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Osteoradionecrosis of the jaw bones at the university of sousse medical center (Tunisia)
Oral Presentation early diagnosis of bacteriological investigation and prompt management of cellulite, in order to guarantee healing and reduce complications. http://dx.doi.org/10.1016/j.ijom.2015.08.574 Osteoradionecrosis of the jaw bones at the university of sousse medical center (Tunisia) J. Bouguila 1,2,3 , B. Guiga 1,∗ , W. Moatemri 1 , M. Omezzine 1,2 , R. Mani 1,2 , R. Moatemri 1,2 , H. Khochtali 1,2 1
Sahloul Hospital, Sousse, Tunisia Laboratory of Oral Health and Facial Rehabilitation, Mounastir, Tunisia 3 La Rabta Hospital, Tunis, Tunisia 2
Background: Osteoradionecrosis (ORN) of the jaws is a severe, generally irreversible complication of radiotherapy due to failure of healing. It is a serious and sometimes fatal complication of radiotherapy. Objectives: The aim of our study was to evaluate the epidemiological and clinical features of our patients and to criticize, in the light of recent contributions to the literature, our treatment. Methods: We performed a retrospective study of cases of jaw ORN, collected in the Maxillofacial Surgery at the University Hospital of Sahloul Sousse, for a period of 25 years from 1988 to 2013. We reviewed charts records of oral cancer patients and identified those with ORN. Epidemiological, clinical, and therapeutic data were analyzed using SPSS18® software stastics. Findings: Twenty-two patients with jaw bone osteoradionecrosis were included. The average age was 49 years (16–72 years) and the sex ratio was 2.6 with a male predominance. The most common site of primary tumor was the nasopharynx (n = 13), followed by the lips (n = 2). The time to development of ORN varied between 2 months and 10 years, with mean of 4 years. The mean radiation dose was 72 Gy to the primary tumor. The most common symptoms of ORN were limited mouth opening (50%) and pain when chewing (36, 3% of cases). All patients had medical treatment based primarily on antibiotics and analgesics. The treatment was surgical in 20 patients: bone curettage (19 cases) associated with sequestrectomy 10 cases and one case of mandibulectomy followed by immediate reconstruction with free fibula flaps. Conservative therapy was successful at managing symptoms but not in eradicating exposed bone in most patients. The outcome was favorable in 13 cases (59%), 1 case in pure medical treatment, 11 cases after conservative surgery and 1 case after revascularization. Conclusions: In advanced or refractory cases of ORN surgical treatment, including microvascular reconstructive techniques for bone and soft tissue remains the only option available. Medical treatment and oxygen therapy are only adjuvant therapies or reserved very early stages of the disease. The use of specific antifibrotic therapeutic combination: PENTOCLO protocol achieved clinical and radiological regression of ORN with, in parallel, a reduction of the indications for major surgery. http://dx.doi.org/10.1016/j.ijom.2015.08.575
e73
Specific forms and significance of perforator flaps for reconstruction of defects in oral and maxillofacial region F. Guo ∗ , X. Bin, X.S. Wu, Y. Zhou, B. Huang, Q. He, C. Jiang, T. Su, X. Jian Department of Stomatology, Xiangya Hospital, Central South University, Changsha, China Background: Perforator flap (PF) has become the most advanced flap different from the traditional flap due to the thoroughly anatomy of vascular pedicle and perforator and been applied in oral and maxillofacial surgery. Objectives: Introduce the concept of ‘freestyle’ PF and its specific forms in reconstruction of oral and maxillofacial defect and discuss the indications and contraindications. Methods: 80 cases that were applied ‘freestyle” PF to repaire the defects of oral and maxillofacial were collected within 18 months. Factors like the range of applications, definite forms, repairing effect and complications of donor site were evaluated. Findings: 82 PFs in 80 cases including 64 lateral circumflex