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Primary temporary reconstruction of mandibular defects using AO reconstruction plates: a retrospective analysis of 51 cases
222
British
Journal
of Oral and Maxillofacial
Surgery Single-stage titanium cranioplasty for the infected bone flap: ‘putting the lid on infection’. R. K. Lee’, J. P. Grievez. P. T. Blenkinsopp’, B. Conroy’, H. T. Marsh*. ‘Norman Rowe Maxillofacial Unit, Queen Mary’s Hospital, Roehampton, London; ZDepartment of Neurosurgery, Atkinson Morley Hospital, London, UK.
References 1. Hassan S J, Weymuller E A. Assessment of quality of life in head and neck cancer oatients. Head Neck 1993: 15: 485496. 2. Bjordal K, Kassa S. Ps>chometric validation of the EORTC core Quality of Life Questionnaire, 30-item version and a diagnostic-specific module for head and neck cancer patients Acta Oncol 1992; 31: 311-321. 3. Bjordal K, Ahlner-Elmqvist M, Tollesson E et al. Development of a European Organisation for Research and Treatment of Cancer (EORTC) questionnaire module to be used in quality of life assessments in head and neck cancer patients. Acta Oncol 1994; 3303): 879-885.
A treatment algorithm for mandibular ameloblastoma. D. Sampson, M. A. Pogrel. Department of Oral and Maxillofacial Surgery, University of California, San Francisco, CA, USA.
E.
Objective: To develop a treatment algorithm for the management of intraosseous ameloblastoma. Muterials und methods: A retrospective study of 21 consecutive patients referred for management of intraosseous mandibular ameloblastoma. Twelve patients (44%) had already had treatment carried out elsewhere and were referred because of recurrence. Fifteen patients (56%) had soft-tissue involvement on referral. Treatment consisted of curettage alone (n = 2) curettage combined with cryotherapy (n = 7), segmental mandibular resection (n = 16) and soft tissue resection only (n = l), patient refusing treatment (n = 1). The patient having soft-tissue surgery only required a neck dissection and two patients required skull-base surgery for recurrence. Results: The 2 patients treated by curettage alone suffered from tumor recurrence. Of the 7 patients treated by curettage with liquid nitrogen cryotherapy, all had intraosseous lesions only and there were no recurrences. Of the 16 patients having segmental resections because of extraosseous spread, there was one recurrence and this was actually diagnosed histologically as an ameloblastic carcinoma. The one patient having soft-tissue resection only required further surgery for another soft-tissue recurrence at the base of the skull. patients were reconstructed as appropriate with either primary or secondary grafting. Only 3 patients went on to have full reconstruction including osseointegrated implants. Conclusions: Local curettage of ameloblastoma results in unacceptable recurrence rates. Treatment of lesions still contained within the mandible by localized surgery and cryotherapy produces good results. Incontinuity segmental resection of the mandible and associated soft tissues for lesions extending beyond the mandible provides good results. Tumors undergoing inadequate primary treatment can lead to the need for extensive resection for soft-tissue extension and complex management for skull-base lesions. Few patients go on to full reconstruction, including osseointegrdted implants.
Implants in the maxillary sinus - how far can you go? L. Duncan’, I. HollandL, K. Postlethwaite’, J Huwkesfbrdl, D.G. Smith’. ‘Newcastle General Hospital, Newcastle; Sunderland Royal Hospital, Sunderland, 3Newcastle Dental Hospital, Newcastle, UK Satisfactory restoration of the upper dental arch is sometimes only possible with the aid of implant retained prostheses. Grafting of the maxillary sinus is commonly required to provide sufftcient bone into which to place the implants. The factors influencing the successful outcome of ultimate restoration following implant placement are many. Significant amongst them is the length of implant it is possible to place within the grafted sinus. This depends entirely on the amount of graft placed in the sinus and degree of resorption that occurs prior to implant placement. This latter element is unpredictable. Postgrafting CT scanning is utilized to attempt to predict the height of bone present and consequently implant length usable in the grafted site. We report the results of implants placed in a retrospective study of 25 patients who have undergone a sinus lift and bone grafting procedure between 1992 and 1997.
