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A case of cerebral venous sinus thrombosis associated with chemoradiation therapy for oral cancer
293 low-grade malignant behaviour with local recurrence risk and a reported metastatic risk of between 5–10%. Metastatic disease mainly affects the skin and lymph nodes. Objectives: To delineate the number of head and neck cases of primary cutaneous PDS experienced in a single district general hospital and to appreciate its nature and disease course. Methods: Four separate databases were searched for all cases of primary cutaneous PDS to allow further analysis of treatment. Findings and Conclusion: Patients with primary cutaneous PDS had a variety of treatments to include surgery alone with postoperative monitoring to surgery with consideration of adjuvant treatment. http://dx.doi.org/10.1016/j.ijom.2017.02.985 Neutrophil–lymphocyte ratio and intraoperative blood transfusion: independent prognostic factors of elderly patients with oral account C.B. Peng ∗ , Z.Q. Liu, W. Cao, T. Ji Ninth People’s Hospital School of Medicine, Shanghai Jiao Tong University, Shanghai, China Objective: There are many factors that affect the survival of old people aged over 60 years with oral squamous cell carcinoma. The immune state has great impact on suppression of tumour growth. Bad immune state appears to be associated with worse survival in many cases. To investigate the correlation between immune state, including inflammation and blood transfusion, and survival in old patients (aged over 60) with oral squamous cell carcinoma (OSCC). Methods: Data of 559 patients from Shanghai Ninth People’s Hospital between January 2010 and December 2012 who were diagnosed as OSCC and aged over 60 years old were retrospectively reviewed. Related factors including preoperative platelet–lymphocyte ratio (PLR), neutrophil–lymphocyte ratio (NLR) and perioperative blood transfusion were analysed. The cutoff value of PLR and NLR were determined by receiver operating characteristic curve (ROC). Results: The cut-off value of NLR and PLR, based on receiver operating characteristic curve analysis, were 2.20 and 102. Age, tumour grade, site, clinical stage, NLR, PLR and blood transfusion were the significant factors by the univariate analysis for OS (P < 0.05). Conclusion: Preoperative high NLR index and intraoperative blood transfusion predicts a poor prognosis in elder patients who undergoing OSCC. Avoiding or minimised blood transfusion will do good to the survival. http://dx.doi.org/10.1016/j.ijom.2017.02.986 Subcranial middle cranial fossa approach for paranasal sinus tumours extending to middle cranial fossa V. Pillai ∗ , V. Kekatpure, N. Hedne, M.A. Kuriakose Mazumdar Shaw Cancer Centre, Bangalore, India Objective: The objective is to analyse the outcome using the subcranial approach to obtain oncologic clear margins in craniofacial resections for paranasal sinus tumours extending to the middle cranial fossa.
Methods: This was our experience with 4 patients, two with a maxillary sinus squamous cell carcinoma, the others with an adenoid cystic carcinoma of the sinus tracking to the temporal lobe. The craniofacial resection entailed a lip split, cheek flap with a mandible angle osteotomy to obtain access to the skull base and infratemporal fossa. This was combined with a maxillectomy but the pterygoid disjunction being done only after the completion of the pterional craniotomy and resection of the tumour superiorly so as to drop down the tumour en bloc with adequate margins. Reconstruction was done with an anterolateral thigh flap. A titanium mesh was used to support the globe. All patients have also received postoperative adjuvant therapy. Results: Oncologic clear resection margins were obtained at the skull base and intracranially with this approach. This was documented by the clear margins obtained on final histopathology (R0 resection). There were no neurologic complications associated with this procedure, and the added morbidity of the craniofacial resection was minimised by avoiding a formal craniotomy. Conclusion: The subcranial middle fossa approach with a pterional craniotomy is a suitable oncologic access method for paranasal sinus tumours extending into the middle cranial fossa. http://dx.doi.org/10.1016/j.ijom.2017.02.987 A case of cerebral venous sinus thrombosis associated with chemoradiation therapy for oral cancer T. Shimizu ∗ , A. Musha, Y. Takayama, S. Yokoo Department of Stomatology and Maxillofacial Surgery, Graduate School of Medicine, Gunma University, Gunma, Japan Background: Cerebral venous sinus thrombosis (CVST) is occluded venous sinus that is a blood outflow tract from the brain, severe case is a disease that leads to death for significant oedema and cerebral haemorrhage. The main