-
Shamir P Chandarana,
Julia S Lee,
Eric J P Chanowski, Assuntina G Sacco,
Carol R Bradford,
Gregory T Wolf,
Mark E Prince,
Jeffrey S Moyer,
Avraham Eisbruch,
Francis P Worden,
Thomas J Giordano,
Bhavna Kumar,
Katrina G Cordell,
Thomas E Carey,
Douglas B Chepeha
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: The purpose of this study was to describe the relationship of p16 and epidermal growth factor receptor (EGFR) expression with survival in surgically treated patients who had oropharyngeal or oral cavity squamous cell carcinoma (SCC). METHODS: Tissue from 36 patients with oropharyngeal SCC and 49 patients with oral cavity SCC treated between 1997 and 2001 was imbedded and immunostained using a tissue microarray. RESULTS: The p16 was positive in 57% and 13% of patients with oropharyngeal SCC and oral cavity SCC, respectively. EGFR was positive in 60% and 63% of patients with oropharyngeal SCC and oral cavity SCC, respectively. In patients with oropharyngeal SCC, p16 expression was associated with improved disease-specific survival (DSS), overall survival (OS), and time to recurrence (TTR) (p < .01, < .01, and <.01, respectively). EGFR expression was associated with poorer DSS, OS, and TTR (p < .01, = .01, and < .01, respectively). For oropharyngeal SCC, when examining both p16 and EGFR expression as combined biomarkers, high p16 expression coupled with low EGFR expression was associated with improved DSS (p p16 = .01; p EGFR = .01). Patients with oral cavity SCC showed no association between biomarker and outcome. CONCLUSIONS: For patients with oropharyngeal SCC, high p16 and low EGFR were associated with improved outcome, suggesting a predictive role in surgically treated patients. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
Head & Neck 08/2012; · 2.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To assess the feasibility of internal transport disk distraction osteogenesis (ITDDO) for the regeneration of segmental mandibular defects and to evaluate the effect of radiation therapy.
Prospective case series.
Tertiary care academic medical centre.
Nine patients were accrued (M:F 6:3; mean age 63 years, range 37-77 years) and underwent ITDDO for the regeneration of segmental mandibular defects. The mean follow-up time was 43 months (range 6-87 months). The average bony defect was 6.1 cm (range 3.0-10.0 cm).
Construct formation (graded as complete, partial, and none based on evidence of calcification on panorex films and palpation), complications, and plate exposure (grouped by those that were thought to be related to distraction and those that were independent of distraction).
Construct formation was "complete" in two of nine patients (22%), "partial" in four of nine (44%), "none" in two of nine (22%), and one of nine patients (11%) died prior to the 6 month assessment point. Four patients did not undergo radiation therapy, and two had stable constructs 6 years after treatment completion. Five patients underwent radiation therapy, and none of these patients formed stable, ossified constructs. All patients experienced a complication, and seven of nine (78%) developed hardware exposure, with six contributing to construct loss.
Construct formation with ITDDO is possible for large composite mandibular defects in patients who have not received radiation. The complication rate was unacceptably high but may improve with better patient selection, refinement in surgical technique and distractor design, and tissue engineering for construct support.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 08/2011; 40(4):330-6. · 0.71 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To demonstrate that the 3 reconstructive advantages of the thoracodorsal artery scapular tip transplant (Tdast), a long pedicle, independently mobile tissue components, and the 3-dimensional nature of the scapular tip, will improve the quality and success of complex reconstructions by avoiding vein grafting, preventing the need for 2 separate transplants, and facilitating bony inset.
Prospective case series.
Tertiary care academic medical center.
Twenty-one patients (male to female ratio, 16:5; mean age, 52 years) underwent reconstruction of the upper, middle, and lower face from 2001 through 2006. Indications for reconstruction were tumor ablation in 11 patients, secondary reconstruction in 4 patients, osteoradionecrosis in 4, and posttraumatic reconstruction in 2. Seventeen patients underwent radiation.
All patients underwent harvest of an autogenous transplant of scapular tip bone and latissimus dorsi soft tissue based on the thoracodorsal artery. The mean bone length was 5.2 cm (range, 2.5-9.0 cm), and the mean cutaneous surface area was 68 cm² (range, 20-250 cm²).
Reduction of vein grafting, avoidance of 2 transplants, use of the triangular shape of the scapular tip in reconstruction, complications, and shoulder function.