The incidence of bone flap infections following craniotomies is around 2%. The traditional treatment for this is divided into two stages; initially to remove the infected bone flap, then the delayed insertion of a cranioplasty. This involves a minimum of two general anaesthetics and a variable period in between when the patient is at risk from a defect in the skull and has to endure the associated deformity. This prospective study evaluates a single-stage procedure of removing infected bone flaps and the insertion of a titanium cranioplasty. Seven patients, aged between 32 and 75 years, underwent this procedure during the period of July 1994 until November 1997. All the patients subsequently achieved full wound healing and none show signs of active infection to date. With the favourable results that have been obtained so far, bearing in mind the relatively small number of patients, it would seem that this technique demonstrates a significant advance in the management of patients with infected cranial bone flaps. This success is likely to be in part attributable to the properties of titanium as a material which is inert, highly biocompatible, does not induce hypersensitive reactions and its favourable surface properties.
Can orbital shape and volume be reliably restored with alloplastic sheet implants following trauma? A prospective study. .I McMahon, A. IV Baker, A. Sugar, K. E Moos. Canniesburn Hospital, Glasgow; Morriston Hospital, Swansea, UK. Background: The use of alloplastic implants in the repair of moderate-sized defects of the orbital walls has been widely advocated. At Canniesburn and Morriston Hospitals, a trial of two such implants has been conducted. One of the inclusion criteria was that the maximal size of the orbital wall defects should not exceed 2 cm. This report examines the validity of this inclusion criterion with regard to subsequently deserved enophthalmos. Method: Patients were randomly assigned at operation to undergo reconstruction of the orbital wall defect with either PDS or titanium mesh provided the inclusion criteria were met. The nature of the injury sustained, including size of the orbital wall defect, was recorded. Details of the surgical procedure were also recorded. Patient review was at 3 and 12 months, Result: 54 patients were recruited with follow-up in 40. Enophthalmos was observed in 8 out of 24 patients whose orbital wall defect exceeded 1.5 cm in maximal dimension. For those 16 patients in which the maximal dimension was 1.5 cm or less, subsequent enophthalmos was observed in only 1 patient (P = 0.044, x2 test). Conclusion: The use of alloplastic sheet implants in early reconstruction of the orbit should be confined to those cases in which the maximal dimension of the defect does not exceed 1.5 cm. The possible reasons for failure to reliably reconstruct the orbit with larger defects are discussed.
Primary temporary reconstruction of mandibular defects using A0 reconstruction plates: a retrospective analysis of 51 cases. H. Schdning, R. Emshoff Department of Oral and Maxillofacial Surgery, University of Innsbruck, Innsbruck, Austria. This study assessed the incidence of complications and revisions following primary temporary A0 plate reconstructions (PT-AOPR) of the mandible performed between 1971 and 1996. In a retrospective record review, the data of 51 patients undergoing PT-AOPR after composite mandibular resection were analysed according to age, sex, date of reconstruction, anatomic location of reconstruction, use of additional irradiation therapy and/or flap surgery, and incidence of associated complications and revisions. Of the entire sample, the most common complication encountered was infection (33.5) followed by plate exposure (27.9) and plate fracture (10.7). With revisions showing an incidence rate of
BAOMS 38.3, the corresponding site-related values were found to be 55.0 for site A, 37.1 for site B, and 31.1 for site C reconstructions. Revision rates were observed to be significantly increased in radiated (53.2 vs 31.5) and flap nonadded reconstructions (43.2 vs 24.8). Analysis of treatment group-related incidences revealed nonflap reconstructions irradiated (NF/I-R) to be associated with the highest failure rates, while additional flap surgery (F/I-R) resulted in a significant reduction of complications (50 vs 108) and revisions (20 vs 65.7). This article showed PT-AOPR following composite mandibular resection to be associated with a high rate of complications and revisions. The results emphasize the need to relate outcome measures to site and treatment-related parameters.
