Risk factors of recipient site infection in head and neck cancer patients undergoing pectoralis major myocutaneous flap reconstruction.

The aim of this study was to investigate the factors associated with infection at the recipient site of pectoralis major myocutaneous flap (PMMF) of head and neck cancer patients. We retrospectively reviewed head and neck cancer patients who underwent PMMF reconstruction and identified those with recipient site infection. Variables of patients with and without infection were compared and associated factors were investigated by logistic regression model. A total of 478 patients were included in the final analysis and 183 patients (38.3%) developed recipient site infection. Lower margin of skin island, concurrent tracheotomy, diabetes mellitus, mandibular plate reconstruction, prior radiation, and peri-operative blood transfusion were independent factors associated with recipient site infection of PMMF. Skin island of PMMF beyond the eighth intercostal space markedly increased the risk of recipient site infection after major head and neck cancer surgery. Recognition of relevant factors associated with infection may help surgeons to identify those at risk.

The association between surgical site infection and previous operation in oral cavity cancer patients.

We investigated the post-operative surgical site infection (SSI) rate in oral cavity cancer patients who had previous operation in the oral cavity region and compared it with that of patients without previous operation. We retrospectively reviewed over 1,000 chart records of oral cavity cancer patients from January 2004 to November 2010 and relevant data were collected. Statistical methods included descriptive statistics, bivariate analyses, and a multiple logistic regression model for investigating the relevant factors of post-operative SSI. A total of 894 patients were enrolled in the final analyses. The overall post-operative SSI rate was 20.8%. Previous history of operation was identified in 173 patients (19.4%). There was no significant difference in post-operative SSI rate between the patients with previous operation and those without (22.5 vs. 20.4%, P = 0.601). Previous operation in the oral cavity region was not associated with increased post-operative SSI rate in oral cavity cancer patients.

Prognostic factors in patients with buccal squamous cell carcinoma: 10-year experience.

PURPOSE: Squamous cell carcinoma (SCC) of the buccal mucosa accounts for 23% to 37% of all intraoral cancer cases in Taiwan. Because of the high recurrence rate and invasive tumor behavior, the prognosis is generally poor. The aim of this study was to evaluate the prognostic significance of clinicopathologic factors on survival rates for patients with buccal SCC in a medical center in central Taiwan. MATERIALS AND METHODS: Between March 1995 and December 2002, patients admitted to hospital and diagnosed as having buccal SCC were enrolled in the study. There were 415 patients (406 men and 9 women) 25 to 84 years old (mean age, 51.1 ± 11.4 years). The chart records were retrospectively reviewed. Relevant clinical features in each patient, such as primary tumor size, tumor stage, initial treatment modalities, surgical margin status, cervical nodal metastasis status, and histopathologic grade, were compared for survival analysis. RESULTS: Three hundred ninety-four patients received surgical intervention. Univariate analysis of relevant prognostic factors showed that positive surgical margin, positive cervical nodal metastasis, positive extracapsular spread, larger tumor, and advanced tumor stage were associated with poor prognosis. Multivariate analysis identified the factors that independently influenced the survival rate as advanced stage disease (stage III: relative risk [RR], 3.09; P = .006; stage IV: RR, 4.64; P < .001), positive surgical margin (RR, 2.02; P = .001), and extracapsular spread of cervical lymph node metastasis (RR, 6.89; P < .001). CONCLUSIONS: This study represents the largest series in the literature and highlights the importance of tumor stage, surgical margin status, and extracapsular spread of cervical nodal metastasis as the most important prognostic factors in patients with buccal SCC.

Decreased GRP78 protein expression is a potential prognostic marker of oral squamous cell carcinoma in Taiwan.

