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Update on management of oral cancers: diagnostic and therapeutic modalities
Surgical Clinics cient soft tissue envelope and secondary contracture of the wound. The pectoralis major myocutaneous flap is a reliable and versatile flap that can be used to restore soft tissue bulk. A variable sized skin paddle can be customized to fit the resultant defect, and make closure much easier. In cases of radiation-damaged tissue, the pectoralis flap brings highly vascularized undamaged tissue to the defect. Secondary bone grafting is facilitated by the generous soft tissue bulk provided by the flap. At the completion of this course, the participants will be familiar with the pertinent anatomy including the axial blood supply and axis of rotation. Participants will be able to discuss the indications, contraindications, and limitations of the flap. A step-by-step approach of the surgical technique will be presented. And finally, the participants will be able to discuss the avoidance of complications and postoperative management. References Marx RE, Smith BR: An improved technique for development of the pectoralis major myocutaneous flap. J Oral Maxillofas Surg 48:1168, 1990 Urken ML, Biller HF: Pectoralis major, in Urken ML, Cheney ML, Sullivan MJ, et al (eds): Atlas of Regional and Free Flaps for Head and Neck Reconstruction. New York, NY, Raven Press, 1995, pp 3-28 Dedivitis RA, et al: Pectoralis major musculocutaneous flap in head and neck cancer. World J Surg 26:67, 2002
S404 Update on Management of Oral Cancers: Diagnostic and Therapeutic Modalities Eric J. Dierks, DMD, MD, Portland, OR Jon D. Holmes, DMD, MD, Birmingham, AL Approximately 30,000 patients will be diagnosed with oral cancer in the United States this year. The vast majority (90%) of these will be squamous cell cancers. Oral and maxillofacial surgeons are involved in the management of patients with oral cancer. Frequently, it is an oral and maxillofacial surgeon who first sees a patient with a suspicious lesion, and is confronted with breaking the news regarding a biopsy that reveals malignancy. For these reasons, it is incumbent for them to be conversant in current diagnostic and treatment modalities. The goal of this surgical clinic is to update the clinician in current diagnostic and treatment modalities for oral cancer. Included in the presentation will be new modalities such as positron emission tomography (PET) scanning, intensity modulated radiation treatment (IMRT), and the role of combined chemoradiotherapy, as well as advances in ablative and reconstructive surgical treatments. References Holmes J, Dierks E: Oral cancer treatment, in Miloro (ed): Peterson’s Principles of Oral and Maxillofacial Surgery (ed 2). Lewiston, NY, BC Decker, 2004
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Jemal A, Murray T, Samuels A, et al: Cancer statistics, 2004. CA Cancer J Clin 54:8, 2004 Pillsbury HC, Dark M: A rationale for therapy of the N0 neck. Laryngoscope 107:1294, 1997
S405 Management of Pediatric Maxillofacial Trauma Bruce B. Horswell, MD, DDS, FACS, Charleston, WV James M. Henderson, MD, DDS, Charleston, WV Over 22 million children are injured annually, comprising 12% of all trauma patients. Of those, 10% will have facial injuries. Children are uniquely susceptible to cranio-maxillofacial injury due to their cranial mass-tobody ratio. Soft-tissue injuries are relatively common, and include contusions, abrasions, lacerations, and burns. Children sustain a small, but increasing portion of reported facial fractures as age increases, peaking in adolescence. Triage and evaluation of the pediatric trauma patient require understanding the differences in anatomy and physiology, concomitant injuries, and the stage in growth and development at the time of injury. Goals of treatment should be prevention of infection, restoration of and return to function, and measures to minimize scarring and secondary deformity. The clinician treating the pediatric maxillofacial trauma patient should be aware of the potential for late adverse sequelae in the head and neck region. Individual clinicians may not manage sufficient volumes of pediatric trauma cases to formulate systematic and consistent treatment plans, particularly as they relate to significant soft tissue facial injuries and midfacial trauma. Consideration should be given for referral to dedicated pediatric institutions and practitioners with greater pediatric experience, as evidenced by improved clinical outcomes. Finally, prevention of injury to children is paramount as a public health measure. Clinicians can, and should, be involved with their local, state, and national organizations to help raise public awareness of pediatric facial trauma and implementation of preventative measures. This clinic will concentrate on triage and initial treatment of the injured child patient, evaluation and management of significant soft-tissue wounds, and craniomaxillofacial fractures. References Haug RH, Foss J: Maxillofacial injuries in the pediatric patient. