The prognostic significance of tumour infiltrating lymphocytes in oral squamous cell carcinoma.

Currently there is being conducted an extensive search to find new prognostic factors in oral squamous cell carcinoma which would assist in better patient management. One of the most promising prognostic markers is the density of tumour infiltrating lymphocytes. 100 cases of patients with oral squamous cell carcinoma that underwent surgical resection between 2006 and June 2016 at our institution were included in this study. From each case the most representative HE stained slide was identified and the density of tumour infiltrating lymphocytes were classified as non-brisk or brisk, which was included in the survival analysis. Upon analysis there was a strong correlation between non-brisk (n = 28) and brisk (n = 72) tumour infiltrating lymphocytes and the primary clinical outcomes: overall survival (p = 0.0472) and local recurrence-free survival (p = 0.00037). Univariate and multivariate Cox regression model confirmed the high prognostic value of tumour infiltrating lymphocytes as the independent prognostic indicator of better survival, being even superior, in our study, to the traditional pTNM system. This study provides robust evidence that the density of tumour infiltrating lymphocytes demonstrates a high prognostic significance in oral squamous cell carcinoma.

[Merkel cell carcinoma of the facial skin. Cases presentation and general rules of treatment].

Merkel cell carcinoma is an aggressive, malignant, neuroendocrine tumor of the skin. The aim of the study is to present the clinical pictures, methods and results of treatment of MCC in the Clinic of Maxillofacial Surgery in Rzeszow in years 2003-2010. Changes were located on the skin of the face of four patients. All patients were treated surgically, the primary change was removed. Recurrence after surgical treatment was observed in all patients. The observations confirmed the data from the literature about the incidence of MCC over 75 years of age, aggressiveness and difficulties in treatment of this disease.

Mucoceles of minor salivary glands in children. Own clinical observations.

INTRODUCTION: Mucoceles are benign lesions associated with the pathology of the oral mucosa of minor salivary glands. Two types of cysts are distinguished depending on their pathogenesis. Most often they occur as a result of mechanical trauma and mucus extravasation into tissues or obstruction of the gland ducts. AIM: The aim of the study was to present our own experiences regarding mucoceles of minor salivary glands in the oral cavity taking into account how frequently the individual types of cysts occur in children. MATERIAL AND METHODS: The research was carried out based on medical files from the years 2005-2015. These were: medical case records, operating books and the medical registry of patients treated at the Clinic of Maxillofacial Surgery, Frederic Chopin Clinical Regional Hospital in Rzeszow. In that period 64 children and teenagers, 28 girls and 36 boys were treated. What was considered was the age and gender of the patients, the reason for their appointment with a doctor, the location, size and histopathological type of the cysts, as well as the course and results of the diagnostic and therapeutic process. RESULTS: In the group analyzed, the reasons for referral to the Clinic were: in 25 patients accidental ascertainment of a non-symptomatic tumor in the oral cavity during examination by a dentist, pediatrician or laryngologist which had not caused any discomfort to the children; in 13 patients concern had been raised by a gradually increasing tumor; in 18 cases there was an increased tissue tension surrounding the tumor, while in 3 children red oedema was observed in the oral cavity (suspicion of abscess). The most frequent mucocele location was the lower lip (34 children). The most frequent size was 2.1-3 cm (28 children). The most frequent histological type was MEP. All the patients were treated at the Clinic in the one-day surgery mode, with good outcome. CONCLUSIONS: Mucocele ascertainment in children's oral cavity could be made accidentally in routine pediatric examination, therefore it is necessary to extend pediatricians' knowledge about small salivary gland mucoceles. The most frequent type of MEP could be related to different types of trauma in the oral mucose.

Procedure Increasing the Accuracy of Modelling and the Manufacturing of Surgical Templates with the Use of 3D Printing Techniques, Applied in Planning the Procedures of Reconstruction of the Mandible.

