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Jaw reconstruction assisted by computer techniques
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Abstracts
X. Peng
underlying this is debatable. However its widespread use often delays definitive “curative” intent surgical modalities of treatment. Very often most of these patients are relegated to palliative intent treatment. The management of advanced carcinomas of the gingivobuccal and tongue has two endpoints: oncologic and functional outcome. To decide which modality namely surgical versus nonsurgical is superior one needs to assess both these endpoints as these would provide best levels of evidence in deciding the superiority of one over the other. Tumour differentiation, nodal involvement, extracapsular spread and perineural invasion are significant prognostic determinants of outcome. Functional endpoints primarily relate to airway, speech and oral intake. This symposium would focus on current scientific evidence, our experience and future pathways in the management of advance oral carcinomas of these two subsets.
Peking University School of Stomatology, Beijing, China
http://dx.doi.org/10.1016/j.ijom.2017.02.149
Pharyngeal reconstruction S. Parmar University Hospital Birmingham, Birmingham, United Kingdom Reconstruction of the pharyngolaryngectomy defect is difficult due to poor surrounding tissues whose vascularity is often complicated by the effects of radiotherapy. Many modes of reconstruction have been recommended and we will present one of the largest jejunal series in the world and our experience with the anterolateral thigh will also be discussed. http://dx.doi.org/10.1016/j.ijom.2017.02.147 Jaw reconstruction assisted by computer techniques
Mandibular and maxillary defects resulted from tumour resection and trauma may cause severe functional and cosmetic deformities. The vascularised fibula and deep circumflex iliac artery (DCIA) flap are already widely used in maxillofacial reconstruction. The success of jaw reconstruction generally depends on the surgeons’ experience, and although acceptable results are achieved in many patients, some degree of patient dissatisfaction does occur because the conventional surgical approach lacks an objective design process. Computer-aided design/computer-aided manufacturing techniques, such as virtual planning, rapid prototyping, reverse engineering and surgical navigation, can be used to improve the process. The experience at Peking University is introduced. The three-dimensional position of the fibula flap in computerassisted group is significantly more accurate and ideal than the traditional group. The average difference between the real postoperative position and virtual planning of the fibula in the computer-assisted group was less than 5 mm. Application of computer techniques can significantly improve the clinical outcome of maxillary and mandibular defect reconstruction with free fibula and DCIA flap. http://dx.doi.org/10.1016/j.ijom.2017.02.148 Contemporary management of advanced gingivobuccal and tongue carcinomas: perspective from the subcontinent V. Pillai Mazumdar Shaw Cancer Centre, Bangalore, India Oral cancer accounts for the majority of head and neck cancers in the Indian subcontinent that can be attributed to the use of tobacco both in the chewable and smoked forms. The magnitude of the problem can be perceived from: (1) lack of education, awareness and thus advanced stage of presentation, (2) economic implications of treatment and paucity of trained personnel and competent institutions to address the problem and (3) differing and variable philosophies of thought about treatment principles. Advanced buccal mucosa carcinoma and tongue carcinomas are considered moderately advanced disease based on current staging principles. Though guidelines are ambiguous about respectability, this has contributed to a surging interest in the use of neoadjuvant chemotherapy for the management of these patients. The rationale
Investigating the neck in oral squamous cell carcinoma V. Pillai Mazumdar Shaw Cancer Centre, Bangalore, India The assessment of the neck in oral squamous cell carcinoma (OSCC) is critical for staging and it precedes further management, it also predicts disease specific survival, and recurrence is the hallmark of a malignant phenotype. Investigation by imaging and tissue diagnosis are both crucial to further management. This presentation review various evidence-based modalities in current clinical practice along with an algorithmic approach to the assessment of the neck. The various imaging modalities are computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) CT. Tissue diagnosis is commonly obtained by ultrasound-guided (USG) fine-needle aspiration cytology (FNAC). Sentinel lymph node biopsy (SLNB) and categorised biomarkers and gene expression profiles are the newer tools in the armamentarium. USG FNAC has a specificity approaching nearly 100% for the evaluation of nodal disease. Drawbacks are its operator sensitivity and expertise required for nodes less than 5 mm. With CT or MRI between 40 and 60% of all occult metastasis can be detected. PET CT has an advantage of combining anatomical and functional imaging, however false positives due to physiologic uptake and inflammation are high. Its drawbacks are for metastatic deposits less than 5 mm and low sensitivity in the N0 neck ranging from 25 to 78%. It has a role in the recurrent and salvage settings. SLNB for early T1 and T2 lesions is a promising tool as it avoids the morbidity due to a neck dissection. With negative predictive value (NPV) from the 2 major trials ranging between 88 and 98% it is a very promising tool. Combined with frozen section it has a NPV of 83%. Cancer stem cells have been implicated in tumourigenesis and chemoresistance. Methylation markers such as Wnt-1 induced secreted protein 1 (WISP1) and programmed cell death ligand 1 (PD-L1) expression in primary and circulating tumour cells are predictors of nodal metastasis. However both SLNB and biomarkers are still experimental tools. http://dx.doi.org/10.1016/j.ijom.2017.02.150
Abstracts
X. Peng
underlying this is debatable. However its widespread use often delays definitive “curative” intent surgical modalities of treatment. Very often most of these patients are relegated to palliative intent treatment. The management of advanced carcinomas of the gingivobuccal and tongue has two endpoints: oncologic and functional outcome. To decide which modality namely surgical versus nonsurgical is superior one needs to assess both these endpoints as these would provide best levels of evidence in deciding the superiority of one over the other. Tumour differentiation, nodal involvement, extracapsular spread and perineural invasion are significant prognostic determinants of outcome. Functional endpoints primarily relate to airway, speech and oral intake. This symposium would focus on current scientific evidence, our experience and future pathways in the management of advance oral carcinomas of these two subsets.