symptoms are headache nausea and vomiting by increased intracranial pressure. We report experienced a case of the CVST associated with the chemoradiation therapy for oral cancer. Case: A 25-year-old male visited our department for right tongue cancer. He was enforced right partial glossectomy. Finding the right cervical lymph node metastasis about one and a half years after, he was enforced right neck dissection. Postoperative radiation 60 Gy + chemotherapy (PF: 2 cool) was planned. He complained of a severe headache and nausea after the first cool end. The abnormal findings were not observed on computed tomography, but the symptoms did not improve. A wide range of thrombus formation from the right transverse sinus to Sshaped sinus was observed on magnetic resonance imaging. It has started an antithrombotic therapy with heparin immediately after imaging in the diagnosis of CVST. Symptoms after the start of antithrombotic therapy showed an improvement trend. Antithrombotic therapy was stopped, because deterioration of symptoms and the increase of thrombosis were not observed. Discussion and Conclusion: The present case showed a severe headache and nausea after chemoradiation therapy. At the time of normal chemotherapy, nausea is frequently observed; it often improves by symptomatic treatment. However, if it finds the nausea and severe headache with no improvement as this case, it is necessary to perform the quick response. http://dx.doi.org/10.1016/j.ijom.2017.02.988
Methods: This was our experience with 4 patients, two with a maxillary sinus squamous cell carcinoma, the others with an adenoid cystic carcinoma of the sinus tracking to the temporal lobe. The craniofacial resection entailed a lip split, cheek flap with a mandible angle osteotomy to obtain access to the skull base and infratemporal fossa. This was combined with a maxillectomy but the pterygoid disjunction being done only after the completion of the pterional craniotomy and resection of the tumour superiorly so as to drop down the tumour en bloc with adequate margins. Reconstruction was done with an anterolateral thigh flap. A titanium mesh was used to support the globe. All patients have also received postoperative adjuvant therapy. Results: Oncologic clear resection margins were obtained at the skull base and intracranially with this approach. This was documented by the clear margins obtained on final histopathology (R0 resection). There were no neurologic complications associated with this procedure, and the added morbidity of the craniofacial resection was minimised by avoiding a formal craniotomy. Conclusion: The subcranial middle fossa approach with a pterional craniotomy is a suitable oncologic access method for paranasal sinus tumours extending into the middle cranial fossa. http://dx.doi.org/10.1016/j.ijom.2017.02.987 A case of cerebral venous sinus thrombosis associated with chemoradiation therapy for oral cancer T. Shimizu ∗ , A. Musha, Y. Takayama, S. Yokoo Department of Stomatology and Maxillofacial Surgery, Graduate School of Medicine, Gunma University, Gunma, Japan Background: Cerebral venous sinus thrombosis (CVST) is occluded venous sinus that is a blood outflow tract from the brain, severe case is a disease that leads to death for significant oedema and cerebral haemorrhage. The main symptoms are headache nausea and vomiting by increased intracranial pressure. We report experienced a case of the CVST associated with the chemoradiation therapy for oral cancer. Case: A 25-year-old male visited our department for right tongue cancer. He was enforced right partial glossectomy. Finding the right cervical lymph node metastasis about one and a half years after, he was enforced right neck dissection. Postoperative radiation 60 Gy + chemotherapy (PF: 2 cool) was planned. He complained of a severe headache and nausea after the first cool end. The abnormal findings were not observed on computed tomography, but the symptoms did not improve. A wide range of thrombus formation from the right transverse sinus to Sshaped sinus was observed on magnetic resonance imaging. It has started an antithrombotic therapy with heparin immediately after imaging in the diagnosis of CVST. Symptoms after the start of antithrombotic therapy showed an improvement trend. Antithrombotic therapy was stopped, because deterioration of symptoms and the increase of thrombosis were not observed. Discussion and Conclusion: The present case showed a severe headache and nausea after chemoradiation therapy. At the time of normal chemotherapy, nausea is frequently observed; it often improves by symptomatic treatment. However, if it finds the nausea and severe headache with no improvement as this case, it is necessary to perform the quick response. http://dx.doi.org/10.1016/j.ijom.2017.02.988