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5 Involved surgical margins in oral and oropharyngeal cancer – an anatomical problem
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Oral presentations / British Journal of Oral and Maxillofacial Surgery 48 (2010) S1–S24
into clinical trials when tumour targeted agents are offered in addition to radiotherapy to prevent relapse for cases with minimal residual disease in surgical margins. 4 Nasal cosmesis following alveolar bone grafting in unilateral cleft patients K. Shekar, N. Jones, T.R. Flood. Salisbury NHS Foundation Trust, UK Objective: To assess the affects of secondary alveolar bone grafting to the unilateral cleft defect on nasal aesthetics. Methods: Secondary alveolar bone grafting was carried out with a formal reconstruction of the bony nasal floor. This retrospective study used pre and postoperative photographs to assess six components of nasal aesthetics. A panel of 12 used a five point scale to grade each component. Results: All assessors noted a statistically significant improvement in columella deviation (P = 0.008) and alar base symmetry (P = 0.001). The consultant surgeon group also noted an improvement in nasal symmetry (P = 0.014). Conclusion: Secondary alveolar bone grafting using a technique with formal reconstruction of the bony nasal floor using a cortical plate graft from the iliac crest appears to significantly improve the columella deviation and symmetry of the alar base. 5 Involved surgical margins in oral and oropharyngeal cancer – an anatomical problem J. McMahon, J. Devine, C. MacIver, R. Jampana, G. Bryson. Southern General Hospital, Glasgow, UK Introduction: A previous audit conducted in the West of Scotland (WoS) suggested anatomical factors accounted for a significant proportion of involved surgical margins associated with resection of an oral or oropharyngeal SCC. Since that audit a number of technical improvements have taken place, arguably the most significant of which has been advances in digital imaging enabling better surgical planning. This study compares the occurrence of involved surgical margins in a recent cohort compared with that observed in the earlier audit. Methods: The earlier (WoS) cohort comprised a consecutive series of patient undergoing surgery for an oral cavity or oropharyngeal primary SCC between November 1999 and November 2001 (n = 296). The later series comprised 178 patient undergoing resection of oral or orophayngeal SCC at the Southern General Hospital (SGH) in Glasgow between 2006 and 2009. Results: A total of 245 patients in the WoS cohort had information available on margin status of which 68 (28%) had an involved surgical margin. Of 177 patients in the SGH cohort a total of 9 (5%) had an involved surgical margin (p = 0.001). Conclusion: An anatomical approach to the resection of oral and oropharyngeal SCC, is appropriate. This approach results in a rate of involved margins of less than 10%, irrespective of primary size and site.
Method: A retrospective audit of 98 patients who had secondary alveolar bone grafting, 6 of whom had repeat procedures (of which all 6 were bilateral clefts) over a six year period. A full review of all clinical notes and radiographs. The success of graft was scored using the Kindelan Grading system by two examiners independently. Results: Our unit audit suggests a success rate of 96% can be achieved for secondary alveolar bone grafting with minimal complications using the Kindelan grading system. Conclusion: The CSAG standard for secondary alveolar bone grafting can be attained and should considered to be 96% as shown to be achievable in this regional cleft unit. 7 A clinically relevant biomarker in HPV related oropharyngeal SCC A. Schache, A. Filia, L. Wright, J. Woolgar, C. HarveyWoodworth, D. Lowe, J. Risk, T. Liloglou, R. Shaw. University of Liverpool, UK Introduction and Aims: The incidence of Oropharyngeal Squamous Cell Carcinoma (OPSCC) is increasing. Recognition of the role of Human Papilloma Virus 16 (HPV-16) infection in the pathogenesis of such tumours is increasing, with evidence indicating a survival benefit following chemo radiation for individuals with HPV positive tumours. Accurate identification of HPV-16 induced malignancy is necessary to differentiate from coincidental HPV-16 infection. Simple HPV DNA detection lacks specificity and therefore the establishment of a predictive biomarker for HPV +ve OPSCC would be beneficial. The carcinogenic effects of HPV-16 are linked to viral E2 gene expression. The significance of epigenetic changes in the HPV genome is explored through analysis of E2 promoter methylation using pyrosequencing and, for the first time, whole viral genome promoter methylation analysis in OPSCC. Material and Methods: From a series of 125 OPSCC, all HPV DNA positive tumours were analysed using p16 immunohistochemistry (IHC), mRNA expression utilising real time PCR, and pyrosequencing to determine E2 gene promoter methylation. Viral DNA integration was also measured by PCR. Results and Statistics: E2 promoter methylation varied between 10% and 90% amongst HPV positive samples. E2 methylation correlates well with p16 IHC and has merit for further investigation as a clinically relevant biomarker. HPV integration into the host genome is shown in a significant proportion of cases. Conclusions and Clinical relevance: The role of epigenetic regulation of the HPV genome is discussed with particular reference to potential predictive biomarkers of HPV status. Relevance of HPV integration into the host genome is also discussed with reference to possible viral-host epigenetic interactions.