BACKGROUND/PURPOSE: Oral squamous cell carcinoma (OSCC) is an aggressive tumor and its occurrence in Taiwan is closely related to chronic smoking, alcohol consumption, and especially to betel quid chewing. It became the fourth most common malignant tumor of Taiwanese men in 2006. Unfortunately, there are few biomarkers for diagnosis and treatment of this disease. METHODS: To find potential markers, two domestic cell lines (OC2 and OCSL) derived from different grades of OSCC were established and their proteins were compared by global proteomic analysis. The expression differences of GRP78 protein in these two cell lines and clinical samples from OSCC patients were verified. RESULTS: Of the 11 candidate proteins expressed differentially in both cell lines, six [heat shock protein 90 kDa beta member 1 (94 kDa glucose-regulated protein; GRP94), protein disulfide-isomerase precursor, vimentin, tubulin beta-2C chain, 78 kDa glucose-regulated protein precursor (GRP78), and annexin A2] were increased in OC2 cells (low-grade OSCC), and five (heat shock protein 90-beta, annexin A1, stress-induced phosphoprotein 1, elongation factor-2, and integrin alpha-3 precursor) were increased in OCSL cells (high-grade OSCC). Some of these proteins have been previously associated with malignant tumors, but no previous association of GRP78 with OSCC has been reported. GRP78 protein expression in these two OSCC cell lines was confirmed by Western blotting. Immunohistochemical staining of clinical samples from OSCC patients revealed that decreased GRP78 protein expression was significantly correlated with advance tumor stage (p < 0.001) and neck lymph node metastasis (p = 0.001). CONCLUSION: GRP78 protein is a possible biomarker of oral cancer in Taiwan.

Comparison of the effectiveness of autologous fibrin glue and macroporous biphasic calcium phosphate as carriers in the osteogenesis process with or without mesenchymal stem cells.

BACKGROUND: Facial bone reconstruction has been a challenge for oral and maxillofacial surgeons for a long time. Recently, some studies have reported the use of stem cells in facial reconstruction to achieve osteogenesis. However, to ensure that stem cells remain in the recipient site, a biocompatible carrier is needed to transfer the stem cells. Fibrin glue has been shown to promote hemostasis in wound management and accelerate soft tissue healing, but the role of fibrin glue in bone regeneration remains debatable. The purpose of this study was to compare the effectiveness of autologous fibrin glue and macroporous biphasic calcium phosphate (MBCP) as carriers in the osteogenesis process with/without mesenchymal stem cells. METHODS: Fifteen New Zealand white rabbits were used in this study. Mesenchymal stem cells were harvested from the iliac bone, and autologous fibrin glue was made from peripheral blood. Three cranial defects with a diameter of 6 mm were created over the cranial bone in each rabbit. The 15 animals were separated into 2 groups. The first group contained 12 rabbits. The grafted substances placed over the regions of defect were: (1) stem cells plus autologous fibrin glue; (2) stem cells plus MBCP; (3) defect alone as control. In the second group of 3 rabbits, the cranial defects were grafted with: (1) autologous fibrin glue alone; (2) MBCP alone; (3) defect alone as control. Rabbits were sacrificed at 1, 2 and 3 months post operation. Radiography and histology were used to detect bone formation. RESULTS: Stem cells plus autologous fibrin glue induced more bone formation 2 months post operation and more mature bone was found 3 months post operation compared with the other groups. MBCP with or without stem cells showed moderate tissue reaction, including giant cell, histiocyte and eosinophil cell accumulation. CONCLUSION: Using stem cells plus autologous fibrin glue as the carrier may accelerate new bone regeneration.

Accuracy of implant placement with a computer-aided fabricated surgical template with guided parallel pins: A pilot study.

