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Hypoxia related biomarkers in tongue cancer, prognostic relevance?
Oral Presentation The styloid process hypertrophy, or Eagle syndrome, may be a source of cervicofacial pain and is very difficult to diagnose. The pathogenesis of this abnormality is unknown. Traumatic origin is usually admitted even if recent embryological data suggest a genetic origin with interindividual variations. Objectives: This article presents our experiences in the management of Eagle’s syndrome. Methods: A retrospective chart review was performed of all cases of Eagle syndrome diagnosed at the Division of Maxillofacial Surgery, Sahloul Hospital, University of Sousse (Sousse, Tunisia) from 1989 through 2013. The data collected included age at diagnosis, gender, lesion location, presenting symptoms, treatment, and outcomes. Findings: Of the many patients with facial pain treated between 1989 and 2013, 9 were diagnosed with Eagle syndrome, and 8 of these patients underwent resection of the elongated styloid process. There were 6 women and 3 man, ranging in age from 20 to 68 years (mean 43 years). The average duration of disease was 27months (2–60 months). In all patients, a preoperative workup revealed unilateral or bilateral elongation of the styloid process. All patients underwent resection of the styloid process on the symptomatic side using a lateral cervical approach (6patients) or transoral approach (2 patients). The average length of the resected segment was 3 cm (6 1.5 cm). There were no surgical complications. Sex patients experienced pain relief immediately after the operation. Two patients are still complaining neck pain, although the discomfort has a lower grade and is pharmacologically controllable. The average follow-up was 52 months, range 18 months to 8 years). Conclusions: Although rare, Eagle’s Syndrome should be always considered in the differential diagnosis in patients with chronic orofacial pain refractory to conventional treatments. The diagnosis is made on several elements: exacerbated cervical pain on neck hyperextension and sudden head movements, typical pain caused by palpation of the tonsillar fossa, diagnostic test with xylocaine, and radiological investigation. Treatment is surgery and excision of the styloid process via a transoral or cervical approach. http://dx.doi.org/10.1016/j.ijom.2015.08.480 Post-traumatic closed rhinoplasty J. Bouguila 1,2,3,∗ , K. Slimane 1 , S. Triter 1 , M. Omezzine 1,2 , R. Mani 1,2 , R. Moatemri 1,2 , H. Khochtali 1,2
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Findings: Fifty-four of these patients, including 35 males and 19 females, underwent the internal approach. The patients were, on average, 28 years old at the time of reconstruction and were followed up for an average period of 18 months. The interval from injury to the rhinoplasty procedure was 4 years, on average. The outcome was assessed by (an independent investigator and the patients themselves). The overall aesthetic-improvement rate was 85%, and the patient-satisfaction rate was 90%. There was no complication. Conclusions: Not only is the skeletal structure severely deformed, but the soft tissue may also be disfigured by a previous injury. The closed rhinoplasty technique provides great predictability and minimal postoperative discomfort, with no aesthetic damage http://dx.doi.org/10.1016/j.ijom.2015.08.481 Can pre-operative psychological assessment predict outcomes after temporomandibular joint arthroscopy? G. Bouloux ∗ , A. Gibbs, M. Celano, T. Dai, K. Easley Emory University School of Medicine, Georgia Objectives: The purpose of this study was to determine if preoperative psychological assessment can be used to predict patient outcomes after temporomandibular joint arthroscopy. Methods: Consecutive patients with TMD who could benefit from arthroscopy were prospectively enrolled. All subjects completed the Millon Behavior Medicine Diagnostic (MBMD) survey. The primary predictor variables were psychometric scores on multiple parameters. The primary outcome variable was pain recorded on a visual analog scale. Findings: Eighty-six patients were enrolled in the study. Seventy-five subjects completed the study and were included in the final analyses. Data was obtained pre-operatively and at one month after arthroscopy. The mean change in VAS pain score after arthroscopy was −15.4 points (95% confidence interval: −6.0 to −24.7; P < 0.001). Jaw function also improved following surgery (P < 0.001). Multivariable analyses suggested that a greater pain reduction was weakly associated with a longer duration of pre-operative symptoms (P = 0.054) and lower chronic anxiety (P = 0.064). Conclusions: There is a potential relationship between chronic anxiety and the outcome following arthroscopy for TMD.