6 A six year post-operative review of secondary alveolar bone grafting in the Trent Region
8 An investigation of variables associated with length of stay related to primary cleft lip and palate and alveolar bone graft operations. N. Izadi, P. Haers. Evelina Children’s Hospital, St Thomas’ Hospital, UK
N. Ahmed, J. Rowson. Queens Medical Centre, Nottingham, UK Aim: To consider whether the standard specified by CSAG for secondary alveolar bone grafting is appropriate and being achieved. The standard as specified by Clinical Standards Advisory Group suggests a success rate of 58% for secondary alveolar bone grafting.
Aim: To study factors influencing length of hospital stay for children undertaking primary cleft lip and palate and alveolar bone graft operations. Method: Data was collected on all the primary cleft lip, palate and alveolar bone graft operations carried out at the Evelina Children’s Hospital between January 2007 and April 2009.
Oral presentations / British Journal of Oral and Maxillofacial Surgery 48 (2010) S1–S24
into clinical trials when tumour targeted agents are offered in addition to radiotherapy to prevent relapse for cases with minimal residual disease in surgical margins. 4 Nasal cosmesis following alveolar bone grafting in unilateral cleft patients K. Shekar, N. Jones, T.R. Flood. Salisbury NHS Foundation Trust, UK Objective: To assess the affects of secondary alveolar bone grafting to the unilateral cleft defect on nasal aesthetics. Methods: Secondary alveolar bone grafting was carried out with a formal reconstruction of the bony nasal floor. This retrospective study used pre and postoperative photographs to assess six components of nasal aesthetics. A panel of 12 used a five point scale to grade each component. Results: All assessors noted a statistically significant improvement in columella deviation (P = 0.008) and alar base symmetry (P = 0.001). The consultant surgeon group also noted an improvement in nasal symmetry (P = 0.014). Conclusion: Secondary alveolar bone grafting using a technique with formal reconstruction of the bony nasal floor using a cortical plate graft from the iliac crest appears to significantly improve the columella deviation and symmetry of the alar base. 5 Involved surgical margins in oral and oropharyngeal cancer – an anatomical problem J. McMahon, J. Devine, C. MacIver, R. Jampana, G. Bryson. Southern General Hospital, Glasgow, UK Introduction: A previous audit conducted in the West of Scotland (WoS) suggested anatomical factors accounted for a significant proportion of involved surgical margins associated with resection of an oral or oropharyngeal SCC. Since that audit a number of technical improvements have taken place, arguably the most significant of which has been advances in digital imaging enabling better surgical planning. This study compares the occurrence of involved surgical margins in a recent cohort compared with that observed in the earlier audit. Methods: The earlier (WoS) cohort comprised a consecutive series of patient undergoing surgery for an oral cavity or oropharyngeal primary SCC between November 1999 and November 2001 (n = 296). The later series comprised 178 patient undergoing resection of oral or orophayngeal SCC at the Southern General Hospital (SGH) in Glasgow between 2006 and 2009. Results: A total of 245 patients in the WoS cohort had information available on margin status of which 68 (28%) had an involved surgical margin. Of 177 patients in the SGH cohort a total of 9 (5%) had an involved surgical margin (p = 0.001). Conclusion: An anatomical approach to the resection of oral and oropharyngeal SCC, is appropriate. This approach results in a rate of involved margins of less than 10%, irrespective of primary size and site.
