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PD.59 Surgical management of squamous cell carcinoma of the buccal surface of oral mucosa
Surgeo' 1 outcome o f surgery. Marginal mandibulectomy is a mandible preserving procedure for the resection of oral cavity cancers. Marginal mandibulectomy, though commonly used for floor of mouth cancers, its oncological safety in Gingivo-buccal cancers is rarely reported. Here we report a retrospective series of marginal masldibulectomy with special reference to ats oncologlcal safety m terms of local failure rate and disease free survival. Materials and Methods: We did a retrospective study of 107 patients who underwent marginal mandibulectomy between 1994 and 2001. We analyzed the data of 92 patients who had squanlous cell carcinoma o f Gmglvo-buccal complex and had follow up of at least 18 months. Tile local Pallure rate was calculated. The disease free survival and local recurrence free survival was calculated using Kaplan-Meir method. A log rank test was used to study the unpact of various prognostic factors. Results: In course of follow up, 22 pat:ents developed recurrent d:sease. Local recurrences were most common (12 patients) followed by regional (7) and locoreglonal (3) recurrences. The local failure rate was 16%. 15 out of 22 patients who developed recurrence, could be salvaged by surgery mad / or radiotherapy. The overall local control rate mclus:ve of salvaged recurrences was 90°'o at 5 years. Positive surg:cal margin, grade of turnout and bone involvement clad not slgmficantly corelate wath local recurrence. The two year mad five year disease free survaval rates were 69°.0 and 60°.0 respectavely. The local recurrence free survaval at two and five years were 79% and 70% respectavely. Conclusion: In carefully selected patients, marginal mandlbulectomy is a oncologlcally safe procedure to achieve good local control.
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Treatment of squamous cell carcinoma of the retromolar trigone
S.-P. Hao. CTmng Gung Memorml Hospttal & CT~ang Gung
Untver~t.v, t'atwan Introduction: Carcinomas originating m the retromolar tr~gone (RMT) are unconmaon and characterized by aggressave spread and poor prognosas. The purpose of th:s retrospective study was to report the results of 40 consecuhve pat:ents treated at the Chang Gung Memorial Hospatal and ('hang Gung Umverslty, Taawan from 1993 to 2003. Materials and Methods: A retrospective review of the 40 patients with squamous cell carcinoma arising from RMT who were treated pr:marlly with surgery between 1993-2003 m Chang Gung Memorial Hospital and Chang Gung Umverslty, Talwan was carreld out. The surgical tectmlque varies accordnag to the location mad spread o f the RMT tumors including 16 marginal nmndibulectomles, 9 segmental mas~dibulectomles, 15 inferior maxlllectormes and 4 subtotal maxlllectonnes. All but one patients had neck dissections, including 1 classical radical neck dissection, 23 modified radical neck dissections and 15 supraomohyold neck d:ssectlons. The surgical defects were reconstructed with either a local buccal fat pad flap (3), a free soft hssue flap (31) or a free fibular osteocutaneous flap (6). Twenty-sLx pahents underwent postoperahve lrradmtlon. Local-regional control and survival were correlated with age, sex, presenting signs and symptoms, T and N classification, surgical findings and the various modalities of treatment. Results: Pathological t ~ n o r stages were Tl(5), T2(13), T3(1) and T4(21 ). Cervical metastas:s rate was 35.1 °,5 with an occult metastas:s rate o f 20%. Fourteen (350,5) pat:ents had pathology proved maxilla or mandible mvas:on. To date, 40 pat:ents had 7 local recurrence, 4 neck recurrence and 4 distant metastasis.
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Eight (20%) patients developed 12 new primaries. The 5-year actuarial overall survival rate was 570,5. Conclusion: Surgery and postoperative irradiation protocol still yield a poor prognosis for the patients with RMT squamous cell carcinomas. Further effort should be d:rected to prevent or detect the new primary.