Patterns of failure and results of salvage therapy in oral cancer. R. A. Ord. Division OMSlGreenbaum Cancer Center, University of Maryland, Baltimore, MD, USA. This retrospective study analyses 86 patients with epidermoid carcinoma of the oral cavity seen between December 1991 and December 1994, and followed until December, 1997, or until death. Follow-up ranged from 36 to 72 months (median 46 months). Treatment failure was defined as cancer recurrence at local, regional or distant sites, or the development of a second upper aerodigestive tract (UADT) primary cancer. Thirty-eight patients (44.2%) failed treatment, 28 (32.7’%1) failed due to recurrent oral cancer with average times of 7.6 months for local, 14.3 months for regional and 15.2 months for distant recurrance. 10 (11.5%) patients failed from second UADT cancer with average time to failure of 26.5 months. 39% of Stage I failed treatment increasing to 51% in Stage IV. In Stages I and II, second UADT cancer 17% and regional recurrence (14%) were the major problem, while in Stage IV distant metastasis 19% and local recurrence 15% were most significant. Salvage was successful on 12 of 38 patients (32.4’x)). only surgery or surgery plus radiation was effective. Radiation, chemotherapy alone or in combination was ineffective. Outcome: 60 of 86 patients (69%) were cancer free after 36 months. Twenty patients (23%) died of oral cancer.
Epidemiology of premalignant lesions in patients with epidermoid carcinoma of the oral cavity R. A. Ord. Division OMS/Greenbaum Cancer Center, University of Maryland, Baltimore, MD, USA. This study analyses the incidence of premalignant lesions associated with epidermoid carcinoma in 200 consecutive patients with oral cancer seen between February 1991 and April 1997. Premalignant lesions were divided into leukoplakia, mixed and red lesions. 53.4% of oral cancers had associated premalignant lesions, 66% in women and 45% in men. The incidence fell with more advanced cancers being 78% in Stage I disease and 31% in Stage IV. Leukoplakia was most common occurring in 33% of all patients, while mixed and red lesions each occurred in IOU/i, of patients. Incidence of premalignancy was unrelated to age. Cancer of the tongue and gingiva was associated with premalignancy in 63% of cases, while floor of mouth 52% and retromolar only 30%. (However, approximately 80% retromolar cancer were Stage III and IV.) Red and mixed lesions were mostly associated with retromolar and floor of mouth cancer, while leukoplakia was more frequent in gingival and tongue carcinoma. 75% of patients who developed a second primary cancer in the oral cavity had premalignant lesions compared to 45% of patients who developed second primary lung cancer. 100%1 of non-smokers with early cancer had associated premalignancy; only 69’/;, of smokers showed premalignant lesions.
MR imaging in the assessment of cervical lymph node metastases in oral squamous cell carcinomas H. G Lewis-Jones, J M. Wide, JI A. Woo/gar, D. u! White. Department of Radiology, Fazakerley Hospital, Liverpool, UK. Preoperative assessment of cervical lymph nodes remains difficult in the management of oral squamous cell carcinoma. We assessed the value of MR imaging in detecting nodal disease within the neck,
Abstracts
223
A retrospective study was performed on 59 patients with oral squamous cell carcinoma. Preoperative MR imaging included axial STIR, coronal STIR and Tl-weighted pre- and post-Gadolinium sequences. 75 sides of neck were examined. Images were reviewed by two head and neck radiologists and pathological specimens examined by an experienced pathologist. Imaging and pathological findings were correlated. All nodes were identified. creating an anatomical map of normal and abnormal nodes in areas I 5 of the neck. MRI scans were considered positive using conventional criteria of size, grouping and appropriate signal characterization. Correlation was considered a true positive if MR identified histologically positive nodes, and located them to within one anatomic level of that determined histologically. Histologically. positive nodes were present in 28 cases (37.3’%,). MR sensitivity was 60.7%) and specificity 68.1% for the detection of positive nodes. The false positive rate was 46.9’%, and we documented enlarged high signal nodes which histologically contained no malignant cells. The false negative rate was 25.6%. Enlarged and histologically positive nodes were undetected by imaging in 7 cases (9.3%) and in 7 cases only a single histological micrometastasis measuring less than 3 mm was present, MR being reported positive in 3 cases. MR imaging is insufficiently sensitive or specific to replace elective neck dissection for staging or prognostic purposes.