BACKGROUND: A precise positioning for dental implant placement is important for further prosthesis fabrication and maintenance. Computer-aided surgery has been developed to transfer digitally planned implant positioning to the patient over the past decades. This study aimed to evaluate the accuracy of a computer-aided laboratory-fabricated surgical template. A further objective was to compare the accuracy between in vivo and in vitro groups. METHODS: A total of 20 implants were placed in the posterior tooth region through the aid of surgical templates on 17 partially edentulous patients in the in vivo group. The surgical template was fabricated in laboratory after virtual implant planning was completed using computer software. In the in vitro group, the same procedures were performed on the models without placing fixture with the same templates used in surgery. Deviations of the implant access at the implant platform level and apical region, as well as the angle deviations between the virtual planning data and the surgical results, were measured using a follow-up Cone Beam Computerized Tomography (CBCT) investigation, and image fusion with planning data. RESULT: The median deviation at platform level, apex and angulation was 0.95 mm (0.3-1.3 mm),1.35 mm (0.1-3.6 mm) and 3.92° (0.44-11.66°) respectively in the in vivo group; and 0.4 mm (0-1.0 mm), 0.65 mm (0.1-1.9 mm), 2.16° (0.17-6.91) respectively in the in vitro group. The in vitro group displayed significantly less deviation (p < 0.05). CONCLUSION: The data from this study shows that computer-aided laboratory-fabricated template may be a reliable tool for implant placement. However, the clinical conditions seem to affect the accuracy of the template.

Effects of non-thermal plasma on sandblasted titanium dental implants in beagle dogs.

BACKGROUND: In this study, we investigated the effects of treating dental implants made from titanium with argon based non-thermal plasma, immediately before insertion on implant stability and bone formation. Biodegradable sandblasting and acid etching had been previously used to modify the surface of the implants. METHODS: To obtain data for 4-time points in triplicate with references, a total of 36 dental implants were divided into 2 groups; 18 implants served as the experimental group and received a spray containing non-thermal plasma, while the other 18 implants served as controls. Two treated and two untreated implants were each inserted in the jaws of 9 beagle dogs. After periods of 4, 8, and 12 weeks, the Implant Stability Quotient scores were determined and histometric values obtained. RESULTS: Plasma spray treatment increased the healing time slightly during the early recovery period (4th to 8th week, p = 0.1595 and 0.1041, respectively), but was not profoundly effective in the later recovery stage (12th week, p = 0.4942). Both non-decalcified histometric measurements and bone growth analysis showed no statistically significant differences between the plasma spray group and the controls at 4, 8, and 12 weeks. CONCLUSION: Non-thermal plasma did not enhance the stability of the implants nor did it increase bone formation in our animal models.

The correlation between HIF-1 alpha and VEGF in oral squamous cell carcinomas: Expression patterns and quantitative immunohistochemical analysis.

BACKGROUND: The prognostic predict biomarkers are important in oral squamous cell carcinoma (OSCC). We investigated the expression patterns and quantitation of hypoxia-inducible factor-1 alpha (HIF-1α) and vascular endothelial growth factor (VEGF) in OSCC patients. Among OSCC patients with recurrence and metastasis, the expression percentages of HIF-1α and VEGF also were analyzed. METHODS: Thirty-eight patients (8 hyperkeratosis, 30 oral squamous cell carcinoma) were included in this study. In the follow-up period, 5 OSCC patients had metastasis and 12 OSCC patients had local recurrence. We used computer-assisted image processing to analyze immunohistochemistry (IHC). The quantitative analysis of IHC slides, including upper-layer epithelium (U) and lower-layer epithelium (L), was calculated. RESULTS: We found homogeneous expression of VEGF in the epithelium. However, two patterns of HIF-1α expression were observed: homogeneous and heterogeneous. The highest U + L layer percentage in HIF-1α and VEF expression had significant association in tumor metastasis and recurrence (p<0.001 in HIF-1α and p<0.001 in VEGF). U + L layer HIF-1α expression percentage was >156.4%, and the survival rate was poor (p < 0.001). CONCLUSION: HIF-1α expression was not only influenced by tumor hypoxia, it also reflected tumor cell characteristics. High concentrations of VEGF and HIF-1α may have value as prognostic markers of tumor metastasis and recurrence.

Increase of disintergin metalloprotease 10 (ADAM10) expression in oral squamous cell carcinoma.

