents IPSS = 5 and Qmax of 17ml / sec. Conclusions: It is feasible and safe to resolve a pananterior urethral stenosis of 16 centimeters, using the technique of Asopa in one stage.

Study of the risk factors of postoperative surgical site infection in geriatric patients with oral squamous cell carcinoma / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To review and analyze the risk factors of postoperative surgical site infection (SSI) in geriatric patients who undergo surgical treatment of oral squamous cell carcinoma.</p><p><b>METHODS</b>A retrospective study was conducted on 143 geriatric patients who have undergone surgical treatment of oral squamous cell carcinoma. Factors were classified into four types, namely, characteristics, tumor factors, general comorbidity factors, and perioperative factors. The primary outcome variable was the presence of SSI. A logistic stepwise regression model was used for the subsequent multivariate analysis, wherein only significant risk factors in the univariate analysis were included.</p><p><b>RESULTS</b>Among 143 cases, 33 showed postoperative SSI. Results of univariate analysis indicated that risk factors included age, body mass index (BMI), tumor location, tumor size, diabetes, chronic obstructive pulmonary disease, American Society of Anesthesiologists (ASA) score, Charlson comorbidity index (CCI), adult comorbidity evaluation-27 (ACE-27) score, previous radiotherapy, reconstructive method, operation time, and blood transfusion. Among these factors, six parameters were identified to have a significant factor association with the development of SSI, namely BMI, diabetes, ASA score, ACE-27 score, operation time, and reconstructive method.</p><p><b>CONCLUSION</b>Special attention should be given to factors associated with the development of SSI before operation of geriatric patients with oral squamous cell carcinoma.</p>

Attitude and awareness of medical and dental students towards collaboration between medical and dental practice in Hong Kong.

BACKGROUND: Medical-dental collaboration is essential for improving resource efficiency and standards of care. However, few studies have been conducted on it. This study aimed to investigate the attitude and awareness of medical and dental students about collaboration between medical and dental practices in Hong Kong. METHODS: All medical and dental students in Hong Kong were invited to complete a questionnaire survey at their universities, hospitals and residential halls. It contained 8 questions designed to elicit their attitudes about the collaboration between medical and dental practice. Students were also asked about their awareness of the collaboration between dentistry and medicine. The questionnaires were directly distributed to medical and dental students. The finished questionnaires were immediately collected by research assistants on site. RESULTS: A total of 1,857 questionnaires were distributed and 809 (44%) were returned. Their mean attitude score (SD) towards medical-dental collaboration was 6.37 (1.44). Most students (77%) were aware of the collaboration between medical and dental practice in Hong Kong. They considered that Ear, Nose & Throat, General Surgery and Family Medicine were the 3 most common medical disciplines which entailed collaboration between medical and dental practice. CONCLUSION: In this study, the medical and dental students in general demonstrated a good attitude and awareness of the collaboration between medical and dental practice in Hong Kong. This established an essential foundation for fostering medical-dental collaboration, which is vital to improving resource efficiency and standards of care.

Vaginoplasty with autologous buccal micromucosa combined with acellular allogenic dermal matrix / 中华整形外科杂志

<p><b>OBJECTIVE</b>To introduce and evaluate the technical feasibility and anatomical and functional outcomes of one-stage vaginoplasty with autologous buccal micromucosa combined with acellular allogenic dermis.</p><p><b>METHODS</b>We retrospectively reviewed our experiences with 17 patients with Mayer- Rokitansky-Kuster-Hauser syndrome treated with primary surgery from September 2010 to April 2013. All patients underwent vaginoplasty with autologous buccal micromucosa combined with acellular allogenic dermis. We describe the details of this technique, observe the time of epithelization and evaluate the long- term anatomical, functional, and sexual outcomes.</p><p><b>RESULTS</b>The time of epithelization was 13 d (range: 12-15 d). At a mean follow-up of 15 months (range: 12-24 months), the mean postoperative dependence on the vaginal stent was 11.7 ± 1.64 months (range: 9-15 months), the mean depth of the neovagina was (9.0 ± 0.94) cm (range: 7-11 cm), the mean circumference was (12.3 ± 1.36) cm (range: 10.0-14.5 cm) and the mean volume was (105 ± 10) ml (range 85-120 ml). The mean female sexual function index score of the 12 sexually active patients was 29.5 ± 2.6. No spouse reported discomfort during intercourse.</p><p><b>CONCLUSIONS</b>Vaginoplasty with autologous buccal micromucosa combined with acellular allogenic dermis is an effective and feasible approach for patients with Mayer-Rokitansky-Kuster-Hauser syndrome. The procedure has satisfactory long-term anatomical and functional results. The use of the acellular allogenic dermis is limited by the high price and the potential infection.</p>

