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New perspectives for defining invasiveness in oral squamous cell carcinoma
Free oral communications 23 from the normal to the affected side, expressed as a percentage. The affected side presented a width reduction between 15-45% with a mean value of 26%, compared with the healthy side. As expected, this difference is more pronounced in the lower (alveolar process) section than the upper (nasal floor) ones. From these data we can state that as far as it concerns bone formation in the alveolar cleft, gingivo-alveoloplasty is a suitable technique. Nevertheless, a difference with the normal side is constant but the need of a secondary procedure (bone grafting) should be avoided and the possibility that eruption of permanent dentition could increase bone width should be considered.
Versatility of Buccinator Myomucosal Arterial Flaps in Reconstruction of Oral Cavity Defects
Buric N. 1, Krasic 19.1, Visnjic M. 2, Jovanovic G.1 1Clinic of Stomatology and Oral and Maxillo-Facial and :Clinic of Surgery and Plastic and Reconstructive Surgery, Nis, Serbia Larger soft tissue defects of the oral cavity create difficulties due to lack of sufficient adjacent tissue for reconstruction. Such defects (up to 7 x 5 cm) could be reconstructed by buccinator myomucosal arterial flaps. The aim of our work was to investigate the possibilities of use a buccinator myomucosal based on buccal artery flaps and anteriorly based on facial artery buccinator myomucosal island flaps in reconstruction of intraoral defects. In the period from 1993 to 1995 a group of 9 patients with intraoral defects underwent reconstruction with buccinator myomucosal arterial flaps. In the age group from 20 to 65 years, male/female ratio was 2:1. Location of intraoral defects in treated patients were as follows: posterior maxilla with large oro-antral communication in one (11.1%) patient, posterior part of mandible 3 (33.3%) patients, anterior floor of mouth 4 (44.5%) patients and oro-nasal fistula in 1 (11.1%0) patient. The anteriorly based buccinator myomucosal flaps were used in 8 (88.8%) patients while buccinator myomucosal on buccal artery flap was used for reconstruction of oro-nasal fistula. All flaps were raised by intraoral techniques. Direct complication (infection, hematoma, dehiscence) occurred in 2 (22.2%) patients. Complications were successfully treated with conservative therapy. Due to minimal morbidity in harvesting of buccinator myomucosal arterial flaps and their reliability in reconstruction of intraoral defects, these flaps represent a useful surgical option for reconstruction of intraoral defects.
Five Years of Experience in using a Romanian Biovitroceramic Material
Burlibasa C., Popescu-Negreanu T. Department of Oral and Maxillofacial Surgery, Clinical Hospital of Stomatology, Bucharest, Romania Laboratory studies on tissue culture revealed the perfect tolerability of biovitroceramics. Experimental studies on rabbits and dogs suggest neo-osteogenesis inducing phenomena by biovitroceramic fragments introduced in surgically produced osseous defects. In our clinic we used a 0.2 mm granular form and also different forms and dimensions made up as rods. Finally, we preferred the granular form for rectifying medium bone contour defects (menton, nose, zygomaticoorbital relief), where usually we resorted to bone or cartilage self-transplant. The granular form is much easier to mould because it preserves the initial structure much like the sand
in the first 10 days after application. It allows the preserving of the desired contour by a conformator. Ulterior the granules become homogeneous. They adhere on bone substratum without the tendency to superficialize and hurt the covering soft tissues. If hypercorrection material is used, the excess of granules is removed among the suture threads without suppurative complications. We extended the use of this material also in parodontal and dentoalveolar surgery, where it proves to be highly tolerable and able to support the masticatory pression. We also get good results by producing 3-4 mm capsules inside of which we introduced gentamycin. We used these capsules in the treatment of some bone or soft tissue suppurations not responding to classical treatment.
Surgical Management of Benign Parotid Turnouts: A Retrospective Analysis of One Hundred and Eighty-Seven Patients
Caleya M., Bescds M.S., ValldoseraM., Hueto J. A., Gonzalez J., Malet 1)., Bassas C., Raspall G.
Department of Oral and Maxillofacial Surgery, CSU Vall d'Hebron, Barcelona, Spain About 80% of all parotid gland turnours are benign and, of these, 80% are pleomorphic adenomas. The most common surgical treatment has been for years the formal superficial parotidectomy but, at the present time, several authors are reviewing other possibilities specially in the case of recurrent pleomorphic adenomas. A retrospective analysis was carried out on 187 patients with benign parotid gland tumours that where surgically treated at CSU Vall d'Hebron Barcelona between 1975-1994. We study epidemiologic data, surgical options, complications, recurrences and development of late malignancies of pleomorphic adenoma.
