- Email: [email protected]
Translation medicine in oral cancer to decrease mortality in Taiwan
e8
Abstracts
Encephaloceles associated with Tessier Clefts are relatively rare. The growth disturbance is intrinsic and the CNS herniation is often due to lack of cranial bone development and dysplastic dura. Patients are often born with facial bifidity and true orbital hypertelorism. The deformities are likely to be asymmetric and include severe nasal clefts and dysplasias. The surgical correction involves sealing off the encephalocele and full craniofacial bone repositioning. Nasal reconstruction is often required and staged procedures may be necessary. This paper will outline the combined management of Frontal Encephaloceles by the Departments of Plastic and Maxillofacial Surgery and Neurosurgery over 35 years, illustrating the types and surgical techniques involved, as well as the long-term results. http://dx.doi.org/10.1016/j.ijom.2015.08.940 Soft tissue injuries in children B. Horswell CAMC Physicians Group Facial Surgery Centre at Women and Children’s Hospital, Charleston, USA The paediatric maxillofacial surgeon will see children with various injuries of the facial region. Due to the particular wound healing mechanisms and the small and complex structures which may be injured in a child, successful planning and management should be based upon proper understanding of tissue healing, timing, function and the social-family dynamic for that child. This presentation will address wound healing in children, proper assessment and treatment planning in the injured child, plus management of special wounds-scalp avulsions, eyelid structures, ear and nasal wounds. http://dx.doi.org/10.1016/j.ijom.2015.08.941 Face Lift under local anaesthetic V. Ilankovan Poole Hospital NHS Foundation Trust, Dorset, UK Surgery is becoming simpler and minimal access is gaining popularity in all nine sections of the surgical disciplines. Patient expectations are high irrespective of country, age or ethnicity. Aesthetic surgery is a self-funded exercise and is not an exception. Traditionally, Face Lifts are done under a general anaesthetic with drains and hospital stay. Not only does the patient need to go through the surgical trauma but has to cope with the anaesthetic assault hospitalisation, and double the expenditure. Simpler techniques are done as a day case procedure but fails to fulfil the final outcome of an unoperated natural look. With the advent of tumescent solution and the ability of nerve blocks we describe how to carry out a standard Face and Neck Lift under a local anaesthetic without a drain or an Anaesthetists as an outpatient exercise. The patient selection, suitability, preparation, and postoperative care are discussed. The whole procedure is described in an edited video fashion. http://dx.doi.org/10.1016/j.ijom.2015.08.942
Jaw tumors in children: an update on diagnosis and management L.B. Kaban Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA Primary benign jaw tumors in children are uncommon and few surgeons have extensive experience with their management. Chuong and Kaban, in 1985, first reported a series of paediatric jaw tumors with diagnostic and treatment guidelines. They concluded that the benign histologic appearance frequently did not predict the aggressive nature of these tumors. They recommended that management be based on biologic behaviour and not on a descriptive histological diagnosis. The existing literature pertaining to paediatric benign jaw tumors is primarily composed of case reports and small cohort studies. Multiple treatment modalities have been tried in a variety of lesions. The inconsistent outcomes reported provide little helpful guidance for the treating surgeon. In addition, the reported follow-up periods are inadequate to accurately assess recurrence rates and outcomes. This presentation is an update on the diagnosis and management of paediatric jaw tumors based on the biologic behaviour as determined by the most current diagnostic techniques and an update of advances in treatment.1 The primary focus will be on giant cell tumors and on fibro-osseous lesions where the greatest progress has been made during the last 20 years.2
References Abramowicz, S., Goldwaser, B., Troulis, M., Padwa, B., & Kaban, L. B. (2013). Primary jaw tumors in children. J Oral Maxillofac Surg, 71(January (1)), 47–52. Lee, J. S., FitzGibbon, E. J., Chen, Y. R., Lusig, L. R., Akintoye, S. O., Collins, M. T., & Kaban, L. B. (2012). Clinical guidelines for the management of craniofacial fibrous dysplasia. Orphanet J Rare Dis, 7(Suppl. 1), S2.
