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P94 Our reconstructive protocol following maxillectomy in oral cancer
Poster abstracts, Friday 18 May
P93 Dental extractions related to head and neck radiotherapy: a retrospective study of 405 patients D. Koga, J.V. Salvajoli, L. Kowalski, I. Nishimoto, D. Perez, F. Alves *. Cancer Hospital AC Camargo, Brazil Osteoradionecrosis is the most severe secondary effect related to head and neck irradiation, which can be associated to previous or post-radiotherapy dental extractions. Objectives: This study analyses the dental extractions performed before, during and after radiotherapy. Methods: A retrospective evaluation of the medical charts of 2.677 head and neck cancer patients that received radiotherapy at A.C. Camargo Hospital between 1992 and 2002 was performed. Of these, 405 patients were submitted to dental extractions by Stomatology Department. All patients received radiation doses equal or over 4.000 cGy and all teeth were within radiation fields. Results: In 343 patients were removed 1.647 teeth before radiotherapy (ranging from 1 to 32; median 4.0; ×4.7). Mean time between extractions and the radiotherapy was 30.7 days (median 24.0 days). It was observed only 2 case of osteoradionecrosis (0.5%) in this group. In five patients were extracted 33 teeth during radiotherapy (5.0×6.1), with the procedures executed 7.2 days after the beginning of irradiation (median 3.0). After radiotherapy, were removed 290 teeth in 55 patients (ranging from 1 to 19; mean 5.3; median 4.0; ×4.4) and in 2 patients the number of removed teeth could not be established. The dental extractions were performed in media 42.6 months after the end of the radiotherapy (median 31.1). It was observed only one case of osteoradionecrosis (1.7%) in this group of patients. Conclusions: This study presented low prevalence of osteoradionecrosis related to dental extractions in head and neck irradiated patients. In 405 patients, only 3 cases of osteoradionecrosis were observed, being 2 cases related to dental extractions performed before radiotherapy and 1 due to exodontias after irradiation. The exodontias in this group of patients should be realized for experimented dentists in oncology and with well defined protocols. Keywords: Side effects, Radiotherapy, Dental extractions, Osteoradionecrosis P94 Our reconstructive protocol following maxillectomy in oral cancer L.G. Monle´ on, V.P. Garc´ ıa, J.H. Cobos, S.R. Varela, J.A. Sanz *, C.N. Vila. Gregorio Mara˜ no ´n University Hospital, Spain Introduction: Oncological midfacial resections cause important functional and aesthetic sequela. Its reconstruction is a surgical challenge for the head and neck surgeon. Methods: We reviewed a series of 21 maxillectomies performed in the last two years in the Department of Oral and Maxillofacial Surgery of the Gregorio Mara˜ no ´n Hospital. Epidemiologic characteristics, location of the tumour, histologic diagnosis, type of maxillectomy, method of reconstruction, aesthetical and functional results and complications were analyzed. We used the classification of the maxillary defect described by Brown that divides the defect depending on the level and width of the resection. Discussion: The most frequent diagnosis was squamous carcinoma (76%). We performed 15 low unilateral maxillectomies (I-IIA of Brown), one bilateral low maxillectomy (IIC), two high maxillectomies including orbital floor (IIIA) and three extended maxillectomies (IVA). The method of reconstruction
most frequently used was the temporalis flap, indicated in resections types I and IIA of Brown (71%). Microsurgical flaps were used in more extended resections: a fibula flap (for a resection IIC), iliac crest flap (2 cases, IIIA) and three rectus abdominis flap (IV A). We observed the following complications: 1 haematoma, 2 seromas, 1 infection, 1 total necrosis of a iliac crest flap, a partial necrosis of a miofascial temporal flap and 2 wound dehyscences. Aesthetical and functional results were classified as good or very good for 80, 95% of the patients. Conclusions: The temporalis flap is a good method in the reconstruction of low unilateral maxillary defects. When a low defect cross midline, we choose the fibula flap. In case of high or radical maxillectomies, we consider the iliac crest flap to be the best option to obtain support for the orbital contents or place dental implants. The rectus abdominis flap is indicated to reconstruct massive resections in the midface. Keywords: Maxillary, Resection, Reconstruction, Oral Cancer P95 Oral cancer: correlation between biological behavior and anatomical site C.M. Navarro *, T. Pereira, M.R. Sposto. Faculty of Odontology of Araraquara UNESP, Brazil The rates of oral cancer incidence, morbidity and mortality are inciting questions in spite of the studies to improve the understanding of this disease. The aim of this study was to evaluate the biological behavior of oral cancer according to anatomical site. Of the 5,498 files assessed, from the Oral Medicine Service (OMS) in AraraquaraSP, 100 with histological confirmation of oral cancer were selected. The information was inserted in the database of Epi Info 3.2.2 software. To statistical analysis, P < 0.05 was significant. Patients showed in the results were predominantly male (78%), white (92%), mean-aged 57 years old, with cancers of tongue (29%), lip (27%), floor of the mouth (24%) or alveolar ridge (20%). Cancer of alveolar ridge was most frequent in women (P = 0.01). Cancer of floor of the mouth was associated to the combined use of tobacco and alcohol (P = 0.01). There was strong negative correlation between cancer of tongue and worn prosthesis (P = 0.002); and positive correlation for cancer of alveolar ridge (P = 0.04). 