Fine Needle Aspiration Diagnosis of Orbital and Periorbital Turnouts: A Retrospective Analysis of Fifteen Patients
Caleya M., Hueto J.A., Lorenzo R., TaUadaN., Raspall G.
Department of Oral and Maxillofacial Surgery, CSU Vall d'Hebron, Barcelona, Spain Fine-needle aspiration is not a very common technique in the diagnosis of orbital masses. A retrospective analysis was carfled out on 22 patients with orbital and periorbital tumours seen at CSU Valt d'Hebron Barcelona between 1993-1994. Twenty-three fine-needle aspiration procedures were performed by cytopathologists with a cameco gun and 22,23-G needles on 10 men and 10 women. The age of these patients ranged from 17 to 79 years. The most frequent presenting features were proptosis and loss of visual acuity. Diagnostic specimens were obtained in 17 patients, and there was agreement of cytologic with final histologic diagnosis in 10 cases. We discuss the technique and diagnostic utility of fine-needle aspiration cytology in the evaluation of these orbital lesions.
New Perspectives for Defining Invasiveness in Oral Squamous Cell Carcinoma
Cannell H., Nouri A.
Departments of Oral and Maxillofacial Surgery and of Medical Oncology, The London Hospital, London, UK In recent years it has been generally accepted that for tumour growth to succeed, two interdependent mechanisms
24 Journalof Cranio.Maxillofacial Surgery have to operate in concert. Firstly, an escape from immune surveillance and secondly, acquirement of growth autonomy. Escape from immune surveillance has been demonstrated by frequent loss of MHC antigens in various malignancies. The evidence for autonomous growth has come not only from overexpression of growth factor receptors, including epidermal growth factor (EGF), but also from a defective apoptotic mechanism as shown by mutation of the p53 suppressor gene. Research work on oral squamous cell carcinomas (OSCC)at our unit has focused on some of these phenomena, studying both human material and a syngentic animal model, Our results have shown: (i) abnormal expression of monomorphic and polymorphic Class I antigens; (ii) overexpression of EGF receptor in > 90% cases; (iii) that the expression of the p53 gene influence radio- and chemosensitivity of epithelial cell lines; and (iv) the sensitivity of the animal tumour to hormones, These findings have encouraged us to propose that OSCC is a multi-step malignancy initiated by escape from the immune system as reflected by the abnormal expression of MHC antigens and subsequent exposure to growth factor machinery whilst loosing apopofic characteristics. The hormonal sensitivity of the animal model, if applicable to human tumours, could have important treatment implications.
Mandibulofaeial Dysostosis: Compared Study between a Neonate with mandiulofaeial dysostosis and a Normal Neonate
Cannistr~ C.1, Barber j,z, Houette A. 2, !annetti G.1, Pavy B. ~
1Cattedra Chirurgia Maxillo-Facciale, University of Rome La Sapienza, Rome, Italy 2Laboratoire de Pathologie Pediatrique, H6pita! St-Vincent de Paul, Paris, France 3UnitO de Chirurgie Pediatrique, H6pital St-Vincent de Paul, Paris, France Mandibulofacial dysostosis (MFD) is a malformative syndrome with autosomal dominant transmission and variable expressivity that mainly affects derivatives of the first and second branchial arches. The subsurface anatomy of this condition is still partly unexplored, since there have been only four reported dissections of MDE A detailed dissection of the head and neck of a neonate with mandibulofacial dysostosis is described and compared with a normal neonate. Theories of the pathogenesis are discussed on the basis of these observations.
Block Resection of T3-T4 Malignant Tumours of the Maxillary Sinus
Cantfl G., Mattavelli F., Salvatori P., Pizzi N.
Department of ENT and Maxillo-Facial Surgery, Istituto Nazionale per 1o Studio e la Cura dei Tumori, Milan, Italy
of the infratemporal fossa are freed. With the second, standard, transfacial approach the radical maxillectomy can be completed. At the Istituto Nazionale Tumori of Milan, Italy, 50 patients underwent this procedure. Crude free disease survival after 12 months is 56%.