The application of anatomical models and surgical templates in maxillofacial surgery allows, among other benefits, the increase of precision and the shortening of the operation time. Insufficiently precise anastomosis of the broken parts of the mandible may adversely affect the functioning of this organ. Applying the modern mechanical engineering methods, including computer-aided design methods (CAD), reverse engineering (RE), and rapid prototyping (RP), a procedure used to shorten the data processing time and increase the accuracy of modelling anatomical structures and the surgical templates with the use of 3D printing techniques was developed. The basis for developing and testing this procedure was the medical imaging data DICOM of patients treated at the Maxillofacial Surgery Clinic of the Fryderyk Chopin Provincial Clinical Hospital in Rzeszów. The patients were operated on because of malignant tumours of the floor of the oral cavity and the necrosis of the mandibular corpus, requiring an extensive resection of the soft tissues and resection of the mandible. Familiarity with and the implementation of the developed procedure allowed doctors to plan the operation precisely and prepare the surgical templates and tools in terms of the expected accuracy of the procedures. The models obtained based on this procedure shortened the operation time and increased the accuracy of performance, which accelerated the patient's rehabilitation in the further course of events.

Calcifying Epithelial Odontogenic Tumour. Review of the literature and own experience.

The present paper discusses the case of a patient who was surgically treated for a rare calcifying epithelial odontogenic tumour (Pindborg tumour) at the Department of Maxillofacial Surgery, F. Chopin Clinical Voivodeship Hospital in Rzeszow. Calcifying Epithelial Odontogenic Tumour (CEOT) is a benign odontogenic tumour arising from the remnants of the dental lamina epithelium. The first three cases of this tumour were recognized by the Danish pathologist J.J. Pindborg in 1955. Since then Calcifying Epithelial Odontogenic Tumour has been commonly referred to as the Pindborg tumour. This type of neoplasm is relatively rare, since it occurs in approximately 0.4% of all odontogenic tumour cases. Due to a fairly common tendency of recurrence, estimated to be approximately 14% of all cases, the preferred o choice of treatment is radical surgical procedure and postoperative follow-up. Appropriate clinical and histopathological diagnosis is very important before applying the most suitable surgical treatment. Based on the case reviewed and the available literature, we can confirm the suitability of the therapeutic procedure course aligned with contemporary views, guidelines and established standards.

Clinical-pathological characteristics of patients treated for cancers of the eyelid skin and periocular areas.

BACKGROUND: Malignant cancers of the eyelid skin and the periocular area comprise 5-10% of facial skin malignant cancers. Basal cell carcinomas (BCCs) dominate, comprising approx. 80-90% of cancers of this area of the face. Considerably less often, in 9-14% of cases, squamous cell carcinomas (SCCs) are observed. OBJECTIVES: The aim of this study is to provide an epidemiological-clinical assessment of patients treated over the period 2006-2015 for primary malignant cancers of the eyelid skin considering histological diagnosis and clinical staging. MATERIAL AND METHODS: This study was based on an analysis of the medical records of 262 patients. Demographic data, age, sex, size and location of lesions, histological types, and clinical staging were assessed. RESULTS: In the analyzed group of 262 patients, most were over the age of 60 years. Primary cancers were most frequently located in the area of the medial canthus of the eye and in the lower eyelid skin. They were mainly lesions of 6-10 mm and 16-20 mm with histologically diagnosed basal cell carcinoma of nodular and cystic types. CONCLUSIONS: The most represented group was that of patients aged 60-70 years with primary cancers located in the medial canthus of the eye (47.3%) and in the lower eyelid. Basal cell carcinoma was diagnosed, mainly nodular and cystic types.

Observations on surgical reconstructive management following the excision of malignant neoplasms of the eyelid and periocular area.

