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Is elective neck dissection needed in squamous cell carcinoma of maxillary gingiva, palate and maxillary sinus?
Oral Presentation
e45
occlusal plane and skeletal deformities who underwent orthognathic surgery with maxilomandibular counterclockwise rotation only or simultaneous temporomandibular joint (TMJ) surgery for articular disc plication using mini-anchors. This was a retrospective study in which 70 TMJs were studied from 35 patients that were divided into two groups. Group 1 (n = 34 TMJs) was treated with orthognathic surgery only, while group 2 (n = 36 TMJs) were treated with articular disc repositioning surgery and orthognathic surgery. The purpose was to investigate changes in the position of the articular disc through the magnetic resonance imaging (MRI) analyzed by on pre and post surgery, that were treated from two Surgical Centers, one in Brazil and another in the USA. The clinical findings associated with these results were also evaluated. The results showed clinical improvement and symptoms in 100% of patients undergoing joint surgery and a tendency to maintain the corrected position of the disks by MRI of the TMJ. All of these patients had stable occlusion. Patients, who did not undergo surgery of TMJs, remained unchanged or worsened preexisting changes to disc position seen by MRIs, and the symptoms remained similar, some improved or some worsened after surgery. It was to expect the best treatment protocol to be followed by the effectiveness of the TMJ and orthognathic surgery performed at the same operation, safely and predictably.
Patients and methods: Medical records of 124 patients with maxillary SCC were screened. Of 124 patients, 67 patients with cN0 neck who satisfied the criteria were analyzed retrospectively. Findings: 10 of 67 patients with cN0 neck had occult cervical metastasis. Rate of occult cervical metastasis was 17.1% (6 of 35 patients) for SCC in maxillary gingiva or palate and 12.5% (4 of 32 patients) for SCC in maxillary sinus. 9 patients underwent END simultaneously with primary tumor resection (END group) and 58 patients were treated by only primary tumor resection (non-END group). 5-year overall survival rate was 51.9% for the END group and 74.0% for the non-END group. Among the 7 patients who had regional only failure, 5 patients (71.4%) were treated successfully in contrast with poor success rates of local or locoregional failure. Conclusions: END is recommended for SCC in maxillary gingiva or palate but not recommended for SCC in maxillary sinus. Even for SCC in maxillary gingiva or palate, observation of cN0 neck can be the treatment of choice when patients are compliant follow-up protocol and early detection is possible.
http://dx.doi.org/10.1016/j.ijom.2015.08.492
S. Chandra 1,∗ , P. Pirgousis 2 , R. Fernandes 2
http://dx.doi.org/10.1016/j.ijom.2015.08.494 Thymo pericardial fat (TPF) flap-description and use in tracheal surgery
1
Use of illiac bone grafts in cleft patients C. Cerullo ∗ , P. Iwanyk, G. Tohus Hospital Italiano, Buenos Aires, Argentina Bone grafts are a need in cleft patients to reconstruct alveolar bone, in order to let the teeth erupt in children or to place dental implants in adults. This paper will show our experience with illac bone grafts in cleft patients, including paediatric (according to current protocols) and adults cases. The goal of this work is to analyze success–failure rates, related to age, kind of cleft and fixation method, considering more than 40 cases operated by the authors at Hospital Italiano de Buenos Aires, Argentina. All patients were studied clinically and radiographically at least during 6 months after surgery. A controversial issue to consider is an outcome of partial resorption, that bridges the cleft, but it is not enough for dental implant placement. We can conclude that this practice is useful nowadays, although new techniques such as distraction osteogenesis or growth factoraided tissue engineering placement, are in development, to replace grafting in the future, with the advantage of avoiding morbidity in donor site and better results. http://dx.doi.org/10.1016/j.ijom.2015.08.493 Is elective neck dissection needed in squamous cell carcinoma of maxillary gingiva, palate and maxillary sinus? J.H. Park, W. Nam, H.J. Kim, I.H. Cha ∗ Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea Objectives: To define the risk of occult cervical metastasis of maxillary squamous cell carcinoma (SCC) and therapeutic value of elective neck dissection (END) in survival of clinically negative neck node (cN0) patients.