Gradual Distraction of the Hard Palate in Dogs
Caris FJ, Jackson L Z 2, Lash S. 2, Topf J.z
1Department of Oral and Maxillofacial Surgery, University of Ziirich, Ziirich, Switzerland 2Institutefor Craniofaeial and Reconstructive Surgery, Southfield, Michigan, USA Many procedures have been described to correct velopharyngeal incompetence; satisfactory results are often not obtained. If the short soft palate could be moved towards the posterior pharyngeal wall by distraction osteogenesis, and if muscle function was satisfactory, a totally new concept of treatment would be available. Six dogs were anaesthetised and the palatal mucosa was elevated; a mid palatal transverse osteotomy was performed. Tantalum bone markers for cephalometric analysis were placed, and an orthodontic-like expansion device with a jack screw was inserted and fixed with titanium mini-screws. Distraction began after latency periods of 10-15 days at a rate of 0.25 mm per day in 3 dogs, and at a rate of 0.5 mm per day in 3 other dogs. The device was left for 6-10 weeks after expansion. Assessment was by cephalograms, computed tomography (CT) scans, histology with bone labelling and direct examination. All dogs filled the experimental gap with de novo osteogenesis. Cephalometric analysis demonstrated a distraction of up to 10 mm (i.e. the greatest possible expansion of the jack screw). Computed tomography at 1 month after completion of the distraction showed calcification of the experimental gap from the anterior and posterior bone ends. Calcification was completed after 5 months, Histology showed new bone formations within the distraction zone in all dogs. The new bone was always in continuity with the original anterior and posterior bone margins of the palatal bone. It bridged the experimental gap either fully or left a small central zone of fibrous tissue (0.1 mm wide), where intramembranous ossification occurred, The soft tissues showed no sign of an alteration, in particular no haernorrhage, necrosis or scar formation, but appeared to have followed the longitudinal displacement This technique may offer a solution to the problem posed by the palate with good muscular function especially when the lateral pharyngeal wall movement is good, The fact that a bony cleft may be present, is not thought to pose significant problems.
Prefabrication of a Free Flap Lined by Expanded Mucosa: A Two-Phase Experimental Study
Carls F.1, Celebiler O.B.2, Behl A. 2, Jackson L Z 2 Maxillary malignant tumours invading posterior wall, pterygoid process and muscles were thought unresectable for many years. In practice, the anterior approach for maxillectomy does not allow control of posterior spread towards the infratemporal fossa. We developed a double approach that overcomes this problem. Namely, the first is a preauricular, infratemporal one allowing preparation of the temporalis muscle for both access and repair, division of pterygoid muscles and intemal maxillary artery and osteotomy of the pterygoid process: in this way, tissues
IDepartment of Oral and Maxillofacial Surgery, University of Ziirich, Ziirich, Switzerland 2Institutefor Craniofacial and Reconstructive Surgery, Southfield, Michigan, USA In order to perform 'like with like' reconstruction of composite defects that are normally lined with mucosa0 skin lined flaps are unsatisfactory and the available donor mucosa for flap lining is limited. The purpose of this study
Versatility of Buccinator Myomucosal Arterial Flaps in Reconstruction of Oral Cavity Defects
Buric N. 1, Krasic 19.1, Visnjic M. 2, Jovanovic G.1 1Clinic of Stomatology and Oral and Maxillo-Facial and :Clinic of Surgery and Plastic and Reconstructive Surgery, Nis, Serbia Larger soft tissue defects of the oral cavity create difficulties due to lack of sufficient adjacent tissue for reconstruction. Such defects (up to 7 x 5 cm) could be reconstructed by buccinator myomucosal arterial flaps. The aim of our work was to investigate the possibilities of use a buccinator myomucosal based on buccal artery flaps and anteriorly based on facial artery buccinator myomucosal island flaps in reconstruction of intraoral defects. In the period from 1993 to 1995 a group of 9 patients with intraoral defects underwent reconstruction with buccinator myomucosal arterial flaps. In the age group from 20 to 65 years, male/female ratio was 2:1. Location of intraoral defects in treated patients were as follows: posterior maxilla with large oro-antral communication in one (11.1%) patient, posterior part of mandible 3 (33.3%) patients, anterior floor of mouth 4 (44.5%) patients and oro-nasal fistula in 1 (11.1%0) patient. The anteriorly based buccinator myomucosal flaps were used in 8 (88.8%) patients while buccinator myomucosal on buccal artery flap was used for reconstruction of oro-nasal fistula. All flaps were raised by intraoral techniques. Direct complication (infection, hematoma, dehiscence) occurred in 2 (22.2%) patients. Complications were successfully treated with conservative therapy. Due to minimal morbidity in harvesting of buccinator myomucosal arterial flaps and their reliability in reconstruction of intraoral defects, these flaps represent a useful surgical option for reconstruction of intraoral defects.