The success rate of transplantation was 100%. The use of this transplant avoided vein grafting in 16 patients and the need for 2 separate transplants in 11 patients, and the 3-dimensional nature of the scapular tip facilitated inset in 13 patients. In 14 patients, more than 1 of these reconstructive advantages was achieved. In 6 patients, all 3 were accomplished. Eleven patients experienced a complication. The major complication rate was 33%, and the minor complication rate was 33%. The mean Constant-Murley test of shoulder function score was 87 of 100 (range, 74-100).
The Tdast is an excellent choice for reconstruction in the head and neck as an alternative to procedures requiring vein grafting and multiple free tissue transplants, or in which the 3-dimensional contour of the scapular tip aids in reconstruction. The complication rate should be assessed in the context of the risk factors of the patient population and the outcome with respect to stable employment, increasing body mass index, and maintenance of shoulder function.
Archives of otolaryngology--head & neck surgery 10/2010; 136(10):958-64. · 1.92 Impact Factor
-
Douglas B Chepeha, Assuntina G Sacco,
Vanessa R Erickson,
Teresa Lyden,
Marc Haxer,
Jeffrey Moyer,
Theodoros N Teknos,
Mark E Prince,
Avraham Eisbruch,
Carol R Bradford,
Gregory T Wolf
[show abstract]
[hide abstract]
ABSTRACT: To determine if oropharyngoplasty using a Gehanno technique of superior constrictor velopharyngoplasty, base of tongue mounding, and primary hypopharyngeal closure in combination with template-based revascularized free tissue transfer is effective for reconstruction of the oropharyngeal defect.
Prospective case series.
Tertiary care academic medical center.
The study population comprised 25 patients (21 men and 4 women; mean age, 55.3 years) presenting from January 1998 to January 2001 with oropharyngeal squamous cell carcinoma. A comparison was performed based on the percentage of resection of the soft palate (group 1, < or =50% palate; group 2, >50% palate).
Of the 25 patients, 24 (96%) received radiotherapy. The donor sites were radial forearm for 23 of 25 patients (92%) and lateral arm for 2 of 25 patients (8%). The mean area was 92 cm(2) (range, 25-150 cm(2)), and the mean length of the velopharyngoplasty component of the oropharyngoplasty was 2.15 cm (range, 1-3 cm).
Gastrostomy tube dependence, major and minor complications, time to oral intake, speech and swallowing assessment, and quality-of-life assessment.
Of the 25 patients, 2 (8%) remain gastrostomy dependent; 6 (24%) developed major complications; and 7 (28%) developed minor complications. Speech in both groups 1 and 2 was considered understandable most of the time, with occasional repetition. The group 1 patient with a median assessment score could eat a solid diet without restriction of place or person, whereas the group 2 patient with a median assessment score could eat a soft, moist diet with selected persons in selected places.
Integration of oropharyngoplasty with template-based revascularized free tissue transfer produced speech results that were independent of palate defect size, and swallow function test results were similar to other published reconstructive techniques.
Archives of otolaryngology--head & neck surgery 09/2009; 135(9):887-94. · 1.92 Impact Factor
-
Douglas B Chepeha, Assuntina G Sacco,
Lance E Oxford,
Rahul Karamchandani,
Tamara H Miller,
Theodoros N Teknos,
Carol R Bradford,
Avraham Eisbruch,
Frank M Worden,
Susan G Urba,
Suresh K Mukherji,
Chuong Bui,
Kirk A Frey,
Gregory T Wolf,
Julia S Lee
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the efficacy of fluorine-18-fluorodeoxyglucose emission tomography (FDG-PET) and CT versus endoscopy with biopsy under general anesthesia for estimating tumor volume reduction among patients treated with induction chemotherapy for advanced squamous cell carcinoma (SCC) of the oropharynx.
Twelve patients with oropharyngeal SCC nested in a phase II, induction chemoradiation, organ preservation trial (University of Michigan Cancer Center 9921) underwent tumor volume reduction estimation as assessed by FDG-PET, CT, and endoscopy with biopsy.
In 9 of 12 patients, FDG-PET, CT, and endoscopy demonstrated agreement in estimation of tumor reduction. Two patients had discordant results, whereas 1 patient was inadequately evaluated with FDG-PET. The kappa value for PET versus endoscopy was 0.62, which is categorized as substantial agreement. The kappa value for CT versus endoscopy was 0.40, which is categorized as fair agreement.
FDG-PET may be as efficacious as endoscopy with biopsy under general anesthesia for estimating tumor volume reduction with induction chemotherapy.