Sahloul Hospital, Sousse, Tunisia Laboratory of Oral Health and Facial Rehabilitation, Mounastir, Tunisia 3 La Rabta Hospital, Tunis, Tunisia
http://dx.doi.org/10.1016/j.ijom.2015.08.482
Background: The application of rhinoplasty in the treatment of traumatic nasal deformity remains one of the most challenging problems in plastic surgery. Objectives: This article presents our experiences in the reconstruction of traumatic nasal deformities using the internal rhinoplasty approach. Methods: We conducted a retrospective study from January 2001 to December 2013. We included in this study all patients operated for nasal post-traumatic deformity using closed approach. Each patient chart was reviewed with regard to: age and gender, circumstances and date of nasal trauma, timing of the rhinoplasty as well as for the functional and aesthetic outcomes.
M. Bredell 1,∗ , K. Ikenberg 2 , B. Apel 2 , O. Riesterer 3 , G. Studer 3 , J. Ernst 1 , R. Wenger 4 , L. Borsig 4 , D. Schumann 1
1
2
Hypoxia related biomarkers in tongue cancer, prognostic relevance?
1 Department of Cranio-, Maxillofacial and Oral Surgery, University Hospital of Zurich, Zürich, Switzerland 2 Institute of Surgical Pathology, University Hospital of Zuric, Zürich, Switzerland 3 Clinic of Radiation Oncology, University Hospital Zürich, Zürich, Switzerland 4 Institute of Physiology, University of Zürich-Irchel, Zürich, Switzerland
Background: Hypoxic tumors have proven to have a poor prognosis compared to their well oxygenated counterparts in head
e42
Oral Presentation
and neck cancer patients. Selection of hypoxic tumors has therapeutic and prognostic relevance. Objectives: The aim of this study was to establish the survival predictive value of selected hypoxia related biomarkers in a large retrospective tongue carcinoma cohort. Methods: A cohort of 229 primary tongue carcinoma cases with a TMA of 139 representative patient core and peripheral tissue samples were established. Demographic data was gathered and staining for a selected number of biomarkers was established. Statistical analysis with univariate and multivariate analysis were used to link biomarker expression to overall and disease specific survival. Findings: HIF1␣ is predictive for overall survival (OS) P < 0.05, OPN, CAIX were the most predictive for OS independently and together with known pathological risk factors (P < 0.05) CK19 was the sole predictor for a statistically significant improved disease specific survival (DSS), however HIF1␣ and CAIX selected for DSS within the supposedly good prognosis N0 subgroup. P16 alone or in combination with selected biomarkers was not predictive for a statistically significant improved survival. Conclusions: Apart from some known histological predictive factors, biomarkers are playing an increasing role of selecting the most relevant therapy in head and neck cancer. CK19 was the overall the most sensitive predictive factor. Hypoxia related biomarkers, especially HIF1 ␣ and CAIX played an important role in predicting prognosis in a low risk subgroup (N0) in this tongue carcinoma cohort and may dictate treatment options in the future. http://dx.doi.org/10.1016/j.ijom.2015.08.483 Retrospective case series of mucosal melanoma at the royal Melbourne Hospital and literature review O. Breik ∗ , F. Sim, T. Wong, D. Wiesenfeld The Royal Melbourne Hospital, Victoria, Australia Introduction: Mucosal malignant melanoma of the head and neck (HNMM) is an aggressive and rare neoplasm. It accounts for 0.72% of all melanoma cases, most commonly affecting the sinonasal area and oral cavity. To date, few case series have been published on outcomes of patient’s treated for mucosal head and neck melanoma (HNMM). Aim: To complete a retrospective chart review of HNMM from a tertiary institution within Victoria over a 15 year period (2000–2015). The clinical features and treatment modalities were identified and correlated with outcomes. Methods: Data was collected from the Royal Melbourne Hospital’s ACCORD head and neck database and it is predecessor database with subsequent medical record review. Results: A total of 15 cases were found. Two were excluded due to inaccessible data. Out of 13 cases, the majority were sinonasal melanomas (8/13). The remaining 4 originated in the oral cavity. Sinonasal tumour patients presented with epistaxis or visual impairment. Oral melanoma patients presented commonly with a visually pigmented lesion or ulceration. All patients were offered surgical excision. Four patients underwent post-operative radiotherapy. Follow up ranged from 8 months to 7 years (mean 4 years). The overall 2-year and 5-year survival rates were 62% and 37.5% respectively. Four patients died due to distant metastasis despite clear surgical margins. One of these patients had a locoregional recurrence resected. Only one patient was still alive at 7 years follow up.