The A disintergin and metalloprotease (ADAM) superfamilies play important roles in angiogenesis, development, and tumorigenesis. Amyloid precursor protein (APP) is an important protein related to Alzheimer's disease. Recent research shows that ADAM10 alpha-secretase activity can release the secreted form of APP. We have previously demonstrated an increase of APP expression in oral squamous cell carcinoma (OSCC) and related OSCC cell lines. The present study characterizes ADAM10 expression in the neoplastic process of OSCC. RT-PCR analysis revealed a two-fold increase in APP mRNA expression in 50% of OSCC (n=50) relative to corresponding non-malignant matched tissues (NMMT). This increase in mRNA expression occurred at the preneoplastic stage. A significant correlation between mRNA expression of ADAM10 and APP in OSCC was noted. A non-buccal subset of OSCC correlated with an increase of mRNA expression of both ADAM10 and APP. The increase of ADAM10 protein expression in the majority of OSCC tissues and cell lines studies was confirmed by Western blot analysis. Additionally, an increase of ADAM10 immunoreactivity in OSCC relative to NMMT was noted. An antisense oligonucleotide against ADAM10 reduced ADAM10 expression as well as growth in an OSCC cell line. However, this treatment did not reduce the secreted form APP. This study suggests that ADAM10 expression plays a role in the carcinogenesis of OSCC and proliferation of OSCC cells, independent of APP processing.

Risk factors for wound infection after surgery in primary oral cavity cancer patients.

OBJECTIVES: Few studies have discussed the predictive factors of surgical wound infection (WI) in primary oral cavity cancer patients. Therefore, we aimed to determine the relevant factors associated with postoperative WI in a large group of patients with oral cavity cancers. STUDY DESIGN: Retrospective chart review. METHODS: We retrospectively reviewed 1,693 chart records of oral cavity cancer patients. Twenty variables were obtained from chart review. Statistical methods included descriptive statistics, bivariate analyses, and a multiple logistic regression model for investigating the predictive factors for WI. RESULTS: Postoperative WI rate was 19.8%. Diabetes mellitus (odds ratio [OR]: 2.511, 95% confidence interval [CI]: 1.409-4.475), perioperative blood transfusion (OR: 4.293, 95% CI: 2.448-7.529), reconstruction with free flap or pectoris major myocutaneous flap (OR: 3.682, 95% CI: 1.909-7.102), and postoperative serum albumin level less than 2.8 g/dL (OR: 2.853, 95% CI: 1.928-4.221) were all independent factors associated with postoperative WI. CONCLUSIONS: Recognition of relevant factors can help surgeons to identify those at high risk of WI after surgery for primary oral cavity cancer and can enable better management of such cases.

Impact of recurrence interval on survival of oral cavity squamous cell carcinoma patients after local relapse.

OBJECTIVE: The aim of this study was to investigate whether the recurrence interval influenced the survival of oral cavity squamous cell carcinoma patients after relapse. STUDY DESIGN AND SETTING: Retrospective charts were reviewed at a medical center. METHODS: We retrospectively reviewed 1687 chart records of oral cancer patients. Statistical methods included descriptive statistics, bivariate analyses, Kaplan-Meier survival analyses, and Cox proportional hazard models for investigating the relationship between the recurrence interval and survival of oral cancer patients after relapse. RESULTS: Local recurrence rate was 31.3 percent. Kaplan-Meier survival analyses showed the 5-year overall survival after recurrence was 31.56 percent. Cox proportional hazard model revealed that those with recurrence interval less than 18 months tended to have a higher probability of death than those with recurrence interval greater than or equal to 18 months (relative risk, 1.743; 95% confidence interval, 1.298-2.358). CONCLUSION: The interval from initial treatment to recurrence is an independent prognostic factor for oral squamous cell carcinoma patients. Those with a shorter disease-free interval tend to have a less favorable outcome.

Socio-demographic factors in the prognosis of oral cancer patients.