2
University of Washington, Seattle, USA University of Florida, Jacksonville, USA
Objective: The presentation is to introduce the ThymoPericardial Fat (TPF) Flap and its role in surgical techniques of tracheal repair for trauma, stenosis and neoplastic lesions. Trauma, long-term intubation, airway interventions, inflammatory diseases, fistulas and neoplasia are indications for tracheal surgery and reconstruction. Current treatment options include stents, flaps of intercostal, neck, trunk fasciomuscular origin, omentum, cardiacsac, etc. Alloplastic mesh, sheets, glue, scaffold transplants are described too. Description: The anatomic rationale for using this flap is its vascularity and good bulk based on the internal thoracic artery. One major thymic branch per lobe forms of internal thoracic artery. The bulk is added by overlying mediastinal pleura, homolateral thymic lobe and continuous pericardial fat. In adulthood intrathoracic portion of thymic lobe remains as fat and connective tissue of anterior superior pericardium. The pericardial fat extends to cardiophrenic angle with length. This flap was described to cover the left internal thoracic artery after cardiac bypass. These characteristics make TPF flap ideal for repair and reinforce fistula, suture lines, prevent erosion of contiguous large vessels, hemostasis and postradiation salvage. Conclusion: There is no reported literature for use of this TPF flap for Tracheo-Esophageal fistula (TEF) closure or other airway reconstruction. We utilized TPF flap successfully for traumatic TEF repair and tracheal resections. We also summarize the airway reconstruction anesthetic protocols, TEF repair with muscle flaps along with review of literature and surgical techniques with operative videos. Future innovations include long segment repair with optimized tracheal transplants and increase in disease free survival. http://dx.doi.org/10.1016/j.ijom.2015.08.495
e45
occlusal plane and skeletal deformities who underwent orthognathic surgery with maxilomandibular counterclockwise rotation only or simultaneous temporomandibular joint (TMJ) surgery for articular disc plication using mini-anchors. This was a retrospective study in which 70 TMJs were studied from 35 patients that were divided into two groups. Group 1 (n = 34 TMJs) was treated with orthognathic surgery only, while group 2 (n = 36 TMJs) were treated with articular disc repositioning surgery and orthognathic surgery. The purpose was to investigate changes in the position of the articular disc through the magnetic resonance imaging (MRI) analyzed by on pre and post surgery, that were treated from two Surgical Centers, one in Brazil and another in the USA. The clinical findings associated with these results were also evaluated. The results showed clinical improvement and symptoms in 100% of patients undergoing joint surgery and a tendency to maintain the corrected position of the disks by MRI of the TMJ. All of these patients had stable occlusion. Patients, who did not undergo surgery of TMJs, remained unchanged or worsened preexisting changes to disc position seen by MRIs, and the symptoms remained similar, some improved or some worsened after surgery. It was to expect the best treatment protocol to be followed by the effectiveness of the TMJ and orthognathic surgery performed at the same operation, safely and predictably.
Patients and methods: Medical records of 124 patients with maxillary SCC were screened. Of 124 patients, 67 patients with cN0 neck who satisfied the criteria were analyzed retrospectively. Findings: 10 of 67 patients with cN0 neck had occult cervical metastasis. Rate of occult cervical metastasis was 17.1% (6 of 35 patients) for SCC in maxillary gingiva or palate and 12.5% (4 of 32 patients) for SCC in maxillary sinus. 9 patients underwent END simultaneously with primary tumor resection (END group) and 58 patients were treated by only primary tumor resection (non-END group). 5-year overall survival rate was 51.9% for the END group and 74.0% for the non-END group. Among the 7 patients who had regional only failure, 5 patients (71.4%) were treated successfully in contrast with poor success rates of local or locoregional failure. Conclusions: END is recommended for SCC in maxillary gingiva or palate but not recommended for SCC in maxillary sinus. Even for SCC in maxillary gingiva or palate, observation of cN0 neck can be the treatment of choice when patients are compliant follow-up protocol and early detection is possible.