Application of 1,212 anterolateral thigh myocutaneous flaps in the repair of oral and maxillofacial defects / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To examine the benefits of anterolateral thigh myocutaneous flaps in reconstruction of oral and maxillofacial defects.</p><p><b>METHODS</b>Patients were recruited from February 2002 to June 2013 in the Department of Oral and Maxillofacial Surgery of Central South University. All patients (1,185 patients, 1,212 transferred flaps) underwent reconstructive surgery employing anterolateral thigh myocutaneous flaps. Basic information for all patients including defect side, flap size and type, recipient vessel processing method, donor complications, and postoperative quality of life were recorded and statistically analyzed.</p><p><b>RESULTS</b>Among the 1 212 transferred flaps, 1 176 survived and 36 showed necrosis, for a survival rate of about 97.0%. No cases presented with local serious complications, and 90% of patients achieved good functional recovery and aesthetically acceptable results after reconstruction of oral and maxillofacial defects at various locations using anterolateral thigh myocutaneous flaps. The time for anastomosis of one vein was significantly less than that for two veins (P=-0.000 3), which indicated one vein anastomosis could significantly reduce the operating time. The incidence of venous crisis, the survival rate after treatment, and the rate of venous crisis resulting in flap necrosis were comparable between the groups (P>0.05).</p><p><b>CONCLUSION</b>Anterolateral thigh myocutaneous flaps can be easily obtained and provide a good amount of muscle for filling dead space and fascia lata. These flaps can meet the various requirements of oral and maxillofacial defects. Therefore, the anterolateral thigh myocutaneous free flaps are more suitable for oral and maxillofacial defects than other flaps.</p>

Assessment of the quality of life of oral cancer patients after reconstruction with free anterolateral thigh perforator flaps / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study aims to evaluate the quality of life (QOL) of patients who underwent resection of oral cancer and reconstruction by free anierolateral thigh perforator flaps (ALTF).</p><p><b>METHODS</b>A total of 32 patients with oral and maxillofacial malignancies who had undergone the resection of oral cancer and reconstruction by ALTF were retrospectively analyzed. At 12 months postoperatively, the QOL of these patients was assessed by using the 14-item oral health impact profile (OHIP-14) and the medical outcome study short form-36 (SF-36) questionnaires.</p><p><b>RESULTS</b>A total of 32 questionnaires were collected. In SF-36, the highest scoring domains were bodily pain (78.58 ± 14.82), physical functioning (72.08 ± 27.86), and the role of physical (60.00 ± 42.63), whereas the lowest scoring domains were role-emotional (41.67 ± 39.62), followed by mental health (50.75 ± 13.07) and health transition (54.17 ± 21.75). In OHIP-14, the lowest scoring domains were social disability (34.50 ± 11.32) and handicap (36.04 ± 12.05), indicating the functional recovery was better; and the highest scoring domains were physical pain (73.50 ± 18.96) and psychological discomfort (60.17 ± 20.66), indicating the functional recovery was worse.</p><p><b>CONCLUSION</b>The ALTF is an ideal selection for the reconstruction of oral defects after cancer resection. In using this flap, the basic social need of patients after surgery can be satisfied. Moreover, the appearance and the functions of chewing, deglutition, and speech can be restored in varying degrees. Thus, ALTF can improve the patients' QOL.</p>

Melatonin premedication versus placebo in wisdom teeth extraction: a randomised controlled trial