Five Years of Experience in using a Romanian Biovitroceramic Material
Burlibasa C., Popescu-Negreanu T. Department of Oral and Maxillofacial Surgery, Clinical Hospital of Stomatology, Bucharest, Romania Laboratory studies on tissue culture revealed the perfect tolerability of biovitroceramics. Experimental studies on rabbits and dogs suggest neo-osteogenesis inducing phenomena by biovitroceramic fragments introduced in surgically produced osseous defects. In our clinic we used a 0.2 mm granular form and also different forms and dimensions made up as rods. Finally, we preferred the granular form for rectifying medium bone contour defects (menton, nose, zygomaticoorbital relief), where usually we resorted to bone or cartilage self-transplant. The granular form is much easier to mould because it preserves the initial structure much like the sand
in the first 10 days after application. It allows the preserving of the desired contour by a conformator. Ulterior the granules become homogeneous. They adhere on bone substratum without the tendency to superficialize and hurt the covering soft tissues. If hypercorrection material is used, the excess of granules is removed among the suture threads without suppurative complications. We extended the use of this material also in parodontal and dentoalveolar surgery, where it proves to be highly tolerable and able to support the masticatory pression. We also get good results by producing 3-4 mm capsules inside of which we introduced gentamycin. We used these capsules in the treatment of some bone or soft tissue suppurations not responding to classical treatment.
Surgical Management of Benign Parotid Turnouts: A Retrospective Analysis of One Hundred and Eighty-Seven Patients
Caleya M., Bescds M.S., ValldoseraM., Hueto J. A., Gonzalez J., Malet 1)., Bassas C., Raspall G.
Department of Oral and Maxillofacial Surgery, CSU Vall d'Hebron, Barcelona, Spain About 80% of all parotid gland turnours are benign and, of these, 80% are pleomorphic adenomas. The most common surgical treatment has been for years the formal superficial parotidectomy but, at the present time, several authors are reviewing other possibilities specially in the case of recurrent pleomorphic adenomas. A retrospective analysis was carried out on 187 patients with benign parotid gland tumours that where surgically treated at CSU Vall d'Hebron Barcelona between 1975-1994. We study epidemiologic data, surgical options, complications, recurrences and development of late malignancies of pleomorphic adenoma.
Fine Needle Aspiration Diagnosis of Orbital and Periorbital Turnouts: A Retrospective Analysis of Fifteen Patients
Caleya M., Hueto J.A., Lorenzo R., TaUadaN., Raspall G.
Department of Oral and Maxillofacial Surgery, CSU Vall d'Hebron, Barcelona, Spain Fine-needle aspiration is not a very common technique in the diagnosis of orbital masses. A retrospective analysis was carfled out on 22 patients with orbital and periorbital tumours seen at CSU Valt d'Hebron Barcelona between 1993-1994. Twenty-three fine-needle aspiration procedures were performed by cytopathologists with a cameco gun and 22,23-G needles on 10 men and 10 women. The age of these patients ranged from 17 to 79 years. The most frequent presenting features were proptosis and loss of visual acuity. Diagnostic specimens were obtained in 17 patients, and there was agreement of cytologic with final histologic diagnosis in 10 cases. We discuss the technique and diagnostic utility of fine-needle aspiration cytology in the evaluation of these orbital lesions.
New Perspectives for Defining Invasiveness in Oral Squamous Cell Carcinoma
Cannell H., Nouri A.
Departments of Oral and Maxillofacial Surgery and of Medical Oncology, The London Hospital, London, UK In recent years it has been generally accepted that for tumour growth to succeed, two interdependent mechanisms
24 Journalof Cranio.Maxillofacial Surgery have to operate in concert. Firstly, an escape from immune surveillance and secondly, acquirement of growth autonomy. Escape from immune surveillance has been demonstrated by frequent loss of MHC antigens in various malignancies. The evidence for autonomous growth has come not only from overexpression of growth factor receptors, including epidermal growth factor (EGF), but also from a defective apoptotic mechanism as shown by mutation of the p53 suppressor gene. Research work on oral squamous cell carcinomas (OSCC)at our unit has focused on some of these phenomena, studying both human material and a syngentic animal model, Our results have shown: (i) abnormal expression of monomorphic and polymorphic Class I antigens; (ii) overexpression of EGF receptor in > 90% cases; (iii) that the expression of the p53 gene influence radio- and chemosensitivity of epithelial cell lines; and (iv) the sensitivity of the animal tumour to hormones, These findings have encouraged us to propose that OSCC is a multi-step malignancy initiated by escape from the immune system as reflected by the abnormal expression of MHC antigens and subsequent exposure to growth factor machinery whilst loosing apopofic characteristics. The hormonal sensitivity of the animal model, if applicable to human tumours, could have important treatment implications.