79% of the lesions were symptomatic and there was negative correlation between symptom and lip cancer (P = 0.001) and between symptom and cancer of tongue (P = 0.03). Cancer of tongue was positively correlated with cervical palpable lymph nodes (P = 0.04); the same correlation was strongly negative for lip cancer (P = 0.001). Oral cancer presented variable biological behavior according to anatomical site, patient’s age, evolution time, sex, risk factors, worn prosthesis, symptoms and metastasis. Keywords: oral cancer, biological behavior, anatomical site, clinical evolution P96 The impact of a Brazilian oral cancer prevention programme on the diagnosis of actinic cheilitis C.M. Navarro *, A. Bufalino. Faculty of Odontology of Araraquara UNESP, Brazil Actinic Cheilitis (AC) is potentially malignant, common in sunny countries, and it affects lower lips. The aim of this study was to evaluate the impact of an oral cancer prevention programme (OCPP), comparing the AC rate and the clinical profile of the patients diagnosed before (B) and after (A) the establishment of OCPP. Of the 4,812 files assessed from the Oral Medicine Service (OMS) in Araraquara-S˜ ao Paulo, 473 with AC diagnosis were selected, 148 (31.3%) before and 325 (68.7%) after the OCPP. The information was inserted in the database of Epi Info 3.2.2 software. To statistical analysis P < 0.05 was significant. The mean age of B and A groups was 51 and 55 years old respectively, and the male/female rate was 1.5. The dentists referred 225 (69.2%) patients after OCPP and 79 (53.3%) before (P < 0.001). Dentists from public services referred 80 patients
Poster abstracts
clinical N0 tongue cancer. The extended supraomohyoid neck dissection should be considered against potential possibility of occult neck metastasis to level IV in clinical N0 tongue cancer. Keywords: N0, tongue cancer, occult metastasis, extended supraomohyoid neck dissection
159
P93 Dental extractions related to head and neck radiotherapy: a retrospective study of 405 patients D. Koga, J.V. Salvajoli, L. Kowalski, I. Nishimoto, D. Perez, F. Alves *. Cancer Hospital AC Camargo, Brazil Osteoradionecrosis is the most severe secondary effect related to head and neck irradiation, which can be associated to previous or post-radiotherapy dental extractions. Objectives: This study analyses the dental extractions performed before, during and after radiotherapy. Methods: A retrospective evaluation of the medical charts of 2.677 head and neck cancer patients that received radiotherapy at A.C. Camargo Hospital between 1992 and 2002 was performed. Of these, 405 patients were submitted to dental extractions by Stomatology Department. All patients received radiation doses equal or over 4.000 cGy and all teeth were within radiation fields. Results: In 343 patients were removed 1.647 teeth before radiotherapy (ranging from 1 to 32; median 4.0; ×4.7). Mean time between extractions and the radiotherapy was 30.7 days (median 24.0 days). It was observed only 2 case of osteoradionecrosis (0.5%) in this group. In five patients were extracted 33 teeth during radiotherapy (5.0×6.1), with the procedures executed 7.2 days after the beginning of irradiation (median 3.0). After radiotherapy, were removed 290 teeth in 55 patients (ranging from 1 to 19; mean 5.3; median 4.0; ×4.4) and in 2 patients the number of removed teeth could not be established. The dental extractions were performed in media 42.6 months after the end of the radiotherapy (median 31.1). It was observed only one case of osteoradionecrosis (1.7%) in this group of patients. Conclusions: This study presented low prevalence of osteoradionecrosis related to dental extractions in head and neck irradiated patients. In 405 patients, only 3 cases of osteoradionecrosis were observed, being 2 cases related to dental extractions performed before radiotherapy and 1 due to exodontias after irradiation. The exodontias in this group of patients should be realized for experimented dentists in oncology and with well defined protocols. Keywords: Side effects, Radiotherapy, Dental extractions, Osteoradionecrosis P94 Our reconstructive protocol following maxillectomy in oral cancer L.G. Monle´ on, V.P. Garc´ ıa, J.H. Cobos, S.R. Varela, J.A. Sanz *, C.N. Vila. Gregorio Mara˜ no ´n University Hospital, Spain Introduction: Oncological midfacial resections cause important functional