http://dx.doi.org/10.1016/j.ijom.2015.08.492
S. Chandra 1,∗ , P. Pirgousis 2 , R. Fernandes 2
http://dx.doi.org/10.1016/j.ijom.2015.08.494 Thymo pericardial fat (TPF) flap-description and use in tracheal surgery
1
Use of illiac bone grafts in cleft patients C. Cerullo ∗ , P. Iwanyk, G. Tohus Hospital Italiano, Buenos Aires, Argentina Bone grafts are a need in cleft patients to reconstruct alveolar bone, in order to let the teeth erupt in children or to place dental implants in adults. This paper will show our experience with illac bone grafts in cleft patients, including paediatric (according to current protocols) and adults cases. The goal of this work is to analyze success–failure rates, related to age, kind of cleft and fixation method, considering more than 40 cases operated by the authors at Hospital Italiano de Buenos Aires, Argentina. All patients were studied clinically and radiographically at least during 6 months after surgery. A controversial issue to consider is an outcome of partial resorption, that bridges the cleft, but it is not enough for dental implant placement. We can conclude that this practice is useful nowadays, although new techniques such as distraction osteogenesis or growth factoraided tissue engineering placement, are in development, to replace grafting in the future, with the advantage of avoiding morbidity in donor site and better results. http://dx.doi.org/10.1016/j.ijom.2015.08.493 Is elective neck dissection needed in squamous cell carcinoma of maxillary gingiva, palate and maxillary sinus? J.H. Park, W. Nam, H.J. Kim, I.H. Cha ∗ Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea Objectives: To define the risk of occult cervical metastasis of maxillary squamous cell carcinoma (SCC) and therapeutic value of elective neck dissection (END) in survival of clinically negative neck node (cN0) patients.
2
University of Washington, Seattle, USA University of Florida, Jacksonville, USA
Objective: The presentation is to introduce the ThymoPericardial Fat (TPF) Flap and its role in surgical techniques of tracheal repair for trauma, stenosis and neoplastic lesions. Trauma, long-term intubation, airway interventions, inflammatory diseases, fistulas and neoplasia are indications for tracheal surgery and reconstruction. Current treatment options include stents, flaps of intercostal, neck, trunk fasciomuscular origin, omentum, cardiacsac, etc. Alloplastic mesh, sheets, glue, scaffold transplants are described too. Description: The anatomic rationale for using this flap is its vascularity and good bulk based on the internal thoracic artery. One major thymic branch per lobe forms of internal thoracic artery. The bulk is added by overlying mediastinal pleura, homolateral thymic lobe and continuous pericardial fat. In adulthood intrathoracic portion of thymic lobe remains as fat and connective tissue of anterior superior pericardium. The pericardial fat extends to cardiophrenic angle with length. This flap was described to cover the left internal thoracic artery after cardiac bypass. These characteristics make TPF flap ideal for repair and reinforce fistula, suture lines, prevent erosion of contiguous large vessels, hemostasis and postradiation salvage. Conclusion: There is no reported literature for use of this TPF flap for Tracheo-Esophageal fistula (TEF) closure or other airway reconstruction. We utilized TPF flap successfully for traumatic TEF repair and tracheal resections. We also summarize the airway reconstruction anesthetic protocols, TEF repair with muscle flaps along with review of literature and surgical techniques with operative videos. Future innovations include long segment repair with optimized tracheal transplants and increase in disease free survival. http://dx.doi.org/10.1016/j.ijom.2015.08.495