Imaging of the thorax: its role in the staging of head and neck malignancy. 7: K. Ong C. J Kermula, I. C. Martin, E W St&wd*. Oral & Facial Surgery, *ENT Surgery. Sunderland Royal Hospital. Sunderland, UK. Patients with squamous cell carcinoma of the head and neck are at risk of simultaneous primary malignancies in the upper aerodigestive tract as well as pulmonary metastases. Such diagnoses have major implications in the management of these patients in terms of therapeutic aims, treatment modalities and prognosis. As part of staging patients with newly diagnosed squamous cell carcinoma of the head and neck. plain radiography of the chest (CXR) is widely used to detect thoracic pathology. However. in certain circles there is an increasing trend towards using computed tomography (CT) of the chest for this purpose. We have retrospectively assessed the efficacy of CXR and CT of the chest in 107 patients with head and neck malignancies in detecting pathology within the thorax. The relative yield of abnormalities, the relationship between the stage of the index tumour and the incidence of a second primary malignancy or pulmonary metastases and the resulting effect on the management of these patients were analysed. Simultaneous malignancies or pulmonary metastases were not uncommon, with CT being more sensitive than CXR in detecting these abnormalities. Our findings suggest that CT of the chest should be included in the staging of head and neck malignancies.
Preoperative antibiotic prophylaxis in orthognathic surgery: a randomised double-blind and placebo-controlled clinical trial. S. A. Zijderveld’, L. E. Smeele ‘, P J Kostmse2, D. B. Tuinzing’. ‘Department of Oral and Maxillofacial Surgery, VU Ziekenhuis. Amsterdam; ‘Department of Epidemiology and Biostatistics. Vrije Universiteit. Amsterdam, The Netherlands Purpose: To test the efficacy of antibiotic prophylaxis in orthognathic surgery. Design: Double-blind, placebo-controlled clinical trial. Mut~rialrrndmc~thods: 54 patients (ages 18-40), who underwent bimaxillary orthognathic surgery, were randomized into three groups: placebo (n = 19), 2200 mg amoxicillin-clavulanic acid (n = 18) or 1500 mg cefuroxim (n = 17). Medication was administered intravenously 30 min prior to surgery. During the first month, the postoperative course was observed according to infection parameters: ESR. total white blood cell count, pulse. temperature and clinical view. Results: 16 patients developed a wound infection. Of the 16 patients. 11 had received the placebo, 3 cefuroxim and 2 amoxicillin-clavulanic acid.
British
Journal
of Oral and Maxillofacial
Surgery Single-stage titanium cranioplasty for the infected bone flap: ‘putting the lid on infection’. R. K. Lee’, J. P. Grievez. P. T. Blenkinsopp’, B. Conroy’, H. T. Marsh*. ‘Norman Rowe Maxillofacial Unit, Queen Mary’s Hospital, Roehampton, London; ZDepartment of Neurosurgery, Atkinson Morley Hospital, London, UK.
References 1. Hassan S J, Weymuller E A. Assessment of quality of life in head and neck cancer oatients. Head Neck 1993: 15: 485496. 2. Bjordal K, Kassa S. Ps>chometric validation of the EORTC core Quality of Life Questionnaire, 30-item version and a diagnostic-specific module for head and neck cancer patients Acta Oncol 1992; 31: 311-321. 3. Bjordal K, Ahlner-Elmqvist M, Tollesson E et al. Development of a European Organisation for Research and Treatment of Cancer (EORTC) questionnaire module to be used in quality of life assessments in head and neck cancer patients. Acta Oncol 1994; 3303): 879-885.
A treatment algorithm for mandibular ameloblastoma. D. Sampson, M. A. Pogrel. Department of Oral and Maxillofacial Surgery, University of California, San Francisco, CA, USA.
E.