http://dx.doi.org/10.1016/j.ijom.2015.08.943 Translation medicine in oral cancer to decrease mortality in Taiwan S.Y. Kao School of Dentistry, National Yang-Ming University, Taipai, Taiwan Oral cancer (OC), mostly oral squamous cell carcinoma, is a very prevalent cancer worldwide. This cancer is also the 4th leading malignancy in the male population of Taiwan due to the abuse of areca (betel) chewing, tobacco smoking and alcohol drinking. Besides, there is a tendency that the incidence of OC continuously climbed up in the past decades, and OC is now the most prevalent malignancy in men below 40 years old in Taiwan. The survival for OC patients around the world has remained un-improved in the past decades. About 50% patients die of disease during 5-year period. The local recurrence, metastases and resistance to conventional therapy are the major reasons for the treatment failure. OC is etiologically linked to the exposure to chemical carcinogens, which renders field cancerization and clonal expansion of neoplastic cells. The pathogenesis of OC takes a multi-step and multi-hit process. The understanding of impaired molecules involved in initiation, progression and metastasis will help to improve the
Abstracts prognosis of OC and to develop novel therapeutic regiments. The establishment of effective prevention, early diagnosis and interception of tumour development that could increase the survival are the main goal of the translation research in OC. I will use this presentation to introduce how we conduct this translation medicine research in OC in TVGH. This integrated teamwork will establish new diagnosis and therapeutic attempts.
e9
implants into the reconstructed jaws can bring these patients to the ‘next level’ of functional reconstruction. This presentation will discuss the various uses of dental implants in head and neck reconstruction with particular focus on their use in the free tissue reconstructed jaws along with some of the challenges that face patients and clinicians that offer these services. Several case studies will be presented along with an informal analysis of my personal experiences and a review of the pertinent literature.
http://dx.doi.org/10.1016/j.ijom.2015.08.944 http://dx.doi.org/10.1016/j.ijom.2015.08.946 Current status and treatment experiences of oral cancer in Korea M. Kim Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Republic of Korea In South Korea, cancer involving the oral and maxillofacial region took 1.6% of all newly diagnosed cancer in 2008. It numbered 2848, which is a 9.1% increase compared to 2007. The 5-year survival rate has been gradually increasing, which was 41.1% during the period of 1993–1995, 46.7% during 1996–2000, 53.7% during 2001–2005 and 57.5% during 2004–2008. Surgical ablation of the tumour with reconstruction and adjuvant therapies when required remains to be the mainstay of treatment for patients with cancer of the oral and maxillofacial region. Alternatively definitive radiation therapy is arising for susceptible tumors. Several different sorts of microvascular free flap, such as radial forearm, fibular, and latissimus dorsi are utilized as the cornerstone of reconstruction of the surgical defect after ablation of the tumors. Other microvascular free flaps including scapular, iliac, dorsalis pedis, anterolateral thigh, and lateral arm are also extending their indications. Additionally microvascular osseous free flaps are used to treat segmental defects following osteoradionecrosis. Currently the overall success of free flap in Seoul National University Dental Hospital rated to be 95.5% and we are concentrating on functional rehabilitation for better quality of life to the patients. Research in effort to make progress in treating patients with oral cancer is also actively ongoing. Identification and verification of prognostic indicators such as Ki-67, PCNA and survivin is one aspect of our interest. We are also concentrating to screen the effectiveness of therapeutic reagents such as cetuximab with genistein, CKD-602, tamoxifen with cisplatin and celecoxib. Molecular and genetic mechanism of carcinogenesis in oral cancer waits to be elucidated. With deeper understanding of the mechanism of cancer development, new therapeutic options will become available in the future on the solid base of surgery.
