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Clinical study of tuberculosis in head and neck region
130 Does the merger of two head and neck cancer services affect patient outcomes? H. Mohamedbhai ∗ , S. Thomas, R. Nekrasius, L. Watson, C. Liew, S. Whitley University College London Hospital, London, United Kingdom Background: The paradigm shift to one of centralisation of specialist healthcare services across the United Kingdom has been advocated in numerous white papers. As such, in 2015 head and neck cancer services of the Royal London Hospital (RLH) Oral and Maxillofacial department merged with the University College London Hospital (UCLH). Objective: To determine if there is a clinical difference in patient pathways and outcomes between the service which has moved to another site, when compared to the original home unit. Methods: A retrospective analysis was conducted of all patients who underwent flap surgery for the treatment of head and neck cancers, between September 2015 and August 2016. Findings: 57 flap cases were completed, 21 from the visiting team (RLH), 36 from the home unit (UCLH). Time from first clinic review to surgery was 44 days for RLH and 45 days from UCLH. Time from first MDT to surgery was 26 days for RLH and 27 days for UCLH. The mean intensive care unit stay was four days for RLH and three days for UCLH. The mean inpatient stay for RLH was 19 days while for UCLH was 17 days. Conclusions: There is no clinically significant discrepancy between the times between clinical review, MDT, surgery and ultimately discharge. This suggests that the merger of one site into another does not lead to poor logistical outcomes or slower discharges for the visiting team compared to the home unit. http://dx.doi.org/10.1016/j.ijom.2017.02.452 A summary of the qualitative literature for the quality of life of patients following head and neck cancer A. Mughal ∗ , B. Nandra, S. Rogers Aintree University Hospital, United Kingdom Background: The diagnosis and treatment of head and neck cancer (HNC) can have a devastating impact on patients’ quality of life. Although questionnaires are the main method to quantify this, qualitative research offers an opportunity to gain a greater depth of appreciation of the outcomes from the patient’s perspective. Objectives: To undertake a systematic review of the literature published in qualitative research in HNC. To summarise the studies in respect to: patient cohort, site, treatment, study design, hypothesis, qualitative method employed, key findings. Methods: PubMed was used to search for papers using the terms; ‘Qualitative, head and neck cancer’, ‘grounded theory’, ‘phenomenology’, ‘ethnography’, ‘focus groups’, ‘case studies’, ‘participation’ and ‘narratives’. This revealed 915 papers of which there were 83 on initial hand searching that fulfilled the criteria of English abstract, primary qualitative studies, focusing on head and neck cancer and quality of life. Reporting of the literature used PRISMA checklist methodology. Findings: In this presentation a summary of the literature will be given to describe the cohort, study methodology and findings. There were articles that focused both on patients and carers experiences. Frequent themes included: dysphagia, psychological
distress, intimacy and coping. There is a depth of narrative related to life and difficulties after treatment. Conclusion: It is time consuming to collate and synthesise the literature. This structured review acts as a source of reference to which future papers can be added. The summary highlights areas of previous enquiry and identifies areas of knowledge gap for future service evaluation and research. http://dx.doi.org/10.1016/j.ijom.2017.02.453 Mandibular osteotomy for access improves the cancer outcome of tongue cancers H.S. Ong ∗ , S. Gokavarapu, W. Cao, C.P. Zhang Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China Background: The surgical approach in the resection of oral tongue cancers can involve transoral resection (TOR) or temporary mandibular osteotomy (TMO); the method of choice many times depends on individual surgeon’s preference in overall management of the patient. There are no guidelines and the oncological safety of TOR needs consideration. Objective: To investigate TMO and TOR in pT2 oral tongue cancer surgery for cancer outcome. Methods: Demographic, surgical and histology data of primary pT2 tongue cancers from a tertiary hospital was charted and evaluated in a multivariate Cox regression for local recurrence (LR), disease-free survival (DFS) and overall survival. Findings: A total of 166 pT2 patients with primary oral squamous cell carcinoma of tongue treated from 2007 to 2013 fulfilled the inclusion criteria, of whom 95 patients underwent TOR and 71 TMA. The group comparison showed significantly higher patients with perineural spread and pN positive status in TMA group, involved margin on initial resection was significantly higher in TOR patients, adjuvant postoperative radiotherapy (PORT) was preferred in TMA group in line with high pN positive status. The multivariate Cox regression showed significantly high LR and low DFS in TOR group despite stratification of adjuvant PORT. The initial survival rate of 93.85% fell to 82.19% over 5 years in TOR group, while, the initial survival rate relatively remained constant in TMA group (94.39–93.04% over 5 years). Conclusion: TMA provided superior local control and DFS compared to TOR in pT2 tongue cancers. http://dx.doi.org/10.1016/j.ijom.2017.02.454 Clinical study of tuberculosis in head and neck region P. Pang ∗ , C.F. Sun, R.W. Li, X.X. Tan, S.H. Huang, Z.F. Xu, F.Y. Liu, W.Y. Duan Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, China Background: Tuberculosis is an infective disease and also is a major health concern. Extrapulmonary tuberculosis is a relatively rare disease, which can arise in many regions including head and neck region. Objective: To investigate the clinical manifestation and features of head and neck tuberculosis.