Method: A retrospective audit of 98 patients who had secondary alveolar bone grafting, 6 of whom had repeat procedures (of which all 6 were bilateral clefts) over a six year period. A full review of all clinical notes and radiographs. The success of graft was scored using the Kindelan Grading system by two examiners independently. Results: Our unit audit suggests a success rate of 96% can be achieved for secondary alveolar bone grafting with minimal complications using the Kindelan grading system. Conclusion: The CSAG standard for secondary alveolar bone grafting can be attained and should considered to be 96% as shown to be achievable in this regional cleft unit. 7 A clinically relevant biomarker in HPV related oropharyngeal SCC A. Schache, A. Filia, L. Wright, J. Woolgar, C. HarveyWoodworth, D. Lowe, J. Risk, T. Liloglou, R. Shaw. University of Liverpool, UK Introduction and Aims: The incidence of Oropharyngeal Squamous Cell Carcinoma (OPSCC) is increasing. Recognition of the role of Human Papilloma Virus 16 (HPV-16) infection in the pathogenesis of such tumours is increasing, with evidence indicating a survival benefit following chemo radiation for individuals with HPV positive tumours. Accurate identification of HPV-16 induced malignancy is necessary to differentiate from coincidental HPV-16 infection. Simple HPV DNA detection lacks specificity and therefore the establishment of a predictive biomarker for HPV +ve OPSCC would be beneficial. The carcinogenic effects of HPV-16 are linked to viral E2 gene expression. The significance of epigenetic changes in the HPV genome is explored through analysis of E2 promoter methylation using pyrosequencing and, for the first time, whole viral genome promoter methylation analysis in OPSCC. Material and Methods: From a series of 125 OPSCC, all HPV DNA positive tumours were analysed using p16 immunohistochemistry (IHC), mRNA expression utilising real time PCR, and pyrosequencing to determine E2 gene promoter methylation. Viral DNA integration was also measured by PCR. Results and Statistics: E2 promoter methylation varied between 10% and 90% amongst HPV positive samples. E2 methylation correlates well with p16 IHC and has merit for further investigation as a clinically relevant biomarker. HPV integration into the host genome is shown in a significant proportion of cases. Conclusions and Clinical relevance: The role of epigenetic regulation of the HPV genome is discussed with particular reference to potential predictive biomarkers of HPV status. Relevance of HPV integration into the host genome is also discussed with reference to possible viral-host epigenetic interactions.
6 A six year post-operative review of secondary alveolar bone grafting in the Trent Region
8 An investigation of variables associated with length of stay related to primary cleft lip and palate and alveolar bone graft operations. N. Izadi, P. Haers. Evelina Children’s Hospital, St Thomas’ Hospital, UK
N. Ahmed, J. Rowson. Queens Medical Centre, Nottingham, UK Aim: To consider whether the standard specified by CSAG for secondary alveolar bone grafting is appropriate and being achieved. The standard as specified by Clinical Standards Advisory Group suggests a success rate of 58% for secondary alveolar bone grafting.
Aim: To study factors influencing length of hospital stay for children undertaking primary cleft lip and palate and alveolar bone graft operations. Method: Data was collected on all the primary cleft lip, palate and alveolar bone graft operations carried out at the Evelina Children’s Hospital between January 2007 and April 2009.