The aim of this study was to determine the survival rate of oral cancer patients treated in a medical center in central Taiwan and to investigate whether socio-demographic factors influence their survival. We retrospectively reviewed 1010 chart records of oral cancer patients. Survival was analyzed by the Kaplan-Meier method and Cox proportional hazard model was used for investigating the relationship between socio-demographic factors and survival. The overall 5-year survival rate was 63.24%. Multivariate analysis revealed that those without religious belief tended to have higher probability of death than those who had religious belief (relative risk (RR): 2.057, p<0.001). In addition, those who were single, widow/widower or divorced/separated had a poorer prognosis than those who were married (RR: 1.528, p=0.008). Apart from clinical features, socio-demographic factors also significantly influenced the survival of oral cancer patients. Therefore, care providers should take socio-demographic issues into consideration aside from ordinary clinical health care.

Osteoradionecrosis of mandible bone in patients with oral cancer--associated factors and treatment outcomes.

BACKGROUND: The purpose of this study was to investigate factors associated with osteoradionecrosis (ORN) of the mandible bone in a large cohort of patients with oral cancer. METHODS: We reviewed the medical records of patients with oral cancer and identified those with ORN of the mandible bone. Variables of patients with and without ORN were compared and associated factors were investigated by logistic regression model. RESULTS: A total of 1692 patients were included in the final analysis and 105 patients (6.2%) developed ORN in the mandible bone. Primary site, including mouth floor, buccal mucosa, retromolar trigone, or gum, segmental mandibulectomy, and total radiation dose to the primary site ≥75 Gy were independent factors associated with ORN. After aggressive treatment using surgical intervention with/without hyperbaric oxygen, 93.3% of the patients healed completely. CONCLUSION: Among patients with oral cancer after radiation, ORN is an uncommon and dreaded complication. Recognition of associated factors can help physicians to identify those at risk.

Effect of a nonthermal-atmospheric pressure plasma jet on wound healing: An animal study.

BACKGROUND: The use of a nonthermal plasma (NTP) jet in the treatment of living tissue has been the subject of considerable interest in the field of medical technology, and has the potential to reduce the recovery time of open wounds. We aimed to investigate the wound-healing process by clinical observation, blood tests, and expression of cell adhesion markers and reactive oxygen species in NTP jet-treated rats. METHODS: This study utilized Sprague-Dawley (SD) rats as experimental subjects, and wounds measuring 2 cm × 2 cm were produced on the animals' backs. The experimental group was treated with NTP for 5 min/d for 4 weeks. The NTP was injected in a diffused manner into the cage housing the rats. The SD rats that had not received plasma treatment were designated as the control group. Blood was drawn on Postoperative Day 2, Day 4, and at 3 months. An immunohistochemical stain of E-cadherin and 4-hydroxy-2-nonenal (4-HNE), a reactive oxygen species marker, were evaluated and quantified for analysis using a CMYK color model. RESULTS: A total of 35 SD rats were included in the study (25 in the NTP group and 10 in the control group). Low dose plasma treatment shortened the wound-healing time without damaging organs. In the NTP group, the white blood cell counts at Day 2 post-NTP treatment was not increased significantly more than that in the control group. After quantification of immunohistochemical staining, 4-HNE was increased at Day 14 compared with Day 7 (16.16 ± 12.81% vs. 55.11 ± 8.11%, p < 0.001), and E-cadherin was also increased (52.17 ± 14.96% vs. 70.46 ± 12.78%, p = 0.04) in the NTP group. After comparison of NTP and the control, it was observed that 4-HNE and E-cadherin were increased in the NTP group on Day 14. CONCLUSION: Short-term, low-dose NTP wound treatment was demonstrated to accelerate wound healing in SD rats without vital organ toxicity.

Clinical implications of recent exodontia before diagnosis of gingival squamous cell carcinoma: A new classification.