Predictive genomics for response variability to postoperative pain and opioids use in oral maxillofacial surgery D. Krishnan 1,∗ , W. Goodwin 2 , A.U. Rivera 3 , S. Sadhasivam 4 1 University of Cincinnati Academic Health Center, Cincinnati, United States 2 Private Practice, Charlottesville, United States 3 Eastman Institute for Oral Health – University of Rochester, Rochester, United States 4 Cincinnati Children’s Hospital and Medical Center, Cincinnati, United States
http://dx.doi.org/10.1016/j.ijom.2015.08.945
Background: Clinicians often note variable responses to prescription opioid analgesics in patients that have undergone the same procedure by the same surgeon. Is there a genetic basis for this variable response? Objective: To determine the association between single nucleotide polymorphisms (SNPs), influencing responses to postoperative pain decrease and opioid medication use in patients following third molar removal. Methods: This prospective observational clinical trial was conducted between September 2013 and March 2014 at The University of Cincinnati. Blood samples obtained at the time of surgery were genetically sequenced to analyze polymorphisms in candidate genes for analgesia. Advanced penalized logistic regression techniques and neural networks helped associate genetic polymorphisms with pain relief and adverse effects. N = 82 patients mean ages 24.6 + 5.60 years were included. Of the cohort we analyzed n = 68 subjects presented a genetic phenotype including poor metabolizers (PMs) [n = 27 (34%)] and extensive metabolizers (EMs) [n = 41 (51%)] on CYP2D6 allelic variation. Results: The results on this study demonstrated that patients who were identified as PMs presented a bigger drop in pain that was associated to gene CYP2D6 (P value 0.0061) and consumed more hydrocodone (602 mg + 300.2 mg vs. 463 mg + 200.5 mg, P ≤ 0.05) than the extensive metabolizers (EMs). Conclusion: The significance of this study is that a major genomic factor related to variable analgesic response has been identified, which may ultimately reveal the underlying mechanisms by which the system controls pain with opioids.
Dental implants in head and neck reconstruction
http://dx.doi.org/10.1016/j.ijom.2015.08.947
D. Kim
Why do oral cancer recur locally after R0 resection
Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
M. Kuriakose ∗ , A. Suresh, G. Siddappa, S. Mohanta
The use of endosseous implants has revolutionized prosthetic dentistry and has allowed for the restoration of function and aesthetics for complete and partially edentulous patients. Similarly, the use of composite free tissue reconstruction for head and neck defects has allowed for excellent restoration of form and function for head and neck cancer patients. The placement of dental
Mazumdar-Shaw Center for Translational Research, Narayana Health City, Bangalore, India Background: Despite aggressive multi-modality treatment of oral cancer, over 80% of treatment failures are at the primary site. This can develop despite obtaining uninvolved surgical margins (R0 resection).
Abstracts
Encephaloceles associated with Tessier Clefts are relatively rare. The growth disturbance is intrinsic and the CNS herniation is often due to lack of cranial bone development and dysplastic dura. Patients are often born with facial bifidity and true orbital hypertelorism. The deformities are likely to be asymmetric and include severe nasal clefts and dysplasias. The surgical correction involves sealing off the encephalocele and full craniofacial bone repositioning. Nasal reconstruction is often required and staged procedures may be necessary. This paper will outline the combined management of Frontal Encephaloceles by the Departments of Plastic and Maxillofacial Surgery and Neurosurgery over 35 years, illustrating the types and surgical techniques involved, as well as the long-term results. http://dx.doi.org/10.1016/j.ijom.2015.08.940 Soft tissue injuries in children B. Horswell CAMC Physicians Group Facial Surgery Centre at Women and Children’s Hospital, Charleston, USA The paediatric maxillofacial surgeon will see children with various injuries of the facial region. Due to the particular wound healing mechanisms and the small and complex structures which may be injured in a child, successful planning and management should be based upon proper understanding of tissue healing, timing, function and the social-family dynamic for that child. This presentation will address wound healing in children, proper assessment and treatment planning in the injured child, plus management of special wounds-scalp avulsions, eyelid structures, ear and nasal wounds. http://dx.doi.org/10.1016/j.ijom.2015.08.941 Face Lift under local anaesthetic V. Ilankovan Poole Hospital NHS Foundation Trust, Dorset, UK Surgery is becoming simpler and minimal access is gaining popularity in all nine