131 Methods: We retrospectively reviewed the clinical records of 60 patients diagnosed with tuberculosis in head and neck region in our department between March 2005 and January 2016. Findings: The subjects included 17 males and 43 females, and the male to female ratio was 1:2.53. The average age of the patients was 45 ± 14.67 years (range, 5–76 years). All the patients were confirmed by pathological diagnosis. The major clinical presentation is a lump or swelling (56 patients), followed by oral ulcer (three patients) and skin fistula (one patient). The most common site is cervical lymph node (71.67%). Three patients also suffer with malignant tumour in head and neck region. 95% of the patients received a chest X-ray and 19 patients (33.33%) showed old lesions in their lungs. Conclusion: The majority of head and neck tuberculosis arise in lymph node of head and neck region. Early diagnosis and treatment can largely enhance the therapeutic effect and patients’ quality of life. http://dx.doi.org/10.1016/j.ijom.2017.02.455 Metastasis to the jaws as a first manifestation of hepatocellular carcinoma: report of a case and analysis of 41 cases M. Pesis ∗ , S. Taicher, G. Greenberg, A. Hirshberg Soroka Medical Center, Beer-Sheva, Israel Background: Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Local metastasis is common but metastasis to the jaw is rare with 40 reported cases in the English language literature. Objectives: We describe a case of a 54-year-old man who, for the past two months, had noticed a rapidly growing facial mass in the posterior mandibular area. The patient was known to be a hepatitis C virus carrier and suffered from liver cirrhosis, but the presence of HCC was unknown. Methods: The English language literature was searched for documented cases of HCC metastasis to the jaw; applicable data was evaluated. Findings: The literature analysis revealed 41 reported cases (including the present case). In most cases (81%) the jaw lesion was the only known metastasis at the time of HCC diagnosis. Clinical presentation occurred up to 2 years before discovery of the jaw metastasis. Patients with HCC jaw metastasis have a poor survival rate with an average of 6.1 months between diagnosis and death. Conclusion: This study shows that an isolated jaw mass may be the initial presentation of HCC and therefore must be considered in the differential diagnosis, especially in the presence of known liver cirrhosis or chronic viral hepatitis. http://dx.doi.org/10.1016/j.ijom.2017.02.456
Chromosome instability in tumour resection margins of primary oral squamous cell cancer is a predictor of local recurrence D. Pierssens ∗ , M. Borgemeester, S. van der Heijden, C. Peutz-Kootstra, A. Ruland, A. Haesevoets, P. Kessler, B. Kremer, E.J. Speel Maastricht University Medical Centre, Maastricht, The Netherlands Background: The local recurrence rate in oral squamous cell cancer (OSCC) hardly decreases. This is partly due to the presence of (pre)malignant cells in the remaining tissue after resection, that may lead to the development of a new tumour in time. Detection of histologically (pre)malignant cells in tumour resection margins should predict these patients at risk for recurrence, however this appears to be difficult in routine practice. Objectives: Purpose of this study was to apply easy-to-use molecular tests for more accurate detection of (pre)malignant cells in histopathologically tumour-free margins, to improve diagnosis of patients at risk. Methods: 42 patients with firstly diagnosed, radically resected primary OSCC with histopathologically confirmed tumour-free resection margins (treated between 1994 and 2003) were included. Inclusion criteria comprised of follow-up ≥5 years, and radical surgery without postoperative treatment. Formalin-fixed paraffinembedded tissue sections of 42 tumours, 290 resection margins, and 11 recurrences were subjected to fluorescence in situ hybridisation (FISH) to examine chromosome 1 and 7 copy number variations (CNV), and to p53 immunohistochemistry (IHC). Findings: 11 out of the 42 patients developed a local recurrence within five years. FISH analysis showed that nine of eleven recurrences exhibited chromosome