Objective: To develop a treatment algorithm for the management of intraosseous ameloblastoma. Muterials und methods: A retrospective study of 21 consecutive patients referred for management of intraosseous mandibular ameloblastoma. Twelve patients (44%) had already had treatment carried out elsewhere and were referred because of recurrence. Fifteen patients (56%) had soft-tissue involvement on referral. Treatment consisted of curettage alone (n = 2) curettage combined with cryotherapy (n = 7), segmental mandibular resection (n = 16) and soft tissue resection only (n = l), patient refusing treatment (n = 1). The patient having soft-tissue surgery only required a neck dissection and two patients required skull-base surgery for recurrence. Results: The 2 patients treated by curettage alone suffered from tumor recurrence. Of the 7 patients treated by curettage with liquid nitrogen cryotherapy, all had intraosseous lesions only and there were no recurrences. Of the 16 patients having segmental resections because of extraosseous spread, there was one recurrence and this was actually diagnosed histologically as an ameloblastic carcinoma. The one patient having soft-tissue resection only required further surgery for another soft-tissue recurrence at the base of the skull. patients were reconstructed as appropriate with either primary or secondary grafting. Only 3 patients went on to have full reconstruction including osseointegrated implants. Conclusions: Local curettage of ameloblastoma results in unacceptable recurrence rates. Treatment of lesions still contained within the mandible by localized surgery and cryotherapy produces good results. Incontinuity segmental resection of the mandible and associated soft tissues for lesions extending beyond the mandible provides good results. Tumors undergoing inadequate primary treatment can lead to the need for extensive resection for soft-tissue extension and complex management for skull-base lesions. Few patients go on to full reconstruction, including osseointegrdted implants.
Implants in the maxillary sinus - how far can you go? L. Duncan’, I. HollandL, K. Postlethwaite’, J Huwkesfbrdl, D.G. Smith’. ‘Newcastle General Hospital, Newcastle; Sunderland Royal Hospital, Sunderland, 3Newcastle Dental Hospital, Newcastle, UK Satisfactory restoration of the upper dental arch is sometimes only possible with the aid of implant retained prostheses. Grafting of the maxillary sinus is commonly required to provide sufftcient bone into which to place the implants. The factors influencing the successful outcome of ultimate restoration following implant placement are many. Significant amongst them is the length of implant it is possible to place within the grafted sinus. This depends entirely on the amount of graft placed in the sinus and degree of resorption that occurs prior to implant placement. This latter element is unpredictable. Postgrafting CT scanning is utilized to attempt to predict the height of bone present and consequently implant length usable in the grafted site. We report the results of implants placed in a retrospective study of 25 patients who have undergone a sinus lift and bone grafting procedure between 1992 and 1997.
The incidence of bone flap infections following craniotomies is around 2%. The traditional treatment for this is divided into two stages; initially to remove the infected bone flap, then the delayed insertion of a cranioplasty. This involves a minimum of two general anaesthetics and a variable period in between when the patient is at risk from a defect in the skull and has to endure the associated deformity. This prospective study evaluates a single-stage procedure of removing infected bone flaps and the insertion of a titanium cranioplasty. Seven patients, aged between 32 and 75 years, underwent this procedure during the period of July 1994 until November 1997. All the patients subsequently achieved full wound healing and none show signs of active infection to date. With the favourable results that have been obtained so far, bearing in mind the relatively small number of patients, it would seem that this technique demonstrates a significant advance in the management of patients with infected cranial bone flaps. This success is likely to be in part attributable to the properties of titanium as a material which is inert, highly biocompatible, does not induce hypersensitive reactions and its favourable surface properties.
Can orbital shape and volume be reliably restored with alloplastic sheet implants following trauma? A prospective study. .I McMahon, A. IV Baker, A. Sugar, K. E Moos. Canniesburn Hospital, Glasgow; Morriston Hospital, Swansea, UK. Background: The use of alloplastic implants in the repair of moderate-sized defects of the orbital walls has been widely advocated. At Canniesburn and Morriston Hospitals, a trial of two such implants has been conducted. One of the inclusion criteria was that the maximal size of the orbital wall defects should not exceed 2 cm. This report examines the validity of this inclusion criterion with regard to subsequently deserved enophthalmos. Method: Patients were randomly assigned at operation to undergo reconstruction of the orbital wall defect with either PDS or titanium mesh provided the inclusion criteria were met. The nature of the injury sustained, including size of the orbital wall defect, was recorded. Details of the surgical procedure were also recorded. Patient review was at 3 and 12 months, Result: 54 patients were recruited with follow-up in 40. Enophthalmos was observed in 8 out of 24 patients whose orbital wall defect exceeded 1.5 cm in maximal dimension. For those 16 patients in which the maximal dimension was 1.5 cm or less, subsequent enophthalmos was observed in only 1 patient (P = 0.044, x2 test). Conclusion: The use of alloplastic sheet implants in early reconstruction of the orbit should be confined to those cases in which the maximal dimension of the defect does not exceed 1.5 cm. The possible reasons for failure to reliably reconstruct the orbit with larger defects are discussed.