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Surgical management of squamous cell carcinoma of the buccal surface of oral mucosa
N. Papadogeorgakis, S. Kyriakon, E. Parara, C. Pensamdes, V Petsinis, S. Dimtsas, A.C. Alexandrichs. Euangehsmos
General Hospital, Greece Introduction: Squamous cell carcinoma and verrucous carc:noma are the conm:onest types of mahgnanc:es affecting the buccal surface of the oral mucosa. Although more apparent to examination by the patient and therefore early recogmzed, squarnous cell carcinoma of this area is considered of poor prognosis, due to the rapid perforation and high incidence o f cervical nodal metastases. Tins site is also challenging for reconstruction, especially if affected skin is removed. M a t e r ~ l s and Methods: Twenty-one patients w:th mtraoral carcinoma of the buccal surface were treated at the Oral and Maxfllofacml Surgery Department. In 18 patients, the tumor was squamous cell carcinoma and 3 had verrucous carcinoma. Results: All patients were surgically treated, w:th w:de exc:s:on of the lesion. In 15 patients neck d:ssectzon was performed as necessary. Reconstmchon was accomphshed w:th local flaps. In 7 cases, temporalzs muscle flap was utilized, combined w~th free skin graft or forehead skin flap. Adjunct radiotherapy preoperatively or postoperatavely was reqmred for 10 patients. Local recurrence was noted m 3 patients while one o f them died m the first five years. Conclusion: Squamous cell carcinoma of the buccal surface o f oral mucosa :s usually mvamve w:th poor prognos:s. Verrucous carcinoma of the same s~te as on the other hand o f less aggressave clinical pattern. The removal o f these tumors also presents difficulties m reconstruction o f the deficit area, especially if skin has been exc:sed.
Buccal mucous cancer (BMC): the choice of plastic technique according to the Iocalisation and spreading of tumor process M.A. Kropotov, I.S. Romanov, V.A. Sobolevsky, V.Z. Dobrohotova. 1N N Blokhm~ Russmn Cancer Research
Center, Russian Federanon Introduction: Surgical treatment is an obhgatory step o f combined treatment of BMC. Functional and cosmetic rehabthtatlon ~s tmposslble without single-stage reconstmctxon w~th fimchonal recovery being prmmry point. Matermls and Methods: 21 patients with BMC were enrolled m the study. T2 - 2 cases (9.5?,0), T3 - 10 cases (47.6%) and m 9 (42.9%) recurrent tumors. Results: Various modn%atlons of prmaary plastxc correchon were used. In lesions of the posterior buccal area a fascml temporal graft was apphed (6 pahents - 30%), the lesmns o f the inferior part o f the cheek were replaced by m. platysma. In total involvement of the buccal mucous (2 cases - 10%) the affected area was substituted by a free radial flap. The combined defect of the buccal mucosa and skin in 2 pahents (10°5) was repa:red by fronto-paneto-occ:p:tal graft and m 4 cases (20°5) - by a free radml duphcate graft. Tile combined osteo-mucous lesion was replaced by jump graft (3 pat:cuts 15°,/o) or by a revascularized scapular graft (2 cases - 10%).
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Treatment of squamous cell carcinoma of the retromolar trigone
S.-P. Hao. CTmng Gung Memorml Hospttal & CT~ang Gung
Untver~t.v, t'atwan Introduction: Carcinomas originating m the retromolar tr~gone (RMT) are unconmaon and characterized by aggressave spread and poor prognosas. The purpose of th:s retrospective study was to report the results of 40 consecuhve pat:ents treated at the Chang Gung Memorial Hospatal and ('hang Gung Umverslty, Taawan from 1993 to 2003. Materials and Methods: A retrospective review of the 40 patients with squamous cell carcinoma arising from RMT who were treated pr:marlly with surgery between 1993-2003 m Chang Gung Memorial Hospital and Chang Gung Umverslty, Talwan was carreld out. The surgical tectmlque varies accordnag to the location mad spread o f the RMT tumors including 16 marginal nmndibulectomles, 9 segmental mas~dibulectomles, 15 inferior maxlllectormes and 4 subtotal maxlllectonnes. All but one patients had neck dissections, including 1 classical radical neck dissection, 23 modified radical neck dissections and 15 supraomohyold neck d:ssectlons. The surgical defects were reconstructed with either a local buccal fat pad flap (3), a free soft hssue flap (31) or a free fibular osteocutaneous flap (6). Twenty-sLx pahents underwent postoperahve lrradmtlon. Local-regional control and survival were correlated with age, sex, presenting signs and symptoms, T and N classification, surgical findings and the various modalities of treatment. Results: Pathological t ~ n o r stages were Tl(5), T2(13), T3(1) and T4(21 ). Cervical metastas:s rate was 35.1 °,5 with an occult metastas:s rate o f 20%. Fourteen (350,5) pat:ents had pathology proved maxilla or mandible mvas:on. To date, 40 pat:ents had 7 local recurrence, 4 neck recurrence and 4 distant metastasis.