Conclusion: MM is a rare and aggressive malignancy in the head and neck region associated with poor long term outcomes. Despite technically adequate surgical management, 80% of deaths were due to distant metastasis. Further research of this rare tumour is required to determine the ideal treatment protocol. http://dx.doi.org/10.1016/j.ijom.2015.08.484 Isolated cleft of the hard palate – incidence, variations, classification and reconstruction K.W. Bütow 1,∗ , H. Engelbrecht 2 , S. Naidoo 3 1
University of Pretoria, Pretoria, University of KwaZulu-Natal, Durban and Suite A2 Wilgers Hospital, Pretoria, South Africa 2 The Royal Dental Hospital of Melbourne, Australia 3 University of Pretoria, Pretoria, South Africa Background: Isolated cleft of the hard palate (hP),1 refers to the anterior part of the embryological secondary palate occurring between the bony palatal shelves. Objectives: 4096 facial cleft cases were analyzed to determine incidence and variation. The cleft type is classified according to the clinical appearances. The reconstruction is determined according to the extent and type of the deformity. Methods: Study population of 31 years was drawn from the records of Facial Cleft Deformity Clinic (FCDC) and was evaluated retrospectively for its incidence, variations and frequencies of the hP. The variation of the cleft type determined the type of reconstruction. Findings: Of the 4096 cleft patients, 37 (0.9%) cases presented an isolated cleft hP deformity. Three different variations were noted: (I) a complete cleft, where all the layers are congenitally separated, totally (1) or partially (23), in length of hP; (II) an incomplete or submucosal cleft, where a lack of bony fusion promotes a blind soft tissue fistula allowing food/foreign body impaction (4); (III) (a) a submucosal (7) or (b) a complete cleft (2), where the vomer septum intercedes between the palatal shelves, preventing the bony fusion. Conclusion: The isolated hP cleft, an extremely rare phenomenon, is recorded at 0.9% in CLAP clinic, been subdivided into three distinct variations. The reconstruction was done by means of a double-layered Von Langenbeck procedure or single-nasal-layered procedure, without major dissection of the mucoperiosteum, in conjunction with a PdLAlLA resorbable sheet.
Reference Bütow, K.-W., & Zwahlen, R. (2015). Cleft ultimate treatment (vol. 39) Durban: Reach Publishers., p. 205, 209, ISBN 978-0-620-TBC.