BACKGROUND: The surgical treatment of malignant neoplasms of the eyelid and the periocular area, due to the complex structure of the eye protective apparatus, remains a difficult surgical problem. The aim is to reconstruct the missing tissue as precisely as possible, both from a functional and esthetic point of view. Postoperative disorders of eyelid function may considerably disturb both the functioning and the quality of life of the patients. OBJECTIVES: The aim of the study was to evaluate 262 patients who had underwent operations related to malignant neoplasms of the eyelid and the periocular area, and to demonstrate which reconstruction methods for post-resection defects were the most advantageous in terms of functions and esthetics. MATERIAL AND METHODS: The study was based on an analysis of the medical records of 262 patients. The analysis included the reconstruction techniques used, the patient's age, the sizes and locations of the primary skin cancer, any healing complications, and the distant esthetic and functional outcomes. RESULTS: Various types of flap procedures were the most frequently used techniques in the studied group of patients (66.8%). Single flaps were used in 83 patients, multiple flaps in 89 patients and complex flaps with a cartilage graft in 3 patients. Free skin grafts were used in 52 patients and were associated with complications in the form of partial necrosis. Complications during postoperative wound healing were observed in 18.3% of the patients. In 12 patients, the complications were associated with a local infection, in 15 patients with partial, marginal necrosis and in 8 patients partial wound breakdown after the transfer of the flap occurred. CONCLUSIONS: The most frequently used mechanisms for correction and reconstruction of the deficits following the excision of the eyelid skin and periorbital malignancies included various flaps used in a total of 175 patients (66.8%).

Awareness of Polish undergraduate and graduate students regarding the impact of viral infections and high-risk sexual behaviors on the occurrence of oral cancer.

With every passing year, more and more studies and observations demonstrate growing incidence of oral cancer, a decrease in patients' age, and an increasing number of epidemiological factors. The aim of the study was to determine the level of awareness among undergraduate and graduate university students regarding the incidence of oral cancer linked with viral infections and high-risk sexual behavior, including oral sex. Self-administered questionnaire-based survey was carried out among 196 Polish students aged 19 to 25 years. It was found that the young adults understood the meaning of human papillomavirus (HPV), but associated it only with the squamous cell carcinoma of the cervix. A total of 43.4% did not realize that there was any correlation between HPV infection and the development of oral cancer. The students who were aware of this correlation constituted 40.3% of the total. The majority of the participants, that is, 82 subjects (41.8%), did not associate the occurrence of malignant neoplasms of the oral cavity with oral sex. The study group did not present adequate awareness of the fact that occurrence of oral cancer may be associated with high-risk sexual behaviors. Knowledge of oral cancer was not significantly related to the level of university education (P < .005).

Leiomyosarcoma in the mandible: A rare case report.

Leiomyosarcoma (LMS) is a malignancy which very rarely occurs in maxillofacial location, and the course of the disease is not very characteristic.In this case report, we present a 58-year-old female patient with a painless tumor of the left angle of the mandible causing slight asymmetry of the face. She also reported that she observed deterioration in fitting of the lower denture in the oral cavity for several months, which she had used successfully for 5 years.On the basis of clinical tests, histopatological examination, and imaging (CT, MRI, ultrasound, pantomography), the patient was diagnosed with primary malignant leiomyosarcoma (LMS) of the mandibular corpus and ramus on the left side. The patient received combined surgical and oncological treatment. The first stage was a surgery, and then adjuvant radiotherapy was applied on the site of the resected tumor-a total dose of 60 Gy in 35 fractions. The patient's postoperative course was uneventful. She also underwent adjuvant therapy well. In the period of 3-year follow-up, no signs of recurrence were observed.The findings may extend our knowledge and experiences in the treatment of leiomvosarcoma in the craniofacial area.

A fatal case of descending necrotizing mediastinitis as a complication of odontogenic infection. A case report.

This paper presents the case of a 26-year-old female patient in whom descending necrotizing mediastinitis (DNM) developed as a complication of an odontogenic purulent infection of the mouth. Despite the efforts of a multidisciplinary treatment team, the patient died with symptoms of septic shock and multiple organ failure. According to the literature, and as confirmed by our own observations, successful treatment requires early tomographic diagnosis, radical surgery, combination antibiotic therapy, and intensive care.