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P1.72. Case report of squamous cell carcinoma in a young patient: Rehabilitation using osseointegrated implants
P1.72. Case report of squamous cell carcinoma in a young patient: Rehabilitation using osseointegrated implants J.M. Ozi a,*, P. Bjorklund b, C. Runehammar b, M. Ryndel b, L.P. Kowalski c, L.L. Dib d
147
surgeons involved in reconstruction of patients with submucosal fibrosis acquired from the use of pan or betel quid. doi:10.1016/j.oos.2009.06.359
a
Universidade Paulista, Brazil Medical School, Sahlgrenska Academy at Göteborg University, Sweden c Head and Neck Surgery Department, Brazil d Department of Stomatology, Universidade Paulista, Dental School, Brazil b
Squamous cell carcinoma (SCC) occurs in approximately 95% of cases of malignant tumors in head and neck. Its incidence is more common from the 5th decade of life, rarely occurring in young people. The objective of this report is to present an invasive carcinoma in a young patient, non-smoker that did not consummate alcohol. The patient P.H., 25 years old, male, presented in 2003 SCC of the tongue, being treated with radiotherapy (6200 cGY) and partial glossectomy. Unfortunately after a brief period of time he had the recurrence of the tumor. At that time surgery was necessary, submitting the patient to resection of all the tongue and oral floor, part of the mandible, all inferiors tooth, and lymph node dissection. At his condition, considering absence of the tongue and all inferiors tooth, six implants with an implant-retained prosthesis were indicated. At the present time, the patient is in optimal conditions of speaking, eating and aesthetics. Important aspects of this case are the early occurrence of cancer in young patients, the severity and occurrence of the malignant tumor and the patient’s rehabilitation. doi:10.1016/j.oos.2009.06.358
P1.73. One flap reconstruction of bilateral buccal mucosa and floor of mouth with a radial forearm free flap: ‘‘The aviator flap” design R. Fernandes *, A. Cusano, N. Goldman University of Florida College of Medicine, Jacksonville, United States Reconstruction of fibrosis of the buccal mucosa and floor of mouth poses a significant challenge to the reconstructive surgeon. The reconstruction of these multi-dimensional defects is often carried out by using multiple free flaps or combination of local and distant flaps. This case report describes the use of a new flap design utilizing the radial forearm fasciocutaneous flap to accomplish the reconstruction of these defects with a single flap. The patient is a 65 year old male who ten years prior had attempted suicide with ingestion of Drano. He suffered extensive chemical burns to the oral cavity which resulted in fibrosis and restriction of the oral cavity. He had undergone numerous scar resections and reconstructions with skin grafts however these surgeries resulted in further scar formation and restriction of mouth opening and tongue mobility. The patient was reconstructed with a radial forearm free flap. A design was created to simultaneously reconstruct the entire buccal mucosa bilaterally, the anterior floor of mouth and the mucosal aspect of the lip. We termed the design ‘‘the aviator flap” due to its resemblance to the aviator glasses. The patient had resection of the existing scar bands, re-establishing a near normal mouth opening and the flap was then inset to re-line both buccal mucosa, floor of mouth and inner aspect of the lip. The patient did well from a reconstructive standpoint and has an improved mouth opening, tongue mobility, and is awaiting staged secondary reconstruction. We find that the aviator flap design to be a useful design which allows for a single flap reconstruction of these complex and demanding defects. The utility of this design would of particular interest for
P1.74. Use of the IMAP flap for pharyngocutaneous fistulas in the vessel depleted neck R. Fernandes *, A. Cusano, N. Goldman University of Florida College of Medicine, Jacksonville, United States The internal mammary perforator flap was described by Yu and coworkers for the reconstruction of tracheostoma and anterior neck. The utility of this flap rests in its ability to be used without microvascular anastomosis, its low bulk, and ability to be used in the vessel depleted neck. The IMAP was used in two cases of persistent pharyngocutaneous fistulas. Both patients were males with previous diagnosis of laryngeal squamous cell carcinoma who had failed organ preservation treatment with radiation. Following their larynjectomies, both patients developed pharyngocutaneous fistulaes that were not responsive to local