femoral artery PFs, 3 radial collateral artery PFs, 2 inferior epigastric artery PFs, 3 submental artery PFs, 3 deepcircumflex iliac artery PFs and 7 fibular artery PFs were prepared with microscopical anatomic techniques. PFs carried only the target tissue and vascular pedicle finally, could be shaped freely around the site of peforator, minimized the damage of the donor site and achieved one-time closure of the incision. Flap size from 15 cm2 to 180 cm2 . This group of flaps archived an overall success rate of 97%. It costs 40–90 min to prepare a single PF, 100 min to 150 min for a sublobe PF or a chimeric PF. Operation time could be controlled in 4 h by two groups’ cooperation in carcinoma case. Conclusions: The most prominent feature of the ‘freestyle’ perforator flap is the maximum liberation of perforator vessel pedicle, the variant choice of donor site, archived sufficient freely prepare, shaping and combinative of the flap, the high succeed rate and the minimum damage for donor site. These advantages make it very suitable for promotion in reconstruction of defects of oral and maxillofacial. http://dx.doi.org/10.1016/j.ijom.2015.08.576 Multicenter clinical trial of targeted therapy with advanced head and neck squamous cell carcinoma W. Guo ∗ , G. Ren, C. Li, Y. Wu, C. Zhang 9th People’s Hospital, School of Stomatology, Shanghai Jiaotong University, China Background: The present study aimed to evaluate efficacy and adverse effects of Nimotuzumab combined with docetaxel–cisplatin–fluorouracil regimen in the treatment of advanced oral carcinoma Clinical data and methods: Forty-four patients with advanced oral carcinoma were treated with Nimotuzumab combined with docetaxel–cisplatin–fluorouracil regimen (test group). The treatment was given as follows: Nimotuzumab 200 mg, given as intravenous infusion once a week for 6 weeks; docetaxel and cisplatin, 75 mg/m2 each, on day 1 only; 5-fluorouracil, 750 mg/m2 infused continually for 8 h, used from day 1–5; the total cycle was for 21 days. Another forty-two patients comprised control group (docetaxel–cisplatin–fluorouracil regimen alone). Results: Study patients from both groups were evaluated for objective response. The response rate was significantly (p = 0.044) higher in test group (72.7 vs. 61.9% in control group). The disease
Sahloul Hospital, Sousse, Tunisia Laboratory of Oral Health and Facial Rehabilitation, Mounastir, Tunisia 3 La Rabta Hospital, Tunis, Tunisia 2
Background: Osteoradionecrosis (ORN) of the jaws is a severe, generally irreversible complication of radiotherapy due to failure of healing. It is a serious and sometimes fatal complication of radiotherapy. Objectives: The aim of our study was to evaluate the epidemiological and clinical features of our patients and to criticize, in the light of recent contributions to the literature, our treatment. Methods: We performed a retrospective study of cases of jaw ORN, collected in the Maxillofacial Surgery at the University Hospital of Sahloul Sousse, for a period of 25 years from 1988 to 2013. We reviewed charts records of oral cancer patients and identified those with ORN. Epidemiological, clinical, and therapeutic data were analyzed using SPSS18® software stastics. Findings: Twenty-two patients with jaw bone osteoradionecrosis were included. The average age was 49 years (16–72 years) and the sex ratio was 2.6 with a male predominance. The most common site of primary tumor was the nasopharynx (n = 13), followed by the lips (n = 2). The time to development of ORN varied between 2 months and 10 years, with mean of 4 years. The mean radiation dose was 72 Gy to the primary tumor. The most common symptoms of ORN were limited mouth opening (50%) and pain when chewing (36, 3% of cases). All patients had medical treatment based primarily on antibiotics and analgesics. The treatment was surgical in 20 patients: bone curettage (19 cases) associated with sequestrectomy 10 cases and one case of mandibulectomy followed by immediate reconstruction with free fibula flaps. Conservative therapy was successful