instability (CI) in at least one of the resection margins (P 0.008). p53 overexpression and routine histopathologic classification were not correlated with recurrent disease. The presence of CI in the resection margins revealed a significantly worse progression-free survival (log-rank P = 0.012). Conclusions: CI in the resection margins of OSCC can reliably identify patients at risk for developing a local recurrence. http://dx.doi.org/10.1016/j.ijom.2017.02.457 Functional and oncologic outcomes in patients undergoing total glossectomy V. Pillai ∗ , V. Kekatpure, N. Hedne, M.A. Kuriakose Mazumdar Shaw Cancer Center, Bangalore, India Objectives: This is a prospective study evaluating the functional and oncologic outcomes in patients undergoing total glossectomy. Methods: There are 60 patients in our series from 2012 onwards. The functional outcome analysed was the ability to restart an oral diet and decannulation which was analysed at six months after surgery. The oncologic outcome analysed was in terms of local disease control and overall survival. The oncologic outcome is to be analysed at one year after completion of surgery. Results: The most commonly used flap for the design of the neotongue in our series is the anterolateral thigh flap followed by the pectoralis major myocutaneous flap. All patients had intraoperative tracheostomy tube and percutaneous endoscopic gastrostomy tube placement. Three patients died before
distress, intimacy and coping. There is a depth of narrative related to life and difficulties after treatment. Conclusion: It is time consuming to collate and synthesise the literature. This structured review acts as a source of reference to which future papers can be added. The summary highlights areas of previous enquiry and identifies areas of knowledge gap for future service evaluation and research. http://dx.doi.org/10.1016/j.ijom.2017.02.453 Mandibular osteotomy for access improves the cancer outcome of tongue cancers H.S. Ong ∗ , S. Gokavarapu, W. Cao, C.P. Zhang Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China Background: The surgical approach in the resection of oral tongue cancers can involve transoral resection (TOR) or temporary mandibular osteotomy (TMO); the method of choice many times depends on individual surgeon’s preference in overall management of the patient. There are no guidelines and the oncological safety of TOR needs consideration. Objective: To investigate TMO and TOR in pT2 oral tongue cancer surgery for cancer outcome. Methods: Demographic, surgical and histology data of primary pT2 tongue cancers from a tertiary hospital was charted and evaluated in a multivariate Cox regression for local recurrence (LR), disease-free survival (DFS) and overall survival. Findings: A total of 166 pT2 patients with primary oral squamous cell carcinoma of tongue treated from 2007 to 2013 fulfilled the inclusion criteria, of whom 95 patients underwent TOR and 71 TMA. The group comparison showed significantly higher patients with perineural spread and pN positive status in TMA group, involved margin on initial resection was significantly higher in TOR patients, adjuvant postoperative radiotherapy (PORT) was preferred in TMA group in line with high pN positive status. The multivariate Cox regression showed significantly high LR and low DFS in TOR group despite stratification of adjuvant PORT. The initial survival rate of 93.85% fell to 82.19% over 5 years in TOR group, while, the initial survival rate relatively remained constant in TMA group (94.39–93.04% over 5 years). Conclusion: TMA provided superior local control and DFS compared to TOR in pT2 tongue cancers. http://dx.doi.org/10.1016/j.ijom.2017.02.454 Clinical study of tuberculosis in head and neck region P. Pang ∗ , C.F. Sun, R.W. Li, X.X. Tan, S.H. Huang, Z.F. Xu, F.Y. Liu, W.Y. Duan Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, China Background: Tuberculosis is an infective disease and also is a major health concern. Extrapulmonary tuberculosis is a relatively rare disease, which can arise in many regions including head and neck region. Objective: To investigate the clinical manifestation and features of head and neck tuberculosis.
