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Application of chair side vital staining test for early oral cancer screening for general dentists
Free Papers—Poster Presentations Classic midline mandibulotomy requires lip-splitting, chin-splitting and extensive intraoral incisions, with worse aesthetic results and morbidity. We present another technique through subcutaneous mandibulotomy of these tumours. Methods: Twenty three patients with parapharyngeal space tumours have been operated in our department over the past eight years. The pathologic entities were nineteen large, deep-lobe pleomorphic adenomas of the parotid gland, two schwannomas and two paragangliomas. The surgical approach for these tumours was the subcutaneous mandibulotomy. Results: The additional exposure achieved by this technique was adequate to safely remove large parapharyngeal space tumours without damaging vital structures. Oral feeding started on the fist postoperative day in all patients and they were discharged within four days. No major intraoperative complications appeared and the postoperative morbidity was selflimited. Conclusions: This surgical approach affords excellent access to the parapharyngeal space without damaging any vital structure. Comparing with the classic midline mandibulotomy (lip-split, chinsplit and floor of mouth incisions) the subcutaneous mandibulotomy achieved better functional and aesthetic result. The use of this technique is considered as an intermediate step for extensive parapharyngeal space lesions, which are inaccessible through the transcervical approach. doi:10.1016/j.ijom.2009.03.517
P45 The Sentinel European Node Trial C. Schilling, B. Gurney, M. McGurk, L. Cascarini, Z. Lei ∗ ; and the European SENT Group Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
Background and Objectives: Sentinel node biopsy (SNB) is well-established in management of both breast cancer and melanoma. Tumour within cervical lymph nodes spreads in an orderly fashion from one nodal basin to the next. Lymphoscintigraphy accurately identifies the sentinel node. If negative for metastasis, a neck dissection can be avoided. The interim results of the Sentinel European Node Trial (SENT) are presented.
Methods: Mutlicentre European (n = 15) observational SNB study commenced in 2006. Eligibility criteria was 0.5–4 cm oral squamous cell carcinoma with computed tomography proven N0 necks. Patients with identifiable sentinel nodes on lymphoscintigraphy were enrolled in the study, and nodes retrieved intraoperatively by hand held gamma probe and blue dye. A positive sentinel node led to neck dissection within 3 weeks of biopsy. Results: During the period 2006–2008, 218 cases were recruited (60% were males, 40% were females; 62% T1, 33.5% T2, 4.5% T3). Positive SNB occurred in 48 patients (22%), 13 of which had further positive nodes on neck dissection. False negative occurred in 5 cases, subsequently treated with neck dissection and adjuvant RT (1 with concomitant chemotherapy). Tumour recurrence after positive SNB and neck dissection occurred in 3 patients. Complications were low (<5%). 22 patients excluded from the trial due to disease elsewhere or death from other causes. Conclusions: As a result of SNB, neck dissection was avoided in 75% of patients in the trial. 92.7% of patients are disease free at mean of 14 months follow-up, one patient died due to disease. SNB has a sensitivity of 90.6% and a negative predictive value of 97%. doi:10.1016/j.ijom.2009.03.518
P46 Oral and maxillofacial Langerhans cell histiocytosis J. Fu ∗ , Y. Hu, C. Zhang, L. Wang Ninth People’s Hospital, School of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Background and Objectives: To study the clinical features and treatment of Langerhans cell histiocytosis in oral and maxillofacial area. Methods: Retrospective studies were used to analysis the symptoms and signs, the treatment and the prognoses of oral and maxillofacial Langerhans cell histiocytosis. Results: The median age of oral and maxillofacial Langerhans cell histiocytosis is 8 years old. The male and female ratio is about 1.6:1. It often involves mandible lesions if Langerhans cell histiocytosis occurs in oral and maxillofacial area and does not have specific symptoms and signs. Surgery is the main therapy for oral and maxillofacial Langerhans cell
545
histiocytosis. Some patients may need adjuvant chemotherapy or radiotherapy if necessary. Conclusion: Oral and maxillofacial Langerhans cell histiocytosis has some different feathers from LCH in other regions thus has relatively good outcome. doi:10.1016/j.ijom.2009.03.519
P47 Application of chair side vital staining test for early oral cancer screening for general dentists M. Takano ∗ , Y. Takaku, K. Kasahara, Y. Takasaki, M. Kuwayama, T. Kakizawa Division of Oral and Maxillofacial Surgery, Department of Clinical Oral Health Science, Suidobashi Hospital, Tokyo Dental College, Chiyoda-ku, Tokyo, Japan
Background and Objectives: To improve the recovery rate for oral cancer patient, it is extremely important that detection and treatment of oral cancer and precancer at an early stage. We have used the vital staining test with iodine (modified Lugol’s iodine solution) and toluidine blue (TB) to detect and delineate cancerous lesions of oral mucosa as adjunct diagnosis. In our previous study, the sensitivity of iodine staining test was 77.3%, and that of TB staining was 91.2% when oral and maxillofacial surgeons used. The purpose of this study is to survey the application of vital staining tests with iodine and TB solutions for screening of oral pre-cancer and carcinoma for general dentists. Methods: After practices for general dentists about oral cancer examinations including the vital staining test using 3.0% iodine and 0.5% TB solutions, we conducted a survey on attitudes toward oral cancer screening. Results: Almost all dentists thought that the vital staining test with iodine and TB was useful for chair side oral cancer screening. Many of them needed much more skill-upgrading training for screening and education on oral cancer to the public. On the other hand some doctors worried about diagnostic errors from false negative results. Conclusion: The vital staining test with iodine and TB solutions use for oral cancer screening is considered useful by general dentists. But there are some problems that remain to be solved. doi:10.1016/j.ijom.2009.03.520
P45 The Sentinel European Node Trial C. Schilling, B. Gurney, M. McGurk, L. Cascarini, Z. Lei ∗ ; and the European SENT Group Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
Background and Objectives: Sentinel node biopsy (SNB) is well-established in management of both breast cancer and melanoma. Tumour within cervical lymph nodes spreads in an orderly fashion from one nodal basin to the next. Lymphoscintigraphy accurately identifies the sentinel node. If negative for metastasis, a neck dissection can be avoided. The interim results of the Sentinel European Node Trial (SENT) are presented.