and aesthetic sequela. Its reconstruction is a surgical challenge for the head and neck surgeon. Methods: We reviewed a series of 21 maxillectomies performed in the last two years in the Department of Oral and Maxillofacial Surgery of the Gregorio Mara˜ no ´n Hospital. Epidemiologic characteristics, location of the tumour, histologic diagnosis, type of maxillectomy, method of reconstruction, aesthetical and functional results and complications were analyzed. We used the classification of the maxillary defect described by Brown that divides the defect depending on the level and width of the resection. Discussion: The most frequent diagnosis was squamous carcinoma (76%). We performed 15 low unilateral maxillectomies (I-IIA of Brown), one bilateral low maxillectomy (IIC), two high maxillectomies including orbital floor (IIIA) and three extended maxillectomies (IVA). The method of reconstruction
most frequently used was the temporalis flap, indicated in resections types I and IIA of Brown (71%). Microsurgical flaps were used in more extended resections: a fibula flap (for a resection IIC), iliac crest flap (2 cases, IIIA) and three rectus abdominis flap (IV A). We observed the following complications: 1 haematoma, 2 seromas, 1 infection, 1 total necrosis of a iliac crest flap, a partial necrosis of a miofascial temporal flap and 2 wound dehyscences. Aesthetical and functional results were classified as good or very good for 80, 95% of the patients. Conclusions: The temporalis flap is a good method in the reconstruction of low unilateral maxillary defects. When a low defect cross midline, we choose the fibula flap. In case of high or radical maxillectomies, we consider the iliac crest flap to be the best option to obtain support for the orbital contents or place dental implants. The rectus abdominis flap is indicated to reconstruct massive resections in the midface. Keywords: Maxillary, Resection, Reconstruction, Oral Cancer P95 Oral cancer: correlation between biological behavior and anatomical site C.M. Navarro *, T. Pereira, M.R. Sposto. Faculty of Odontology of Araraquara UNESP, Brazil The rates of oral cancer incidence, morbidity and mortality are inciting questions in spite of the studies to improve the understanding of this disease. The aim of this study was to evaluate the biological behavior of oral cancer according to anatomical site. Of the 5,498 files assessed, from the Oral Medicine Service (OMS) in AraraquaraSP, 100 with histological confirmation of oral cancer were selected. The information was inserted in the database of Epi Info 3.2.2 software. To statistical analysis, P < 0.05 was significant. Patients showed in the results were predominantly male (78%), white (92%), mean-aged 57 years old, with cancers of tongue (29%), lip (27%), floor of the mouth (24%) or alveolar ridge (20%). Cancer of alveolar ridge was most frequent in women (P = 0.01). Cancer of floor of the mouth was associated to the combined use of tobacco and alcohol (P = 0.01). There was strong negative correlation between cancer of tongue and worn prosthesis (P = 0.002); and positive correlation for cancer of alveolar ridge (P = 0.04). 79% of the lesions were symptomatic and there was negative correlation between symptom and lip cancer (P = 0.001) and between symptom and cancer of tongue (P = 0.03). Cancer of tongue was positively correlated with cervical palpable lymph nodes (P = 0.04); the same correlation was strongly negative for lip cancer (P = 0.001). Oral cancer presented variable biological behavior according to anatomical site, patient’s age, evolution time, sex, risk factors, worn prosthesis, symptoms and metastasis. Keywords: oral cancer, biological behavior, anatomical site, clinical evolution P96 The impact of a Brazilian oral cancer prevention programme on the diagnosis of actinic cheilitis C.M. Navarro *, A. Bufalino. Faculty of Odontology of Araraquara UNESP, Brazil Actinic Cheilitis (AC) is potentially malignant, common in sunny countries, and it affects lower lips. The aim of this study was to evaluate the impact of an oral cancer prevention programme (OCPP), comparing the AC rate and the clinical profile of the patients diagnosed before (B) and after (A) the establishment of OCPP. Of the 4,812 files assessed from the Oral Medicine Service (OMS) in Araraquara-S˜ ao Paulo, 473 with AC diagnosis were selected, 148 (31.3%) before and 325 (68.7%) after the OCPP. The information was inserted in the database of Epi Info 3.2.2 software. To statistical analysis P < 0.05 was significant. The mean age of B and A groups was 51 and 55 years old respectively, and the male/female rate was 1.5. The dentists referred 225 (69.2%) patients after OCPP and 79 (53.3%) before (P < 0.001). Dentists from public services referred 80 patients
Poster abstracts
clinical N0 tongue cancer. The extended supraomohyoid neck dissection should be considered against potential possibility of occult neck metastasis to level IV in clinical N0 tongue cancer. Keywords: N0, tongue cancer, occult metastasis, extended supraomohyoid neck dissection
159