131 Methods: We retrospectively reviewed the clinical records of 60 patients diagnosed with tuberculosis in head and neck region in our department between March 2005 and January 2016. Findings: The subjects included 17 males and 43 females, and the male to female ratio was 1:2.53. The average age of the patients was 45 ± 14.67 years (range, 5–76 years). All the patients were confirmed by pathological diagnosis. The major clinical presentation is a lump or swelling (56 patients), followed by oral ulcer (three patients) and skin fistula (one patient). The most common site is cervical lymph node (71.67%). Three patients also suffer with malignant tumour in head and neck region. 95% of the patients received a chest X-ray and 19 patients (33.33%) showed old lesions in their lungs. Conclusion: The majority of head and neck tuberculosis arise in lymph node of head and neck region. Early diagnosis and treatment can largely enhance the therapeutic effect and patients’ quality of life. http://dx.doi.org/10.1016/j.ijom.2017.02.455 Metastasis to the jaws as a first manifestation of hepatocellular carcinoma: report of a case and analysis of 41 cases M. Pesis ∗ , S. Taicher, G. Greenberg, A. Hirshberg Soroka Medical Center, Beer-Sheva, Israel Background: Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Local metastasis is common but metastasis to the jaw is rare with 40 reported cases in the English language literature. Objectives: We describe a case of a 54-year-old man who, for the past two months, had noticed a rapidly growing facial mass in the posterior mandibular area. The patient was known to be a hepatitis C virus carrier and suffered from liver cirrhosis, but the presence of HCC was unknown. Methods: The English language literature was searched for documented cases of HCC metastasis to the jaw; applicable data was evaluated. Findings: The literature analysis revealed 41 reported cases (including the present case). In most cases (81%) the jaw lesion was the only known metastasis at the time of HCC diagnosis. Clinical presentation occurred up to 2 years before discovery of the jaw metastasis. Patients with HCC jaw metastasis have a poor survival rate with an average of 6.1 months between diagnosis and death. Conclusion: This study shows that an isolated jaw mass may be the initial presentation of HCC and therefore must be considered in the differential diagnosis, especially in the presence of known liver cirrhosis or chronic viral hepatitis. http://dx.doi.org/10.1016/j.ijom.2017.02.456
Chromosome instability in tumour resection margins of primary oral squamous cell cancer is a predictor of local recurrence D. Pierssens ∗ , M. Borgemeester, S. van der Heijden, C. Peutz-Kootstra, A. Ruland, A. Haesevoets, P. Kessler, B. Kremer, E.J. Speel Maastricht University Medical Centre, Maastricht, The Netherlands Background: The local recurrence rate in oral squamous cell cancer (OSCC) hardly decreases. This is partly due to the presence of (pre)malignant cells in the remaining tissue after resection, that may lead to the development of a new tumour in time. Detection of histologically (pre)malignant cells in tumour resection margins should predict these patients at risk for recurrence, however this appears to be difficult in routine practice. Objectives: Purpose of this study was to apply easy-to-use molecular tests for more accurate detection of (pre)malignant cells in histopathologically tumour-free margins, to improve diagnosis of patients at risk. Methods: 42 patients with firstly diagnosed, radically resected primary OSCC with histopathologically confirmed tumour-free resection margins (treated between 1994 and 2003) were included. Inclusion criteria comprised of follow-up ≥5 years, and radical surgery without postoperative treatment. Formalin-fixed paraffinembedded tissue sections of 42 tumours, 290 resection margins, and 11 recurrences were subjected to fluorescence in situ hybridisation (FISH) to examine chromosome 1 and 7 copy number variations (CNV), and to p53 immunohistochemistry (IHC). Findings: 11 out of the 42 patients developed a local recurrence within five years. FISH analysis showed that nine of eleven recurrences exhibited chromosome instability (CI) in at least one of the resection margins (P 0.008). p53 overexpression and routine histopathologic classification were not correlated with recurrent disease. The presence of CI in the resection margins revealed a significantly worse progression-free survival (log-rank P = 0.012). Conclusions: CI in the resection margins of OSCC can reliably identify patients at risk for developing a local recurrence. http://dx.doi.org/10.1016/j.ijom.2017.02.457 Functional and oncologic outcomes in patients undergoing total glossectomy V. Pillai ∗ , V. Kekatpure, N. Hedne, M.A. Kuriakose Mazumdar Shaw Cancer Center, Bangalore, India Objectives: This is a prospective study evaluating the functional and oncologic outcomes in patients undergoing total glossectomy. Methods: There are 60 patients in our series from 2012 onwards. The functional outcome analysed was the ability to restart an oral diet and decannulation which was analysed at six months after surgery. The oncologic outcome analysed was in terms of local disease control and overall survival. The oncologic outcome is to be analysed at one year after completion of surgery. Results: The most commonly used flap for the design of the neotongue in our series is the anterolateral thigh flap followed by the pectoralis major myocutaneous flap. All patients had intraoperative tracheostomy tube and percutaneous endoscopic gastrostomy tube placement. Three patients died before