Methods: Mutlicentre European (n = 15) observational SNB study commenced in 2006. Eligibility criteria was 0.5–4 cm oral squamous cell carcinoma with computed tomography proven N0 necks. Patients with identifiable sentinel nodes on lymphoscintigraphy were enrolled in the study, and nodes retrieved intraoperatively by hand held gamma probe and blue dye. A positive sentinel node led to neck dissection within 3 weeks of biopsy. Results: During the period 2006–2008, 218 cases were recruited (60% were males, 40% were females; 62% T1, 33.5% T2, 4.5% T3). Positive SNB occurred in 48 patients (22%), 13 of which had further positive nodes on neck dissection. False negative occurred in 5 cases, subsequently treated with neck dissection and adjuvant RT (1 with concomitant chemotherapy). Tumour recurrence after positive SNB and neck dissection occurred in 3 patients. Complications were low (<5%). 22 patients excluded from the trial due to disease elsewhere or death from other causes. Conclusions: As a result of SNB, neck dissection was avoided in 75% of patients in the trial. 92.7% of patients are disease free at mean of 14 months follow-up, one patient died due to disease. SNB has a sensitivity of 90.6% and a negative predictive value of 97%. doi:10.1016/j.ijom.2009.03.518
P46 Oral and maxillofacial Langerhans cell histiocytosis J. Fu ∗ , Y. Hu, C. Zhang, L. Wang Ninth People’s Hospital, School of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Background and Objectives: To study the clinical features and treatment of Langerhans cell histiocytosis in oral and maxillofacial area. Methods: Retrospective studies were used to analysis the symptoms and signs, the treatment and the prognoses of oral and maxillofacial Langerhans cell histiocytosis. Results: The median age of oral and maxillofacial Langerhans cell histiocytosis is 8 years old. The male and female ratio is about 1.6:1. It often involves mandible lesions if Langerhans cell histiocytosis occurs in oral and maxillofacial area and does not have specific symptoms and signs. Surgery is the main therapy for oral and maxillofacial Langerhans cell
545
histiocytosis. Some patients may need adjuvant chemotherapy or radiotherapy if necessary. Conclusion: Oral and maxillofacial Langerhans cell histiocytosis has some different feathers from LCH in other regions thus has relatively good outcome. doi:10.1016/j.ijom.2009.03.519
P47 Application of chair side vital staining test for early oral cancer screening for general dentists M. Takano ∗ , Y. Takaku, K. Kasahara, Y. Takasaki, M. Kuwayama, T. Kakizawa Division of Oral and Maxillofacial Surgery, Department of Clinical Oral Health Science, Suidobashi Hospital, Tokyo Dental College, Chiyoda-ku, Tokyo, Japan
Background and Objectives: To improve the recovery rate for oral cancer patient, it is extremely important that detection and treatment of oral cancer and precancer at an early stage. We have used the vital staining test with iodine (modified Lugol’s iodine solution) and toluidine blue (TB) to detect and delineate cancerous lesions of oral mucosa as adjunct diagnosis. In our previous study, the sensitivity of iodine staining test was 77.3%, and that of TB staining was 91.2% when oral and maxillofacial surgeons used. The purpose of this study is to survey the application of vital staining tests with iodine and TB solutions for screening of oral pre-cancer and carcinoma for general dentists. Methods: After practices for general dentists about oral cancer examinations including the vital staining test using 3.0% iodine and 0.5% TB solutions, we conducted a survey on attitudes toward oral cancer screening. Results: Almost all dentists thought that the vital staining test with iodine and TB was useful for chair side oral cancer screening. Many of them needed much more skill-upgrading training for screening and education on oral cancer to the public. On the other hand some doctors worried about diagnostic errors from false negative results. Conclusion: The vital staining test with iodine and TB solutions use for oral cancer screening is considered useful by general dentists. But there are some problems that remain to be solved. doi:10.1016/j.ijom.2009.03.520