pedicle flap reconstructions. One patient had a total of 13 reconstructive attempts at closure of the fistula including bilateral sternocleidomastoid muscle flaps, pectoralis muscle and delayed deltopectoral flap. All flaps had failed and he was subsequently referred for repair of two large fistulas. Pre-operative evaluation revealed a strong Doppler pulse at the second and third intercostal spaces. He underwent repair of the fistula with a layered approach using turn in flap and an IMAP flap based on the second intercostals perforator. The other patient also presented with a fistula secondary to larynjectomy. In addition to the fistula he also had loss of the soft tissues over the carotid artery with a resultant exposure of the artery. He was subsequently reconstructed with an IMAP based on the third intercostals perforator. The IMAP flap is an important option to have in the reconstruction of anterior neck defects around trachea stoma. The flap is of particular importance in reconstruction of patients with vessel depleted necks where a thin flap is desired. The harvest of the IMAP flap is straight forward without the necessity of microvascular anastomosis. doi:10.1016/j.oos.2009.06.360
P1.75. Progressive transformation of germinal centers: An uncommon cause of cervical lymphadenopathy T.K. Takahashi *, T.S. Takahashi Division of Oral Surgery, Social Insurance Funabashi Central Hospital, Japan Introduction: The progressive transformation of germinal centers (PTGCs) is a clinicopathologic entity characterized by chronic lymphadenopathy and the presence of germinal centers with fused and expanded mantles within a lymph node that are three to five times the size of a typical reactive follicle. Some studies have demonstrated that PTGCs appear as a prestage of nodular lymphocyte predominant Hodgkin lymphoma. We retrospectively reviewed the clinical and histologic features of PTGCs that were seen in the patients of cervical lymphadenopathy. Materials and methods: Two cases were selected from the files of the author (T.K.) between 1998 and 2007. Medical records including clinical examinations of these cases were extensively reviewed. Tissue specimens were embedded in paraffin, and for light microscopy, the sections were stained with hematoxylin–eosin. Immunohistochemistry was also performed.
Poster Abstracts Oral AbstractsPoster ListOrals ListPan. Disc. & Symp. Abs.Keynote Abs.Keynote Bios.ProgramIAOOWelcomeCommittee Listings
Poster session I / Oral Oncology Supplement 3 (2009) 123–161
147
surgeons involved in reconstruction of patients with submucosal fibrosis acquired from the use of pan or betel quid. doi:10.1016/j.oos.2009.06.359
a
Universidade Paulista, Brazil Medical School, Sahlgrenska Academy at Göteborg University, Sweden c Head and Neck Surgery Department, Brazil d Department of Stomatology, Universidade Paulista, Dental School, Brazil b
Squamous cell carcinoma (SCC) occurs in approximately 95% of cases of malignant tumors in head and neck. Its incidence is more common from the 5th decade of life, rarely occurring in young people. The objective of this report is to present an invasive carcinoma in a young patient, non-smoker that did not consummate alcohol. The patient P.H., 25 years old, male, presented in 2003 SCC of the tongue, being treated with radiotherapy (6200 cGY) and partial glossectomy. Unfortunately after a brief period of time he had the recurrence of the tumor. At that time surgery was necessary, submitting the patient to resection of all the tongue and oral floor, part of the mandible, all inferiors tooth, and lymph node dissection. At his condition, considering absence of the tongue and all inferiors tooth, six implants with an implant-retained prosthesis were indicated. At the present time, the patient is in optimal conditions of speaking, eating and aesthetics. Important aspects of this case are the early occurrence of cancer in young patients, the severity and occurrence of the malignant tumor and the patient’s rehabilitation. doi:10.1016/j.oos.2009.06.358
