- Email: [email protected]
Evolution, current status and future of oral and maxillofacial surgery
Int. J. Oral Maxillofac. Surg. 2009; 38: 397–399 available online at http://www.sciencedirect.com
Presidential Lecture and Plenary Lectures Presidential Lecture Evolution, current status and future of oral and maxillofacial surgery G.E. Ghali Gamble Professor and Chairman, Oral and Maxillofacial Surgery, Head and Neck Surgery, Louisiana University Health Sciences Center, Shreveport, Louisiana, United States
[No abstract available] doi:10.1016/j.ijom.2009.03.010
Plenary 1: Cancer and Reconstructive Surgery PL1 Evolving trends in the management of oral cancer: a cynical surgeon’s view of the role of chemotherapy R. Ord Department of Oral and Maxillofacial Surgery, University of Maryland Medical Center, Baltimore, MD, United States
Oral cancer is currently regarded as a disease requiring a multidisciplinary approach similar to cancer at most other sites. Traditionally the primary modality of treatment has been surgery for squamous cell carcinoma of the oral cavity supplemented by adjuvant radiation therapy when indicated (in the majority of Stage III and IV cases). Although surgery and surgery with postoperative radiation remain the “gold standard” in treatment there is increasing use of chemotherapy in the field of head 0901-5027/000397+399 $36.00/0
and neck cancer especially when combined with radiation therapy either as an adjuvant to surgery or in “organ sparing” regimes as a primary treatment. This presentation will attempt to evaluate the current role of adjuvant therapy especially chemotherapy in the treatment of oral squamous cell carcinoma. Evidence from recent trials regarding the indications for postoperative chemoradiation, possible new indications or considerations for re-evaluating neoadjuvant chemotherapy and the role of chemoradiation in salvage surgery will be reviewed. Although these adjuvant therapies are usually used for locally advanced disease (Stage III and IV) the use of radiation alone as an alternative to surgery in early disease (Stage I and II) will also be discussed as our understanding of the pathophysiology of oral cancer has changed. doi:10.1016/j.ijom.2009.03.011
PL2 Current status of sentinel lymph node biopsy in oral cancer M.A. Kuriakose Head and Neck Institute, Amrita Institute of Medical Sciences and Research Centre, Elamakkara, Kochi, Kerala, India
Sentinel node biopsy (SNB) is emerging as a potential tool to evaluate neck node metastasis in head and neck cancer. Existing data suggest that the status of sentinel lymph node (SLN) predicts pathologic stage of the nodal basin. It has been demonstrated that radiolabeled lymphoscintigraphy is superior to blue dye to localise SLN in head and neck cancer.
Sentinel lymph node biopsy (SNB) should be recommended only in patients with previously untreated early stage (T1/2) oral cavity and orophparynx cancer with clinical N0 stage. The procedure is technique sensitive. The isolated SLN should be subjected to serial step sectioning at 150 m and by haematoxylin and eosin staining and immunohistochemistry. Intraoperative frozen section and imprint cytology are not sensitive to identify small foci of micrometastasis and isolated tumour cells within SLN. The clinical relevance of micrometastasis and isolated tumour cells needs to be established. It is necessary to develop a better method for intraoperative pathological confirmation of SLN metastasis. There exists no randomised clinical trial with adequate power, comparing SNB and elective neck dissection in head and neck cancer. SNB in head and neck squamous cell carcinoma should be considered as an investigational tool pending validation by larger randomised clinical trials, therefore should not be recommended at present outside a clinical trial setting. doi:10.1016/j.ijom.2009.03.012
PL3 State-of-the-art in mandibular reconstruction C.P. Zhang Department of Oral and Maxillofacial Surgery, Affiliated Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
Functional rehabilitation has become the important task in oral maxillofacial and head neck surgery. Mandibular
Presidential Lecture and Plenary Lectures Presidential Lecture Evolution, current status and future of oral and maxillofacial surgery G.E. Ghali Gamble Professor and Chairman, Oral and Maxillofacial Surgery, Head and Neck Surgery, Louisiana University Health Sciences Center, Shreveport, Louisiana, United States
[No abstract available] doi:10.1016/j.ijom.2009.03.010
Plenary 1: Cancer and Reconstructive Surgery PL1 Evolving trends in the management of oral cancer: a cynical surgeon’s view of the role of chemotherapy R. Ord Department of Oral and Maxillofacial Surgery, University of Maryland Medical Center, Baltimore, MD, United States
Oral cancer is currently regarded as a disease requiring a multidisciplinary approach similar to cancer at most other sites. Traditionally the primary modality of treatment has been surgery for squamous cell carcinoma of the oral cavity supplemented by adjuvant radiation therapy when indicated (in the majority of Stage III and IV cases). Although surgery and surgery with postoperative radiation remain the “gold standard” in treatment there is increasing use of chemotherapy in the field of head 0901-5027/000397+399 $36.00/0
and neck cancer especially when combined with radiation therapy either as an adjuvant to surgery or in “organ sparing” regimes as a primary treatment. This presentation will attempt to evaluate the current role of adjuvant therapy especially chemotherapy in the treatment of oral squamous cell carcinoma. Evidence from recent trials regarding the indications for postoperative chemoradiation, possible new indications or considerations for re-evaluating neoadjuvant chemotherapy and the role of chemoradiation in salvage surgery will be reviewed. Although these adjuvant therapies are usually used for locally advanced disease (Stage III and IV) the use of radiation alone as an alternative to surgery in early disease (Stage I and II) will also be discussed as our understanding of the pathophysiology of oral cancer has changed. doi:10.1016/j.ijom.2009.03.011
PL2 Current status of sentinel lymph node biopsy in oral cancer M.A. Kuriakose Head and Neck Institute, Amrita Institute of Medical Sciences and Research Centre, Elamakkara, Kochi, Kerala, India
Sentinel node biopsy (SNB) is emerging as a potential tool to evaluate neck node metastasis in head and neck cancer. Existing data suggest that the status of sentinel lymph node (SLN) predicts pathologic stage of the nodal basin. It has been demonstrated that radiolabeled lymphoscintigraphy is superior to blue dye to localise SLN in head and neck cancer.
Sentinel lymph node biopsy (SNB) should be recommended only in patients with previously untreated early stage (T1/2) oral cavity and orophparynx cancer with clinical N0 stage. The procedure is technique sensitive. The isolated SLN should be subjected to serial step sectioning at 150 m and by haematoxylin and eosin staining and immunohistochemistry. Intraoperative frozen section and imprint cytology are not sensitive to identify small foci of micrometastasis and isolated tumour cells within SLN. The clinical relevance of micrometastasis and isolated tumour cells needs to be established. It is necessary to develop a better method for intraoperative pathological confirmation of SLN metastasis. There exists no randomised clinical trial with adequate power, comparing SNB and elective neck dissection in head and neck cancer. SNB in head and neck squamous cell carcinoma should be considered as an investigational tool pending validation by larger randomised clinical trials, therefore should not be recommended at present outside a clinical trial setting. doi:10.1016/j.ijom.2009.03.012
PL3 State-of-the-art in mandibular reconstruction C.P. Zhang Department of Oral and Maxillofacial Surgery, Affiliated Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
Functional rehabilitation has become the important task in oral maxillofacial and head neck surgery. Mandibular