at managing symptoms but not in eradicating exposed bone in most patients. The outcome was favorable in 13 cases (59%), 1 case in pure medical treatment, 11 cases after conservative surgery and 1 case after revascularization. Conclusions: In advanced or refractory cases of ORN surgical treatment, including microvascular reconstructive techniques for bone and soft tissue remains the only option available. Medical treatment and oxygen therapy are only adjuvant therapies or reserved very early stages of the disease. The use of specific antifibrotic therapeutic combination: PENTOCLO protocol achieved clinical and radiological regression of ORN with, in parallel, a reduction of the indications for major surgery. http://dx.doi.org/10.1016/j.ijom.2015.08.575
e73
Specific forms and significance of perforator flaps for reconstruction of defects in oral and maxillofacial region F. Guo ∗ , X. Bin, X.S. Wu, Y. Zhou, B. Huang, Q. He, C. Jiang, T. Su, X. Jian Department of Stomatology, Xiangya Hospital, Central South University, Changsha, China Background: Perforator flap (PF) has become the most advanced flap different from the traditional flap due to the thoroughly anatomy of vascular pedicle and perforator and been applied in oral and maxillofacial surgery. Objectives: Introduce the concept of ‘freestyle’ PF and its specific forms in reconstruction of oral and maxillofacial defect and discuss the indications and contraindications. Methods: 80 cases that were applied ‘freestyle” PF to repaire the defects of oral and maxillofacial were collected within 18 months. Factors like the range of applications, definite forms, repairing effect and complications of donor site were evaluated. Findings: 82 PFs in 80 cases including 64 lateral circumflex femoral artery PFs, 3 radial collateral artery PFs, 2 inferior epigastric artery PFs, 3 submental artery PFs, 3 deepcircumflex iliac artery PFs and 7 fibular artery PFs were prepared with microscopical anatomic techniques. PFs carried only the target tissue and vascular pedicle finally, could be shaped freely around the site of peforator, minimized the damage of the donor site and achieved one-time closure of the incision. Flap size from 15 cm2 to 180 cm2 . This group of flaps archived an overall success rate of 97%. It costs 40–90 min to prepare a single PF, 100 min to 150 min for a sublobe PF or a chimeric PF. Operation time could be controlled in 4 h by two groups’ cooperation in carcinoma case. Conclusions: The most prominent feature of the ‘freestyle’ perforator flap is the maximum liberation of perforator vessel pedicle, the variant choice of donor site, archived sufficient freely prepare, shaping and combinative of the flap, the high succeed rate and the minimum damage for donor site. These advantages make it very suitable for promotion in reconstruction of defects of oral and maxillofacial. http://dx.doi.org/10.1016/j.ijom.2015.08.576 Multicenter clinical trial of targeted therapy with advanced head and neck squamous cell carcinoma W. Guo ∗ , G. Ren, C. Li, Y. Wu, C. Zhang 9th People’s Hospital, School of Stomatology, Shanghai Jiaotong University, China Background: The present study aimed to evaluate efficacy and adverse effects of Nimotuzumab combined with docetaxel–cisplatin–fluorouracil regimen in the treatment of advanced oral carcinoma Clinical data and methods: Forty-four patients with advanced oral carcinoma were treated with Nimotuzumab combined with docetaxel–cisplatin–fluorouracil regimen (test group). The treatment was given as follows: Nimotuzumab 200 mg, given as intravenous infusion once a week for 6 weeks; docetaxel and cisplatin, 75 mg/m2 each, on day 1 only; 5-fluorouracil, 750 mg/m2 infused continually for 8 h, used from day 1–5; the total cycle was for 21 days. Another forty-two patients comprised control group (docetaxel–cisplatin–fluorouracil regimen alone). Results: Study patients from both groups were evaluated for objective response. The response rate was significantly (p = 0.044) higher in test group (72.7 vs. 61.9% in control group). The disease