http://dx.doi.org/10.1016/j.ijom.2015.08.485
e41
Findings: Fifty-four of these patients, including 35 males and 19 females, underwent the internal approach. The patients were, on average, 28 years old at the time of reconstruction and were followed up for an average period of 18 months. The interval from injury to the rhinoplasty procedure was 4 years, on average. The outcome was assessed by (an independent investigator and the patients themselves). The overall aesthetic-improvement rate was 85%, and the patient-satisfaction rate was 90%. There was no complication. Conclusions: Not only is the skeletal structure severely deformed, but the soft tissue may also be disfigured by a previous injury. The closed rhinoplasty technique provides great predictability and minimal postoperative discomfort, with no aesthetic damage http://dx.doi.org/10.1016/j.ijom.2015.08.481 Can pre-operative psychological assessment predict outcomes after temporomandibular joint arthroscopy? G. Bouloux ∗ , A. Gibbs, M. Celano, T. Dai, K. Easley Emory University School of Medicine, Georgia Objectives: The purpose of this study was to determine if preoperative psychological assessment can be used to predict patient outcomes after temporomandibular joint arthroscopy. Methods: Consecutive patients with TMD who could benefit from arthroscopy were prospectively enrolled. All subjects completed the Millon Behavior Medicine Diagnostic (MBMD) survey. The primary predictor variables were psychometric scores on multiple parameters. The primary outcome variable was pain recorded on a visual analog scale. Findings: Eighty-six patients were enrolled in the study. Seventy-five subjects completed the study and were included in the final analyses. Data was obtained pre-operatively and at one month after arthroscopy. The mean change in VAS pain score after arthroscopy was −15.4 points (95% confidence interval: −6.0 to −24.7; P < 0.001). Jaw function also improved following surgery (P < 0.001). Multivariable analyses suggested that a greater pain reduction was weakly associated with a longer duration of pre-operative symptoms (P = 0.054) and lower chronic anxiety (P = 0.064). Conclusions: There is a potential relationship between chronic anxiety and the outcome following arthroscopy for TMD.
Sahloul Hospital, Sousse, Tunisia Laboratory of Oral Health and Facial Rehabilitation, Mounastir, Tunisia 3 La Rabta Hospital, Tunis, Tunisia
http://dx.doi.org/10.1016/j.ijom.2015.08.482
Background: The application of rhinoplasty in the treatment of traumatic nasal deformity remains one of the most challenging problems in plastic surgery. Objectives: This article presents our experiences in the reconstruction of traumatic nasal deformities using the internal rhinoplasty approach. Methods: We conducted a retrospective study from January 2001 to December 2013. We included in this study all patients operated for nasal post-traumatic deformity using closed approach. Each patient chart was reviewed with regard to: age and gender, circumstances and date of nasal trauma, timing of the rhinoplasty as well as for the functional and aesthetic outcomes.
M. Bredell 1,∗ , K. Ikenberg 2 , B. Apel 2 , O. Riesterer 3 , G. Studer 3 , J. Ernst 1 , R. Wenger 4 , L. Borsig 4 , D. Schumann 1
1
2
Hypoxia related biomarkers in tongue cancer, prognostic relevance?
1 Department of Cranio-, Maxillofacial and Oral Surgery, University Hospital of Zurich, Zürich, Switzerland 2 Institute of Surgical Pathology, University Hospital of Zuric, Zürich, Switzerland 3 Clinic of Radiation Oncology, University Hospital Zürich, Zürich, Switzerland 4 Institute of Physiology, University of Zürich-Irchel, Zürich, Switzerland
Background: Hypoxic tumors have proven to have a poor prognosis compared to their well oxygenated counterparts in head
e42
Oral Presentation
and neck cancer patients. Selection of hypoxic tumors has therapeutic and prognostic relevance. Objectives: The aim of this study was to establish the survival predictive value of selected hypoxia related biomarkers in a large retrospective tongue carcinoma cohort. Methods: A cohort of 229 primary tongue carcinoma cases with a TMA of 139 representative patient core and peripheral tissue samples were established. Demographic data was gathered and staining for a selected number of biomarkers was established. Statistical analysis with univariate and multivariate analysis were used to link biomarker expression to overall and disease specific survival. Findings: HIF1␣ is predictive for overall survival (OS) P < 0.05, OPN, CAIX were the most predictive for OS independently and together with known pathological risk factors (P < 0.05) CK19 was the sole predictor for a statistically significant improved disease specific survival (DSS), however HIF1␣ and CAIX selected for DSS within the supposedly