sections of the surgical disciplines. Patient expectations are high irrespective of country, age or ethnicity. Aesthetic surgery is a self-funded exercise and is not an exception. Traditionally, Face Lifts are done under a general anaesthetic with drains and hospital stay. Not only does the patient need to go through the surgical trauma but has to cope with the anaesthetic assault hospitalisation, and double the expenditure. Simpler techniques are done as a day case procedure but fails to fulfil the final outcome of an unoperated natural look. With the advent of tumescent solution and the ability of nerve blocks we describe how to carry out a standard Face and Neck Lift under a local anaesthetic without a drain or an Anaesthetists as an outpatient exercise. The patient selection, suitability, preparation, and postoperative care are discussed. The whole procedure is described in an edited video fashion. http://dx.doi.org/10.1016/j.ijom.2015.08.942
Jaw tumors in children: an update on diagnosis and management L.B. Kaban Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA Primary benign jaw tumors in children are uncommon and few surgeons have extensive experience with their management. Chuong and Kaban, in 1985, first reported a series of paediatric jaw tumors with diagnostic and treatment guidelines. They concluded that the benign histologic appearance frequently did not predict the aggressive nature of these tumors. They recommended that management be based on biologic behaviour and not on a descriptive histological diagnosis. The existing literature pertaining to paediatric benign jaw tumors is primarily composed of case reports and small cohort studies. Multiple treatment modalities have been tried in a variety of lesions. The inconsistent outcomes reported provide little helpful guidance for the treating surgeon. In addition, the reported follow-up periods are inadequate to accurately assess recurrence rates and outcomes. This presentation is an update on the diagnosis and management of paediatric jaw tumors based on the biologic behaviour as determined by the most current diagnostic techniques and an update of advances in treatment.1 The primary focus will be on giant cell tumors and on fibro-osseous lesions where the greatest progress has been made during the last 20 years.2
References Abramowicz, S., Goldwaser, B., Troulis, M., Padwa, B., & Kaban, L. B. (2013). Primary jaw tumors in children. J Oral Maxillofac Surg, 71(January (1)), 47–52. Lee, J. S., FitzGibbon, E. J., Chen, Y. R., Lusig, L. R., Akintoye, S. O., Collins, M. T., & Kaban, L. B. (2012). Clinical guidelines for the management of craniofacial fibrous dysplasia. Orphanet J Rare Dis, 7(Suppl. 1), S2.
http://dx.doi.org/10.1016/j.ijom.2015.08.943 Translation medicine in oral cancer to decrease mortality in Taiwan S.Y. Kao School of Dentistry, National Yang-Ming University, Taipai, Taiwan Oral cancer (OC), mostly oral squamous cell carcinoma, is a very prevalent cancer worldwide. This cancer is also the 4th leading malignancy in the male population of Taiwan due to the abuse of areca (betel) chewing, tobacco smoking and alcohol drinking. Besides, there is a tendency that the incidence of OC continuously climbed up in the past decades, and OC is now the most prevalent malignancy in men below 40 years old in Taiwan. The survival for OC patients around the world has remained un-improved in the past decades. About 50% patients die of disease during 5-year period. The local recurrence, metastases and resistance to conventional therapy are the major reasons for the treatment failure. OC is etiologically linked to the exposure to chemical carcinogens, which renders field cancerization and clonal expansion of neoplastic cells. The pathogenesis of OC takes a multi-step and multi-hit process. The understanding of impaired molecules involved in initiation, progression and metastasis will help to improve the
Abstracts prognosis of OC and to develop novel therapeutic regiments. The establishment of effective prevention, early diagnosis and interception of tumour development that could increase the survival are the main goal of the translation research in OC. I will use this presentation to introduce how we conduct this translation medicine research in OC in TVGH. This integrated teamwork will establish new diagnosis and therapeutic attempts.
e9
implants into the reconstructed jaws can bring these patients to the ‘next level’ of functional reconstruction. This presentation will discuss the various uses of dental implants in head and neck reconstruction with particular focus on their use in the free tissue reconstructed jaws along with some of the challenges that face patients and clinicians that offer these services. Several case studies will be presented along with an informal analysis of my personal experiences and a review of the pertinent literature.