BACKGROUND: The purpose of this study was to clarify the clinical implications of cases with recent dental extractions to establish a new classification of gingival squamous cell carcinoma (SCC). METHODS: A total of 156 patients were enrolled in this study. The subjects were divided into 3 groups: type I (dentate; n = 46), type II (edentulous; n = 55), and type III (dental extraction; n = 55). Continuous clinical and treatment variables were analyzed by 1-way analysis of variance (ANOVA) or t test, and categorical variables were evaluated by chi-square tests. Assessment of 5-year survival rates were carried out by the Kaplan-Meier analysis, and the influence of related factors was evaluated by the log-rank test. RESULT: The 55 type III patients showed a high probability of bony invasion (80%) and a lower 5-year survival rate (48%) than the other 2 groups. CONCLUSION: Our proposed classification may help clinicians to identify patients with gingival SCC who present with more advanced disease status.

Automatic and objective oral cancer diagnosis by Raman spectroscopic detection of keratin with multivariate curve resolution analysis.

We have developed an automatic and objective method for detecting human oral squamous cell carcinoma (OSCC) tissues with Raman microspectroscopy. We measure 196 independent Raman spectra from 196 different points of one oral tissue sample and globally analyze these spectra using a Multivariate Curve Resolution (MCR) analysis. Discrimination of OSCC tissues is automatically and objectively made by spectral matching comparison of the MCR decomposed Raman spectra and the standard Raman spectrum of keratin, a well-established molecular marker of OSCC. We use a total of 24 tissue samples, 10 OSCC and 10 normal tissues from the same 10 patients, 3 OSCC and 1 normal tissues from different patients. Following the newly developed protocol presented here, we have been able to detect OSCC tissues with 77 to 92% sensitivity (depending on how to define positivity) and 100% specificity. The present approach lends itself to a reliable clinical diagnosis of OSCC substantiated by the "molecular fingerprint" of keratin.

miR-372 inhibits p62 in head and neck squamous cell carcinoma in vitro and in vivo.

Here we showed that exogenous miR-372 expression and knockdown of p62 (sequestosome1 or SQSTM1), both increased migration of head and neck squamous cell carcinoma (HNSCC) cells. p62 induced phase II detoxification enzyme NADPH quinone oxidoreductase 1 (NQO1), which decreased ROS levels and cell migration. Also, miR-372 decreased p62 during hypoxia, thus increasing cell migration. Levels of miR-372 and p62 inversely correlated in human HNSCC tissues. Plasma levels of miR-372 was associated with advanced tumor stage and patient mortality. Both plasma and salivary miR-372 levels were decreased after tumor resection. We conclude that miR-372 decreases p62, thus increasing ROS and motility in HNSCC cells.

Amyloidosis of medium-sized arteries presenting as perioral mass: a case report.

We report a case of amyloidosis localized to the medium-sized arteries of the face and presenting as prominent perioral swelling. The condition was identified as primary AL-type amyloidosis on the basis of immunohistochemical reactivity, predominantly for anti-lambda light chain antibody within amyloid deposits. Subsequent radiographic and laboratory evaluation of the patient disclosed multiple myeloma. Although amyloid deposits were subsequently detected in the temporal arteries, evidence of widespread amyloidosis has not been observed after 1 year of follow-up. To the best of our knowledge, this is the first report of myeloma-associated amyloidosis mainly localized to the medium-sized arteries of the face.

Survival analysis of patients with oral squamous cell carcinoma with simultaneous second primary tumors.

BACKGROUND: The purpose of this study was to investigate the rate of simultaneous second primary tumor (SPT) in patients with oral squamous cell carcinoma. The survival of patients with simultaneous SPT was also compared with patients without. METHODS: The presence of SPT was documented along with the patients' demographic data, tumor-related features, and survival status. Kaplan-Meier method was used for survival analysis. Relevant factors influencing the survival were examined by the Cox proportional hazard model. RESULTS: A total of 897 patients' medical records were obtained. Among them, 43 patients (4.8%) had simultaneous SPT and their prognosis was poorer than that of patients without. The Cox proportional hazard model revealed that patients with simultaneous SPT tended to have a higher probability of death (relative risk [RR], 1.694; p = .015). CONCLUSIONS: Simultaneous SPT is an independent prognostic factor for patients with oral squamous cell carcinoma. Those with simultaneous SPT have poorer survival when compared to those without.