Primary temporary reconstruction of mandibular defects using A0 reconstruction plates: a retrospective analysis of 51 cases. H. Schdning, R. Emshoff Department of Oral and Maxillofacial Surgery, University of Innsbruck, Innsbruck, Austria. This study assessed the incidence of complications and revisions following primary temporary A0 plate reconstructions (PT-AOPR) of the mandible performed between 1971 and 1996. In a retrospective record review, the data of 51 patients undergoing PT-AOPR after composite mandibular resection were analysed according to age, sex, date of reconstruction, anatomic location of reconstruction, use of additional irradiation therapy and/or flap surgery, and incidence of associated complications and revisions. Of the entire sample, the most common complication encountered was infection (33.5) followed by plate exposure (27.9) and plate fracture (10.7). With revisions showing an incidence rate of
BAOMS 38.3, the corresponding site-related values were found to be 55.0 for site A, 37.1 for site B, and 31.1 for site C reconstructions. Revision rates were observed to be significantly increased in radiated (53.2 vs 31.5) and flap nonadded reconstructions (43.2 vs 24.8). Analysis of treatment group-related incidences revealed nonflap reconstructions irradiated (NF/I-R) to be associated with the highest failure rates, while additional flap surgery (F/I-R) resulted in a significant reduction of complications (50 vs 108) and revisions (20 vs 65.7). This article showed PT-AOPR following composite mandibular resection to be associated with a high rate of complications and revisions. The results emphasize the need to relate outcome measures to site and treatment-related parameters.
Patterns of failure and results of salvage therapy in oral cancer. R. A. Ord. Division OMSlGreenbaum Cancer Center, University of Maryland, Baltimore, MD, USA. This retrospective study analyses 86 patients with epidermoid carcinoma of the oral cavity seen between December 1991 and December 1994, and followed until December, 1997, or until death. Follow-up ranged from 36 to 72 months (median 46 months). Treatment failure was defined as cancer recurrence at local, regional or distant sites, or the development of a second upper aerodigestive tract (UADT) primary cancer. Thirty-eight patients (44.2%) failed treatment, 28 (32.7’%1) failed due to recurrent oral cancer with average times of 7.6 months for local, 14.3 months for regional and 15.2 months for distant recurrance. 10 (11.5%) patients failed from second UADT cancer with average time to failure of 26.5 months. 39% of Stage I failed treatment increasing to 51% in Stage IV. In Stages I and II, second UADT cancer 17% and regional recurrence (14%) were the major problem, while in Stage IV distant metastasis 19% and local recurrence 15% were most significant. Salvage was successful on 12 of 38 patients (32.4’x)). only surgery or surgery plus radiation was effective. Radiation, chemotherapy alone or in combination was ineffective. Outcome: 60 of 86 patients (69%) were cancer free after 36 months. Twenty patients (23%) died of oral cancer.
Epidemiology of premalignant lesions in patients with epidermoid carcinoma of the oral cavity R. A. Ord. Division OMS/Greenbaum Cancer Center, University of Maryland, Baltimore, MD, USA. This study analyses the incidence of premalignant lesions associated with epidermoid carcinoma in 200 consecutive patients with oral cancer seen between February 1991 and April 1997. Premalignant lesions were divided into leukoplakia, mixed and red lesions. 53.4% of oral cancers had associated premalignant lesions, 66% in women and 45% in men. The incidence fell with more advanced cancers being 78% in Stage I disease and 31% in Stage IV. Leukoplakia was most common occurring in 33% of all patients, while mixed and red lesions each occurred in IOU/i, of patients. Incidence of premalignancy was unrelated to age. Cancer of the tongue and gingiva was associated with premalignancy in 63% of cases, while floor of mouth 52% and retromolar only 30%. (However, approximately 80% retromolar cancer were Stage III and IV.) Red and mixed lesions were mostly associated with retromolar and floor of mouth cancer, while leukoplakia was more frequent in gingival and tongue carcinoma. 75% of patients who developed a second primary cancer in the oral cavity had premalignant lesions compared to 45% of patients who developed second primary lung cancer. 100%1 of non-smokers with early cancer had associated premalignancy; only 69’/;, of smokers showed premalignant lesions.