<p><b>INTRODUCTION</b>Pain after wisdom teeth surgery can be moderate in severity and is compounded by preoperative anxiety in young patients. We studied the effect of melatonin premedication on postoperative pain and preoperative anxiety in patients undergoing wisdom teeth extractions.</p><p><b>METHODS</b>This randomised controlled trial recruited 76 patients at Khoo Teck Puat Hospital who were American Society of Anesthesiologists physical status I and II, aged 21 to 65 and scheduled to undergo elective extraction of all four wisdom teeth under general anaesthesia. Patients with a history of long-term use or allergy to melatonin were excluded. The patients received either 6 mg melatonin or a placebo 90 minutes before surgery. Visual analogue scale (VAS) scores at multiple time intervals for postoperative pain and preoperative anxiety, patient satisfaction and first-night sleep quality scores were obtained. Mixed-effects regression models were used for longitudinal analysis of VAS pain, anxiety and satisfaction scores.</p><p><b>RESULTS</b>Maximum VAS scores for pain and anxiety were 18.6 ± 19.1 mm at 60 minutes postoperatively and 26.2 ± 23.4 mm at 90 minutes preoperatively, respectively. After adjusting for gender, female patients who received melatonin had a faster rate of reduction of VAS pain (p = 0.020) and anxiety scores (p = 0.003) over time compared to the placebo group. No such effect was demonstrated in male patients. There was no significant difference in sleep quality or satisfaction scores.</p><p><b>CONCLUSION</b>Melatonin use did not consistently contribute to pain and anxiety amelioration in all patients. Our study demonstrated a positive effect in female patients, suggestive of sexual dimorphism.</p>

Quimioterapia de indução seguida de cirurgia com ou sem radioterapia adjuvante para pacientes com diagnóstico de câncer de cavidade oral: revisão sistemática e metanálise / Induction chemotherapy prior to surgery with or without postoperative radiotherapy for oral cavity cancer patients: systematic review and meta-analysis

INTRODUÇÃO: Os tumores da cavidade oral localmente avançados são neoplasias agressivas e com alto risco de recaída após o tratamento radical definitivo. O presente estudo foi realizado para avaliar a eficácia e segurança da quimioterapia de indução antes da cirurgia em pacientes com câncer de cavidade oral. MÉTODOS: Uma revisão sistemática da literatura foi realizada e apenas ensaios clínicos randomizados prospectivos fase III que comparavam a quimioterapia de indução seguida de cirurgia com ou sem radioterapia pósoperatória (Grupo QT) à cirurgia com ou sem radioterapia pós-operatória (Grupo Controle) foram elegíveis. Dois autores selecionaram os estudos de forma independente, respeitando os critérios de elegibilidade preestabelecidos. Avaliou-se também o risco de viés dos estudos incluídos. RESULTADOS: No total, dois estudos foram selecionados. Quatrocentos e cinquenta e um pacientes foram aleatoriamente randomizados para o Grupo QT (n = 226) e para o Grupo Controle (n = 225). A maioria dos pacientes tinha tumores em estádios clínicos III/IV (89,1%). Ambos os estudos foram classificados como tendo baixo risco de viés. Nenhum benefício estatisticamente significante em favor da quimioterapia de indução foi encontrado quanto à recorrência locorregional, à sobrevida livre de doença e à sobrevida global. A análise de subgrupo com dados individuais dos pacientes com doença cervical linfonodal N2 demonstrou benefício estatisticamente significante em sobrevida global no grupo que recebeu quimioterapia de indução. Nenhuma análise estatística foi realizada em relação à segurança das estratégias de tratamento, uma vez que os estudos incluídos não avaliaram diretamente esse desfecho. CONCLUSÕES: Com base nos estudos disponíveis, a quimioterapia de indução não melhora os resultados clínicos em pacientes com câncer de cavidade oral quando administrada antes da cirurgia radical com intenção curativa. O subgrupo de pacientes com doença linfonodal cervical N2 é aquele...

INTRODUCTION: Locoregionally advanced oral cavity cancers are aggressive tumors with high risk of relapse after definitive treatment. This study was performed to assess the effectiveness and safety of induction chemotherapy prior to surgery for untreated oral cavity cancer patients. METHODS: Only prospective phase III randomized studies comparing induction chemotherapy followed by surgery with or without postoperative radiotherapy (Chemo Group) compared with surgery with or without postoperative radiotherapy (Control Group) were eligible. Two of the authors independently selected and assessed the studies regarding eligibility criteria and risk of bias. RESULTS: Two studies were selected. A total of 451 patients were randomly assigned to Chemo Group (n = 226) versus Control Group (n = 225). Most patients had tumors at clinical stages III/IV (89.1%). Both trials were classified as having low risk of bias. No significant overall benefit in favor of induction chemotherapy was found regarding loco-regional recurrence, disease-free survival and overall survival. A subgroup analysis of individual data from cN2 patients showed statistically significant overall survival benefit in favor of induction chemotherapy. The included studies did not directly compare toxicity between the groups and no statistical analysis was performed regarding safety outcomes. CONCLUSIONS: Based on the available studies, induction chemotherapy when administered before surgery with curative intent did not improve clinical outcomes in locoregionally advanced oral cavity cancers patients. Clinically assessed N2 patients might benefit from induction chemotheraphy.