Peking University School of Stomatology, Beijing, China
http://dx.doi.org/10.1016/j.ijom.2017.02.149
Pharyngeal reconstruction S. Parmar University Hospital Birmingham, Birmingham, United Kingdom Reconstruction of the pharyngolaryngectomy defect is difficult due to poor surrounding tissues whose vascularity is often complicated by the effects of radiotherapy. Many modes of reconstruction have been recommended and we will present one of the largest jejunal series in the world and our experience with the anterolateral thigh will also be discussed. http://dx.doi.org/10.1016/j.ijom.2017.02.147 Jaw reconstruction assisted by computer techniques
Mandibular and maxillary defects resulted from tumour resection and trauma may cause severe functional and cosmetic deformities. The vascularised fibula and deep circumflex iliac artery (DCIA) flap are already widely used in maxillofacial reconstruction. The success of jaw reconstruction generally depends on the surgeons’ experience, and although acceptable results are achieved in many patients, some degree of patient dissatisfaction does occur because the conventional surgical approach lacks an objective design process. Computer-aided design/computer-aided manufacturing techniques, such as virtual planning, rapid prototyping, reverse engineering and surgical navigation, can be used to improve the process. The experience at Peking University is introduced. The three-dimensional position of the fibula flap in computerassisted group is significantly more accurate and ideal than the traditional group. The average difference between the real postoperative position and virtual planning of the fibula in the computer-assisted group was less than 5 mm. Application of computer techniques can significantly improve the clinical outcome of maxillary and mandibular defect reconstruction with free fibula and DCIA flap. http://dx.doi.org/10.1016/j.ijom.2017.02.148 Contemporary management of advanced gingivobuccal and tongue carcinomas: perspective from the subcontinent V. Pillai Mazumdar Shaw Cancer Centre, Bangalore, India Oral cancer accounts for the majority of head and neck cancers in the Indian subcontinent that can be attributed to the use of tobacco both in the chewable and smoked forms. The magnitude of the problem can be perceived from: (1) lack of education, awareness and thus advanced stage of presentation, (2) economic implications of treatment and paucity of trained personnel and competent institutions to address the problem and (3) differing and variable philosophies of thought about treatment principles. Advanced buccal mucosa carcinoma and tongue carcinomas are considered moderately advanced disease based on current staging principles. Though guidelines are ambiguous about respectability, this has contributed to a surging interest in the use of neoadjuvant chemotherapy for the management of these patients. The rationale
Investigating the neck in oral squamous cell carcinoma V. Pillai Mazumdar Shaw Cancer Centre, Bangalore, India The assessment of the neck in oral squamous cell carcinoma (OSCC) is critical for staging and it precedes further management, it also predicts disease specific survival, and recurrence is the hallmark of a malignant phenotype. Investigation by imaging and tissue diagnosis are both crucial to further management. This presentation review various evidence-based modalities in current clinical practice along with an algorithmic approach to the assessment of the neck. The various imaging modalities are computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) CT. Tissue diagnosis is commonly obtained by ultrasound-guided (USG) fine-needle aspiration cytology (FNAC). Sentinel lymph node biopsy (SLNB) and categorised biomarkers and gene expression profiles are the newer tools in the armamentarium. USG FNAC has a specificity approaching nearly 100% for the evaluation of nodal disease. Drawbacks are its operator sensitivity and expertise required for nodes less than 5 mm. With CT or MRI between 40 and 60% of all occult metastasis can be detected. PET CT has an advantage of combining anatomical and functional imaging, however false positives due to physiologic uptake and inflammation are high. Its drawbacks are for metastatic deposits less than 5 mm and low sensitivity in the N0 neck ranging from 25 to 78%. It has a role in the recurrent and salvage settings. SLNB for early T1 and T2 lesions is a promising tool as it avoids the morbidity due to a neck dissection. With negative predictive value (NPV) from the 2 major trials ranging between 88 and 98% it is a very promising tool. Combined with frozen section it has a NPV of 83%. Cancer stem cells have been implicated in tumourigenesis and chemoresistance. Methylation markers such as Wnt-1 induced secreted protein 1 (WISP1) and programmed cell death ligand 1 (PD-L1) expression in primary and circulating tumour cells are predictors of nodal metastasis. However both SLNB and biomarkers are still experimental tools. http://dx.doi.org/10.1016/j.ijom.2017.02.150