MR imaging in the assessment of cervical lymph node metastases in oral squamous cell carcinomas H. G Lewis-Jones, J M. Wide, JI A. Woo/gar, D. u! White. Department of Radiology, Fazakerley Hospital, Liverpool, UK. Preoperative assessment of cervical lymph nodes remains difficult in the management of oral squamous cell carcinoma. We assessed the value of MR imaging in detecting nodal disease within the neck,
Abstracts
223
A retrospective study was performed on 59 patients with oral squamous cell carcinoma. Preoperative MR imaging included axial STIR, coronal STIR and Tl-weighted pre- and post-Gadolinium sequences. 75 sides of neck were examined. Images were reviewed by two head and neck radiologists and pathological specimens examined by an experienced pathologist. Imaging and pathological findings were correlated. All nodes were identified. creating an anatomical map of normal and abnormal nodes in areas I 5 of the neck. MRI scans were considered positive using conventional criteria of size, grouping and appropriate signal characterization. Correlation was considered a true positive if MR identified histologically positive nodes, and located them to within one anatomic level of that determined histologically. Histologically. positive nodes were present in 28 cases (37.3’%,). MR sensitivity was 60.7%) and specificity 68.1% for the detection of positive nodes. The false positive rate was 46.9’%, and we documented enlarged high signal nodes which histologically contained no malignant cells. The false negative rate was 25.6%. Enlarged and histologically positive nodes were undetected by imaging in 7 cases (9.3%) and in 7 cases only a single histological micrometastasis measuring less than 3 mm was present, MR being reported positive in 3 cases. MR imaging is insufficiently sensitive or specific to replace elective neck dissection for staging or prognostic purposes.
Imaging of the thorax: its role in the staging of head and neck malignancy. 7: K. Ong C. J Kermula, I. C. Martin, E W St&wd*. Oral & Facial Surgery, *ENT Surgery. Sunderland Royal Hospital. Sunderland, UK. Patients with squamous cell carcinoma of the head and neck are at risk of simultaneous primary malignancies in the upper aerodigestive tract as well as pulmonary metastases. Such diagnoses have major implications in the management of these patients in terms of therapeutic aims, treatment modalities and prognosis. As part of staging patients with newly diagnosed squamous cell carcinoma of the head and neck. plain radiography of the chest (CXR) is widely used to detect thoracic pathology. However. in certain circles there is an increasing trend towards using computed tomography (CT) of the chest for this purpose. We have retrospectively assessed the efficacy of CXR and CT of the chest in 107 patients with head and neck malignancies in detecting pathology within the thorax. The relative yield of abnormalities, the relationship between the stage of the index tumour and the incidence of a second primary malignancy or pulmonary metastases and the resulting effect on the management of these patients were analysed. Simultaneous malignancies or pulmonary metastases were not uncommon, with CT being more sensitive than CXR in detecting these abnormalities. Our findings suggest that CT of the chest should be included in the staging of head and neck malignancies.
Preoperative antibiotic prophylaxis in orthognathic surgery: a randomised double-blind and placebo-controlled clinical trial. S. A. Zijderveld’, L. E. Smeele ‘, P J Kostmse2, D. B. Tuinzing’. ‘Department of Oral and Maxillofacial Surgery, VU Ziekenhuis. Amsterdam; ‘Department of Epidemiology and Biostatistics. Vrije Universiteit. Amsterdam, The Netherlands Purpose: To test the efficacy of antibiotic prophylaxis in orthognathic surgery. Design: Double-blind, placebo-controlled clinical trial. Mut~rialrrndmc~thods: 54 patients (ages 18-40), who underwent bimaxillary orthognathic surgery, were randomized into three groups: placebo (n = 19), 2200 mg amoxicillin-clavulanic acid (n = 18) or 1500 mg cefuroxim (n = 17). Medication was administered intravenously 30 min prior to surgery. During the first month, the postoperative course was observed according to infection parameters: ESR. total white blood cell count, pulse. temperature and clinical view. Results: 16 patients developed a wound infection. Of the 16 patients. 11 had received the placebo, 3 cefuroxim and 2 amoxicillin-clavulanic acid.