The MRCS examination--an update on the latest facts and figures.

The Intercollegiate Committee for Basic Surgical Examinations (ICBSE) is responsible for the standard, quality assurance, and continued development of both the MRCS and the Diploma in Otolaryngology and Head and Neck Surgery (DOHNS). It is accountable to the 4 Royal Colleges of Surgeons in the U.K. and Ireland, and the General Medical Council (GMC). This article gives information and an update (including pass rates) for candidates and trainers on the 2013 MRCS format, and summarises the most recent changes to the examination made by the ICBSE with the approval of the GMC.

General anesthesia for dental procedures in patients with fibrodysplasia ossificans progressiva: a review of 42 cases in 30 patients.

BACKGROUND: Fibrodysplasia ossificans progressiva (FOP) is a rare genetic condition characterized by progressive heterotopic ossification of skeletal muscle and soft connective tissues, leading to progressive ankylosis of all joints of the axial and appendicular skeleton. Cervical spine fusion, ankylosis of the temporomandibular joints, thoracic insufficiency syndrome, restrictive chest wall disease, and sensitivity to oral trauma complicate airway management and anesthesia and pose life-threatening risks. METHODS: We conducted a retrospective chart review at 1 institution of patients with FOP who underwent general anesthesia (GA) for dental procedures. RESULTS: Thirty patients underwent 42 general anesthetics. In 35 of 42 cases, GA was induced after the airway was secured by an awake fiberoptic intubation. In 4 of 42 cases, all of them pediatric, GA was first induced with maintenance of spontaneous ventilation, and the trachea was then intubated using a fiberoptic scope. In 2 cases, 1 adult and 1 pediatric, GA was first induced, and the trachea was then intubated using a GlideScope. In 1 case, the patient had a cuffed tracheostomy device in place that was accessed for GA. In 36 of 42 cases, the patients were discharged home on the same day as their dental procedure. No significant postoperative complications were encountered. CONCLUSIONS: GA can be administered safely to patients with FOP for dental procedures with attention to perioperative and airway management using a multidisciplinary approach. An awake nasal fiberoptic intubation should be considered the first choice for airway management. Most patients can be discharged home on the same day as their dental procedure.

Free fibula flap and computed tomographic angiography in the functional reconstruction of oral and maxillofacial hard and soft tissue defects / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Assessed the feasibility of application of free fibular flap and clinical significance of pre-operational contrast enhanced CT angiography in functional reconstruction of oral and maxillofacial hard and soft tissue defects.@*METHOD@#Eight cases with mandibular and soft tissue defects received a free fibula flap using arteriovenous anastomosis anastomosis method. The relationship between fibula flap design, size, repair parts and survival were analyzed. Preoperative enhanced CT angiography (CTA) examination was conducted to detect any abnormal blood vessels in fibula flap valve area.@*RESULT@#Peroneal artery and posterior tibial artery variation was identified in one case of gums cancer, who used other muscle flap. Free fibula flap in the other 7 cases survived, which carried a skin island with an area ranging from 6 cm x 2 cm to 10.0 cm x 3.5 cm. Postoperative facial appearance, functionality, dental occlusion and voice function was normal. Lower limb function returned to normal from 2 weeks to 4 months after surgery.@*CONCLUSION@#CTA examination of the free vascularized fibula flap in the preoperative evaluation of the donor site is a valuable tool. Free fibula flap of bone, periosteum and bone marrow has a dual blood supply and are highly resistant to infection after transplantation. Personalized shaping osteotomy allowed for accurate recovery of mandibular alveolar patterns. Furthermore, the height and width of the fibula and the thickness of cortical bone is suitable for dental implants. Free fibula flap skin island can also be used to monitor the post-operative blood supply and is an ideal technique for mandible and soft tissue defects reconstruction as well as functional restoration.