83
Eight (20%) patients developed 12 new primaries. The 5-year actuarial overall survival rate was 570,5. Conclusion: Surgery and postoperative irradiation protocol still yield a poor prognosis for the patients with RMT squamous cell carcinomas. Further effort should be d:rected to prevent or detect the new primary.
•
Surgical management of squamous cell carcinoma of the buccal surface of oral mucosa
N. Papadogeorgakis, S. Kyriakon, E. Parara, C. Pensamdes, V Petsinis, S. Dimtsas, A.C. Alexandrichs. Euangehsmos
General Hospital, Greece Introduction: Squamous cell carcinoma and verrucous carc:noma are the conm:onest types of mahgnanc:es affecting the buccal surface of the oral mucosa. Although more apparent to examination by the patient and therefore early recogmzed, squarnous cell carcinoma of this area is considered of poor prognosis, due to the rapid perforation and high incidence o f cervical nodal metastases. Tins site is also challenging for reconstruction, especially if affected skin is removed. M a t e r ~ l s and Methods: Twenty-one patients w:th mtraoral carcinoma of the buccal surface were treated at the Oral and Maxfllofacml Surgery Department. In 18 patients, the tumor was squamous cell carcinoma and 3 had verrucous carcinoma. Results: All patients were surgically treated, w:th w:de exc:s:on of the lesion. In 15 patients neck d:ssectzon was performed as necessary. Reconstmchon was accomphshed w:th local flaps. In 7 cases, temporalzs muscle flap was utilized, combined w~th free skin graft or forehead skin flap. Adjunct radiotherapy preoperatively or postoperatavely was reqmred for 10 patients. Local recurrence was noted m 3 patients while one o f them died m the first five years. Conclusion: Squamous cell carcinoma of the buccal surface o f oral mucosa :s usually mvamve w:th poor prognos:s. Verrucous carcinoma of the same s~te as on the other hand o f less aggressave clinical pattern. The removal o f these tumors also presents difficulties m reconstruction o f the deficit area, especially if skin has been exc:sed.
Buccal mucous cancer (BMC): the choice of plastic technique according to the Iocalisation and spreading of tumor process M.A. Kropotov, I.S. Romanov, V.A. Sobolevsky, V.Z. Dobrohotova. 1N N Blokhm~ Russmn Cancer Research
Center, Russian Federanon Introduction: Surgical treatment is an obhgatory step o f combined treatment of BMC. Functional and cosmetic rehabthtatlon ~s tmposslble without single-stage reconstmctxon w~th fimchonal recovery being prmmry point. Matermls and Methods: 21 patients with BMC were enrolled m the study. T2 - 2 cases (9.5?,0), T3 - 10 cases (47.6%) and m 9 (42.9%) recurrent tumors. Results: Various modn%atlons of prmaary plastxc correchon were used. In lesions of the posterior buccal area a fascml temporal graft was apphed (6 pahents - 30%), the lesmns o f the inferior part o f the cheek were replaced by m. platysma. In total involvement of the buccal mucous (2 cases - 10%) the affected area was substituted by a free radial flap. The combined defect of the buccal mucosa and skin in 2 pahents (10°5) was repa:red by fronto-paneto-occ:p:tal graft and m 4 cases (20°5) - by a free radml duphcate graft. Tile combined osteo-mucous lesion was replaced by jump graft (3 pat:cuts 15°,/o) or by a revascularized scapular graft (2 cases - 10%).