P1.73. One flap reconstruction of bilateral buccal mucosa and floor of mouth with a radial forearm free flap: ‘‘The aviator flap” design R. Fernandes *, A. Cusano, N. Goldman University of Florida College of Medicine, Jacksonville, United States Reconstruction of fibrosis of the buccal mucosa and floor of mouth poses a significant challenge to the reconstructive surgeon. The reconstruction of these multi-dimensional defects is often carried out by using multiple free flaps or combination of local and distant flaps. This case report describes the use of a new flap design utilizing the radial forearm fasciocutaneous flap to accomplish the reconstruction of these defects with a single flap. The patient is a 65 year old male who ten years prior had attempted suicide with ingestion of Drano. He suffered extensive chemical burns to the oral cavity which resulted in fibrosis and restriction of the oral cavity. He had undergone numerous scar resections and reconstructions with skin grafts however these surgeries resulted in further scar formation and restriction of mouth opening and tongue mobility. The patient was reconstructed with a radial forearm free flap. A design was created to simultaneously reconstruct the entire buccal mucosa bilaterally, the anterior floor of mouth and the mucosal aspect of the lip. We termed the design ‘‘the aviator flap” due to its resemblance to the aviator glasses. The patient had resection of the existing scar bands, re-establishing a near normal mouth opening and the flap was then inset to re-line both buccal mucosa, floor of mouth and inner aspect of the lip. The patient did well from a reconstructive standpoint and has an improved mouth opening, tongue mobility, and is awaiting staged secondary reconstruction. We find that the aviator flap design to be a useful design which allows for a single flap reconstruction of these complex and demanding defects. The utility of this design would of particular interest for
P1.74. Use of the IMAP flap for pharyngocutaneous fistulas in the vessel depleted neck R. Fernandes *, A. Cusano, N. Goldman University of Florida College of Medicine, Jacksonville, United States The internal mammary perforator flap was described by Yu and coworkers for the reconstruction of tracheostoma and anterior neck. The utility of this flap rests in its ability to be used without microvascular anastomosis, its low bulk, and ability to be used in the vessel depleted neck. The IMAP was used in two cases of persistent pharyngocutaneous fistulas. Both patients were males with previous diagnosis of laryngeal squamous cell carcinoma who had failed organ preservation treatment with radiation. Following their larynjectomies, both patients developed pharyngocutaneous fistulaes that were not responsive to local pedicle flap reconstructions. One patient had a total of 13 reconstructive attempts at closure of the fistula including bilateral sternocleidomastoid muscle flaps, pectoralis muscle and delayed deltopectoral flap. All flaps had failed and he was subsequently referred for repair of two large fistulas. Pre-operative evaluation revealed a strong Doppler pulse at the second and third intercostal spaces. He underwent repair of the fistula with a layered approach using turn in flap and an IMAP flap based on the second intercostals perforator. The other patient also presented with a fistula secondary to larynjectomy. In addition to the fistula he also had loss of the soft tissues over the carotid artery with a resultant exposure of the artery. He was subsequently reconstructed with an IMAP based on the third intercostals perforator. The IMAP flap is an important option to have in the reconstruction of anterior neck defects around trachea stoma. The flap is of particular importance in reconstruction of patients with vessel depleted necks where a thin flap is desired. The harvest of the IMAP flap is straight forward without the necessity of microvascular anastomosis. doi:10.1016/j.oos.2009.06.360
P1.75. Progressive transformation of germinal centers: An uncommon cause of cervical lymphadenopathy T.K. Takahashi *, T.S. Takahashi Division of Oral Surgery, Social Insurance Funabashi Central Hospital, Japan Introduction: The progressive transformation of germinal centers (PTGCs) is a clinicopathologic entity characterized by chronic lymphadenopathy and the presence of germinal centers with fused and expanded mantles within a lymph node that are three to five times the size of a typical reactive follicle. Some studies have demonstrated that PTGCs appear as a prestage of nodular lymphocyte predominant Hodgkin lymphoma. We retrospectively reviewed the clinical and histologic features of PTGCs that were seen in the patients of cervical lymphadenopathy. Materials and methods: Two cases were selected from the files of the author (T.K.) between 1998 and 2007. Medical records including clinical examinations of these cases were extensively reviewed. Tissue specimens were embedded in paraffin, and for light microscopy, the sections were stained with hematoxylin–eosin. Immunohistochemistry was also performed.
Poster Abstracts Oral AbstractsPoster ListOrals ListPan. Disc. & Symp. Abs.Keynote Abs.Keynote Bios.ProgramIAOOWelcomeCommittee Listings
Poster session I / Oral Oncology Supplement 3 (2009) 123–161