http://dx.doi.org/10.1016/j.ijom.2015.08.944 http://dx.doi.org/10.1016/j.ijom.2015.08.946 Current status and treatment experiences of oral cancer in Korea M. Kim Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Republic of Korea In South Korea, cancer involving the oral and maxillofacial region took 1.6% of all newly diagnosed cancer in 2008. It numbered 2848, which is a 9.1% increase compared to 2007. The 5-year survival rate has been gradually increasing, which was 41.1% during the period of 1993–1995, 46.7% during 1996–2000, 53.7% during 2001–2005 and 57.5% during 2004–2008. Surgical ablation of the tumour with reconstruction and adjuvant therapies when required remains to be the mainstay of treatment for patients with cancer of the oral and maxillofacial region. Alternatively definitive radiation therapy is arising for susceptible tumors. Several different sorts of microvascular free flap, such as radial forearm, fibular, and latissimus dorsi are utilized as the cornerstone of reconstruction of the surgical defect after ablation of the tumors. Other microvascular free flaps including scapular, iliac, dorsalis pedis, anterolateral thigh, and lateral arm are also extending their indications. Additionally microvascular osseous free flaps are used to treat segmental defects following osteoradionecrosis. Currently the overall success of free flap in Seoul National University Dental Hospital rated to be 95.5% and we are concentrating on functional rehabilitation for better quality of life to the patients. Research in effort to make progress in treating patients with oral cancer is also actively ongoing. Identification and verification of prognostic indicators such as Ki-67, PCNA and survivin is one aspect of our interest. We are also concentrating to screen the effectiveness of therapeutic reagents such as cetuximab with genistein, CKD-602, tamoxifen with cisplatin and celecoxib. Molecular and genetic mechanism of carcinogenesis in oral cancer waits to be elucidated. With deeper understanding of the mechanism of cancer development, new therapeutic options will become available in the future on the solid base of surgery.
Predictive genomics for response variability to postoperative pain and opioids use in oral maxillofacial surgery D. Krishnan 1,∗ , W. Goodwin 2 , A.U. Rivera 3 , S. Sadhasivam 4 1 University of Cincinnati Academic Health Center, Cincinnati, United States 2 Private Practice, Charlottesville, United States 3 Eastman Institute for Oral Health – University of Rochester, Rochester, United States 4 Cincinnati Children’s Hospital and Medical Center, Cincinnati, United States
http://dx.doi.org/10.1016/j.ijom.2015.08.945
Background: Clinicians often note variable responses to prescription opioid analgesics in patients that have undergone the same procedure by the same surgeon. Is there a genetic basis for this variable response? Objective: To determine the association between single nucleotide polymorphisms (SNPs), influencing responses to postoperative pain decrease and opioid medication use in patients following third molar removal. Methods: This prospective observational clinical trial was conducted between September 2013 and March 2014 at The University of Cincinnati. Blood samples obtained at the time of surgery were genetically sequenced to analyze polymorphisms in candidate genes for analgesia. Advanced penalized logistic regression techniques and neural networks helped associate genetic polymorphisms with pain relief and adverse effects. N = 82 patients mean ages 24.6 + 5.60 years were included. Of the cohort we analyzed n = 68 subjects presented a genetic phenotype including poor metabolizers (PMs) [n = 27 (34%)] and extensive metabolizers (EMs) [n = 41 (51%)] on CYP2D6 allelic variation. Results: The results on this study demonstrated that patients who were identified as PMs presented a bigger drop in pain that was associated to gene CYP2D6 (P value 0.0061) and consumed more hydrocodone (602 mg + 300.2 mg vs. 463 mg + 200.5 mg, P ≤ 0.05) than the extensive metabolizers (EMs). Conclusion: The significance of this study is that a major genomic factor related to variable analgesic response has been identified, which may ultimately reveal the underlying mechanisms by which the system controls pain with opioids.
Dental implants in head and neck reconstruction
http://dx.doi.org/10.1016/j.ijom.2015.08.947
D. Kim
Why do oral cancer recur locally after R0 resection
Louisiana State University Health Science Center Shreveport, Shreveport, LA, USA
M. Kuriakose ∗ , A. Suresh, G. Siddappa, S. Mohanta
The use of endosseous implants has revolutionized prosthetic dentistry and has allowed for the restoration of function and aesthetics for complete and partially edentulous patients. Similarly, the use of composite free tissue reconstruction for head and neck defects has allowed for excellent restoration of form and function for head and neck cancer patients. The placement of dental
Mazumdar-Shaw Center for Translational Research, Narayana Health City, Bangalore, India Background: Despite aggressive multi-modality treatment of oral cancer, over 80% of treatment failures are at the primary site. This can develop despite obtaining uninvolved surgical margins (R0 resection).