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90:26, 2000 Dodson TB, Kaban LB: Special considerations for the pediatric emergency patient. Emerg Med Clin North Am 18:539, 2000 Fida S, Matsuya: Paediatric maxillofacial fractures: Their aetiological characteristics and patterns. J Craniomaxillofac Surg 30:237, 2002
AAOMS • 2004
S404 Update on Management of Oral Cancers: Diagnostic and Therapeutic Modalities Eric J. Dierks, DMD, MD, Portland, OR Jon D. Holmes, DMD, MD, Birmingham, AL Approximately 30,000 patients will be diagnosed with oral cancer in the United States this year. The vast majority (90%) of these will be squamous cell cancers. Oral and maxillofacial surgeons are involved in the management of patients with oral cancer. Frequently, it is an oral and maxillofacial surgeon who first sees a patient with a suspicious lesion, and is confronted with breaking the news regarding a biopsy that reveals malignancy. For these reasons, it is incumbent for them to be conversant in current diagnostic and treatment modalities. The goal of this surgical clinic is to update the clinician in current diagnostic and treatment modalities for oral cancer. Included in the presentation will be new modalities such as positron emission tomography (PET) scanning, intensity modulated radiation treatment (IMRT), and the role of combined chemoradiotherapy, as well as advances in ablative and reconstructive surgical treatments. References Holmes J, Dierks E: Oral cancer treatment, in Miloro (ed): Peterson’s Principles of Oral and Maxillofacial Surgery (ed 2). Lewiston, NY, BC Decker, 2004
102
Jemal A, Murray T, Samuels A, et al: Cancer statistics, 2004. CA Cancer J Clin 54:8, 2004 Pillsbury HC, Dark M: A rationale for therapy of the N0 neck. Laryngoscope 107:1294, 1997
S405 Management of Pediatric Maxillofacial Trauma Bruce B. Horswell, MD, DDS, FACS, Charleston, WV James M. Henderson, MD, DDS, Charleston, WV Over 22 million children are injured annually, comprising 12% of all trauma patients. Of those, 10% will have facial injuries. Children are uniquely susceptible to cranio-maxillofacial injury due to their cranial mass-tobody ratio. Soft-tissue injuries are relatively common, and include contusions, abrasions, lacerations, and burns. Children sustain a small, but increasing portion of reported facial fractures as age increases, peaking in adolescence. Triage and evaluation of the pediatric trauma patient require understanding the differences in anatomy and physiology, concomitant injuries, and the stage in growth and development at the time of injury. Goals of treatment should be prevention of infection, restoration of and return to function, and measures to minimize scarring and secondary deformity. The clinician treating the pediatric maxillofacial trauma patient should be aware of the potential for late adverse sequelae in the head and neck region. Individual clinicians may not manage sufficient volumes of pediatric trauma cases to formulate systematic and consistent treatment plans, particularly as they relate to significant soft tissue facial injuries and midfacial trauma. Consideration should be given for referral to dedicated pediatric institutions and practitioners with greater pediatric experience, as evidenced by improved clinical outcomes. Finally, prevention of injury to children is paramount as a public health measure. Clinicians can, and should, be involved with their local, state, and national organizations to help raise public awareness of pediatric facial trauma and implementation of preventative measures. This clinic will concentrate on triage and initial treatment of the injured child patient, evaluation and management of significant soft-tissue wounds, and craniomaxillofacial fractures. References Haug RH, Foss J: Maxillofacial injuries in the pediatric patient. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90:26, 2000 Dodson TB, Kaban LB: Special considerations for the pediatric emergency patient. Emerg Med Clin North Am 18:539, 2000 Fida S, Matsuya: Paediatric maxillofacial fractures: Their aetiological characteristics and patterns. J Craniomaxillofac Surg 30:237, 2002
AAOMS • 2004