Discussion on reconstruction of the postoperative defect after oral floor carcinoma resection / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the reconstruction approaches and indications in repairing of postoperative defect after resection of oral floor carcinoma.</p><p><b>METHODS</b>To review the clinical data of 106 patients with oral floor carcinoma treated by radical resection with simultaneous reconstruction in the Department of Head and Neck Surgery at our hospital from July 2003 to March 2013, and to evaluate the advantages and disadvantages of various repair methods.</p><p><b>RESULTS</b>The patients were followed up for 2 months to 10 years. Their 3-year survival rate was 63.6% (42/66) and 5-year survival rate was 57.7% (30/52). One case had sternocleidomastoid myocutaneous flap necrosis, and was successfully repaired with elective pectoralis major myocutaneous flap. Another one case showed partial strap muscle flap necrosis, and the wound was well healed after debridement and dressing changes. Three cases of free flap crisis because of poor blood supply were successfully cured by flap emergency exploration. The rest were well healed. The eating and language function of the patients could meet the general needs of life.</p><p><b>CONCLUSIONS</b>At the time of radical resection of oral floor carcinoma, an appropriate repair method should be selected according to many factors such as disease conditions, defect size, patients' physical constitution, etc. Generally, adjacent pedicle flap is not recommended. Prosthodontics membrane, free forearm flap, free anterolateral thigh flap, pectoralis major myocutaneous flap and free fibula flap can basically meet the need of repair of the postoperative defect after resection of oral floor carcinoma, therefore, are recommended.</p>

Submental island pedicled flap for reconstruction of oral soft defects after oral cancer ablation / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of the submental island pedicled flap (SIPF) for the repair of oral soft defects following oral cancer ablation.</p><p><b>METHODS</b>Thirty consecutive patients undergoing resection of oral cancer followed by reconstruction with SIPF from February 2010 to March 2013 were reviewed. The effectiveness complications, oral function recovering and oncologic outcomes after reconstructive operation with SIPF were evaluated.SPSS software was used to analyze the data.</p><p><b>RESULTS</b>The dimensions of SIPF ranged from a minimum of 4 cm×6 cm to a maximum of 6 cm×15 cm. Of the 30 flaps, 28 were survival completely, one had superficial necrosis but healed with treatments, and one failed due to complete necrosis, with a survival rate of 96.7% (29/30). Operative time ranged from a minimum of 4.5 hours to a maximum of 7.5 hours, mean 6.8 hours, and hospital stay time was 11-18 days, mean 13 days. Thirteen patients (43.3%) received tracheotomy before SIPF operation. Surgical or postoperative complications included temporary marginal mandibular never palsy in one case, neck hematoma in one case, hydrops in the mandibular region in 7 cases, and neck infectionin in 2 cases. Postoperative functional results showed mouth opening was normal in 23 patients, light limitation of mouth opening in 6 cases and obvious limitation of mouth opening in one case. The speech function was re-obtained satisfactorily in 29 patients, but one case with poor speech function. Most patients showed normal swallowing function, of them 26 patients on a full oral diet, 3 patients on a soft diet and one patient on a liquid diet only. Postoperative follow-up time was for 6-19 months (median 13 months), and 4 patients had local recurrence and 2 patients had cervical lymph node metastases.</p><p><b>CONCLUSION</b>The SIPF is safe, reliable and simple for the reconstruction of middle-small oral soft defects following resection of early-stage oral cancer.</p>

Resection of parapharyngeal neoplasms via styloid diaphragm approach / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the surgical technique and efficacy of the resection of parapharyngeal space neoplasm via styloid diaphragm approach.</p><p><b>METHODS</b>Thirty-three cases underwent the resection of parapharyngeal space tumors via styloid diaphragm approach from Jan 2005 to Jan 2011 were reviewed. Of the cases, 28 were with benign tumors treated by surgery alone, and 5 were malignant tumors treated by surgery plus postoperative radical radiotherapy.</p><p><b>RESULTS</b>The parapharyngeal neoplasms in all cases were completely resected via styloid diaphragm approach. The postoperative follow-up ranged from 13 months to 7 years (median = 4.6 years). No tumor recurrence was found in 30 cases, but 3 cases experienced tumor recurrence, including 1 chondrosarcoma (3 years after surgery and chemoradiotherapy), 1 chordoma and 1 adenoid cystic carcinoma (5 years after surgery and radiotherapy). Severe postoperative complications were not observed, but 2 cases showed mild mouth askew and fully recovered after 3 months, and 1 case was complicated with hoarseness and cough symptoms that disappeared after heteropathy.</p><p><b>CONCLUSION</b>Resection of parapharyngeal neoplasms via styloid diaphragm approach is an ideal surgical technique, with well-exposed surgical field, less tissue injury, and less postoperative complication.</p>