good prognosis N0 subgroup. P16 alone or in combination with selected biomarkers was not predictive for a statistically significant improved survival. Conclusions: Apart from some known histological predictive factors, biomarkers are playing an increasing role of selecting the most relevant therapy in head and neck cancer. CK19 was the overall the most sensitive predictive factor. Hypoxia related biomarkers, especially HIF1 ␣ and CAIX played an important role in predicting prognosis in a low risk subgroup (N0) in this tongue carcinoma cohort and may dictate treatment options in the future. http://dx.doi.org/10.1016/j.ijom.2015.08.483 Retrospective case series of mucosal melanoma at the royal Melbourne Hospital and literature review O. Breik ∗ , F. Sim, T. Wong, D. Wiesenfeld The Royal Melbourne Hospital, Victoria, Australia Introduction: Mucosal malignant melanoma of the head and neck (HNMM) is an aggressive and rare neoplasm. It accounts for 0.72% of all melanoma cases, most commonly affecting the sinonasal area and oral cavity. To date, few case series have been published on outcomes of patient’s treated for mucosal head and neck melanoma (HNMM). Aim: To complete a retrospective chart review of HNMM from a tertiary institution within Victoria over a 15 year period (2000–2015). The clinical features and treatment modalities were identified and correlated with outcomes. Methods: Data was collected from the Royal Melbourne Hospital’s ACCORD head and neck database and it is predecessor database with subsequent medical record review. Results: A total of 15 cases were found. Two were excluded due to inaccessible data. Out of 13 cases, the majority were sinonasal melanomas (8/13). The remaining 4 originated in the oral cavity. Sinonasal tumour patients presented with epistaxis or visual impairment. Oral melanoma patients presented commonly with a visually pigmented lesion or ulceration. All patients were offered surgical excision. Four patients underwent post-operative radiotherapy. Follow up ranged from 8 months to 7 years (mean 4 years). The overall 2-year and 5-year survival rates were 62% and 37.5% respectively. Four patients died due to distant metastasis despite clear surgical margins. One of these patients had a locoregional recurrence resected. Only one patient was still alive at 7 years follow up.
Conclusion: MM is a rare and aggressive malignancy in the head and neck region associated with poor long term outcomes. Despite technically adequate surgical management, 80% of deaths were due to distant metastasis. Further research of this rare tumour is required to determine the ideal treatment protocol. http://dx.doi.org/10.1016/j.ijom.2015.08.484 Isolated cleft of the hard palate – incidence, variations, classification and reconstruction K.W. Bütow 1,∗ , H. Engelbrecht 2 , S. Naidoo 3 1
University of Pretoria, Pretoria, University of KwaZulu-Natal, Durban and Suite A2 Wilgers Hospital, Pretoria, South Africa 2 The Royal Dental Hospital of Melbourne, Australia 3 University of Pretoria, Pretoria, South Africa Background: Isolated cleft of the hard palate (hP),1 refers to the anterior part of the embryological secondary palate occurring between the bony palatal shelves. Objectives: 4096 facial cleft cases were analyzed to determine incidence and variation. The cleft type is classified according to the clinical appearances. The reconstruction is determined according to the extent and type of the deformity. Methods: Study population of 31 years was drawn from the records of Facial Cleft Deformity Clinic (FCDC) and was evaluated retrospectively for its incidence, variations and frequencies of the hP. The variation of the cleft type determined the type of reconstruction. Findings: Of the 4096 cleft patients, 37 (0.9%) cases presented an isolated cleft hP deformity. Three different variations were noted: (I) a complete cleft, where all the layers are congenitally separated, totally (1) or partially (23), in length of hP; (II) an incomplete or submucosal cleft, where a lack of bony fusion promotes a blind soft tissue fistula allowing food/foreign body impaction (4); (III) (a) a submucosal (7) or (b) a complete cleft (2), where the vomer septum intercedes between the palatal shelves, preventing the bony fusion. Conclusion: The isolated hP cleft, an extremely rare phenomenon, is recorded at 0.9% in CLAP clinic, been subdivided into three distinct variations. The reconstruction was done by means of a double-layered Von Langenbeck procedure or single-nasal-layered procedure, without major dissection of the mucoperiosteum, in conjunction with a PdLAlLA resorbable sheet.
Reference Bütow, K.-W., & Zwahlen, R. (2015). Cleft ultimate treatment (vol. 39) Durban: Reach Publishers., p. 205, 209, ISBN 978-0-620-TBC.
http://dx.doi.org/10.1016/j.ijom.2015.08.485