Mandibulofaeial Dysostosis: Compared Study between a Neonate with mandiulofaeial dysostosis and a Normal Neonate
Cannistr~ C.1, Barber j,z, Houette A. 2, !annetti G.1, Pavy B. ~
1Cattedra Chirurgia Maxillo-Facciale, University of Rome La Sapienza, Rome, Italy 2Laboratoire de Pathologie Pediatrique, H6pita! St-Vincent de Paul, Paris, France 3UnitO de Chirurgie Pediatrique, H6pital St-Vincent de Paul, Paris, France Mandibulofacial dysostosis (MFD) is a malformative syndrome with autosomal dominant transmission and variable expressivity that mainly affects derivatives of the first and second branchial arches. The subsurface anatomy of this condition is still partly unexplored, since there have been only four reported dissections of MDE A detailed dissection of the head and neck of a neonate with mandibulofacial dysostosis is described and compared with a normal neonate. Theories of the pathogenesis are discussed on the basis of these observations.
Block Resection of T3-T4 Malignant Tumours of the Maxillary Sinus
Cantfl G., Mattavelli F., Salvatori P., Pizzi N.
Department of ENT and Maxillo-Facial Surgery, Istituto Nazionale per 1o Studio e la Cura dei Tumori, Milan, Italy
of the infratemporal fossa are freed. With the second, standard, transfacial approach the radical maxillectomy can be completed. At the Istituto Nazionale Tumori of Milan, Italy, 50 patients underwent this procedure. Crude free disease survival after 12 months is 56%.
Gradual Distraction of the Hard Palate in Dogs
Caris FJ, Jackson L Z 2, Lash S. 2, Topf J.z
1Department of Oral and Maxillofacial Surgery, University of Ziirich, Ziirich, Switzerland 2Institutefor Craniofaeial and Reconstructive Surgery, Southfield, Michigan, USA Many procedures have been described to correct velopharyngeal incompetence; satisfactory results are often not obtained. If the short soft palate could be moved towards the posterior pharyngeal wall by distraction osteogenesis, and if muscle function was satisfactory, a totally new concept of treatment would be available. Six dogs were anaesthetised and the palatal mucosa was elevated; a mid palatal transverse osteotomy was performed. Tantalum bone markers for cephalometric analysis were placed, and an orthodontic-like expansion device with a jack screw was inserted and fixed with titanium mini-screws. Distraction began after latency periods of 10-15 days at a rate of 0.25 mm per day in 3 dogs, and at a rate of 0.5 mm per day in 3 other dogs. The device was left for 6-10 weeks after expansion. Assessment was by cephalograms, computed tomography (CT) scans, histology with bone labelling and direct examination. All dogs filled the experimental gap with de novo osteogenesis. Cephalometric analysis demonstrated a distraction of up to 10 mm (i.e. the greatest possible expansion of the jack screw). Computed tomography at 1 month after completion of the distraction showed calcification of the experimental gap from the anterior and posterior bone ends. Calcification was completed after 5 months, Histology showed new bone formations within the distraction zone in all dogs. The new bone was always in continuity with the original anterior and posterior bone margins of the palatal bone. It bridged the experimental gap either fully or left a small central zone of fibrous tissue (0.1 mm wide), where intramembranous ossification occurred, The soft tissues showed no sign of an alteration, in particular no haernorrhage, necrosis or scar formation, but appeared to have followed the longitudinal displacement This technique may offer a solution to the problem posed by the palate with good muscular function especially when the lateral pharyngeal wall movement is good, The fact that a bony cleft may be present, is not thought to pose significant problems.
Prefabrication of a Free Flap Lined by Expanded Mucosa: A Two-Phase Experimental Study
Carls F.1, Celebiler O.B.2, Behl A. 2, Jackson L Z 2 Maxillary malignant tumours invading posterior wall, pterygoid process and muscles were thought unresectable for many years. In practice, the anterior approach for maxillectomy does not allow control of posterior spread towards the infratemporal fossa. We developed a double approach that overcomes this problem. Namely, the first is a preauricular, infratemporal one allowing preparation of the temporalis muscle for both access and repair, division of pterygoid muscles and intemal maxillary artery and osteotomy of the pterygoid process: in this way, tissues
IDepartment of Oral and Maxillofacial Surgery, University of Ziirich, Ziirich, Switzerland 2Institutefor Craniofacial and Reconstructive Surgery, Southfield, Michigan, USA In order to perform 'like with like' reconstruction of composite defects that are normally lined with mucosa0 skin lined flaps are unsatisfactory and the available donor mucosa for flap lining is limited. The purpose of this study