Head & Neck 03/2009; 31(4):452-60. · 2.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine if a rectangular template free tissue transfer is effective for the reconstruction of the hemiglossectomy defect.
Prospective case series.
Tertiary care academic medical center.
A total of 13 patients (male to female ratio, 8:5; mean age, 55 years) presenting with squamous cell carcinoma of the oral tongue from May 2000 to December 2002.
Of the 13 patients, 7 received postoperative radiotherapy and 2 received prior radiotherapy. The radial forearm was the donor site in 11 patients and the lateral arm and anterolateral thigh in 1 patient each. The mean flap area was 50 cm(2) (range, 24-80 cm(2)).
Major and minor complications, speech and swallowing assessment, oral cavity obliteration, premaxillary contact, tongue elevation, and tongue protrusion.
There were no major complications, and 2 of the 13 patients experienced minor complications. Of the 13 patients, 12 achieved the goals of oral cavity obliteration and premaxillary contact and resumed solid oral intake. One patient remained G-tube dependent owing to toxic effects from previous chemoradiation treatment. The mean tongue tip protrusion was 0.7 cm (range, 0-1.7 cm), and the mean elevation was 1.7 cm (range, 1-3 cm). Patients with protrusion greater than 0.8 cm had better swallowing scores for "range of solids" (5.8 of 6 vs 3.9 of 6; P = .045) and "eating in public" (4.6 of 5 vs 3.5 of 5; P = .10). The average patient resumed a full range of liquid and solid intake with minimal restrictions and believed that their speech was mostly understandable with occasional repetition.
The template-based rectangle tongue flap effectively restored speech and swallowing function in this group of patients. Tongue protrusion greater than 0.8 cm is associated with better swallowing results.
Archives of otolaryngology--head & neck surgery 10/2008; 134(9):993-8. · 1.92 Impact Factor
-
Douglas B Chepeha,
Theodoros N Teknos,
Kevin Fung,
Josef Shargorodsky, Assuntina G Sacco,
Brian Nussenbaum,
Lamont Jones,
Avraham Eisbruch,
Carol R Bradford,
Mark E Prince,
Jeffrey S Moyer,
Julia S Lee,
Gregory T Wolf
[show abstract]
[hide abstract]
ABSTRACT: A quasi-experimental retrospective study was undertaken to evaluate a new concept of free tissue volume restoration combined with bridging reconstruction plate (compartment approach) to reduce plate-related complication rates.
We evaluated 40 patients with large lateral mandible defects and associated complex soft tissue defects reconstructed with a revascularized soft tissue flap and titanium hollow screw reconstruction plates. A case-control comparison was performed based on reconstruction type: restoration of soft tissue defect (conventional approach-group 1) versus over-reconstruction of soft tissue defect (compartment approach-group 2).
Plate exposure rate was 6 of 16 (38%) in group 1 versus 2 of 24 (8%) in group 2, and the difference was statistically significant (p = .04). The mean time to exposure was 10 months. Plate fracture rate was 6 of 23 (26.1%) in dentulous patients versus 1 of 17 (5.9%) in edentulous patients. Gastrostomy tube dependence was 6 of 16 (38%) in group 1 versus 6 of 24 (25%) in group 2.
The "compartment approach" reduces plate exposure rate and gastrostomy tube dependence. Revascularized osseocutaneous reconstruction is still required in dentulous patients.
Head & Neck 07/2008; 30(6):709-17. · 2.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Surgical intervention including composite mandibulectomy is the mainstay of treatment for extrication of disease in patients with neoplasms involving the mandible. The associated morbidities and reduction in quality of life after reconstruction of the mandibular defect are dependent on the quality of the reconstruction. Therefore, alternative treatments, such as distraction osteogenesis, could be a viable option to improve patient outcome. The goal of this technology is to restore bony continuity through the use of in-situ bone in an attempt to create an anatomically correct regenerate that is better than bone grafting or revascularised free-tissue transfer. Distraction osteogenesis involves a three-step process in which bone adjacent to the defect is osteotomised and gradually opened (distracted) with the aid of a mechanical device, followed by formation of new bone with subsequent consolidation. Previous work has shown encouraging results regarding the translation of distraction osteogenesis technology from an animal model to human application, with particular success in the unradiated setting. The major challenge surrounding the use of this technology in head and neck oncological reconstruction will be the effect of radiotherapy on the regenerate bone in patients who have previously received or will need radiotherapy as part of their treatment. Although distraction osteogenesis provides an attractive alternative for reconstruction of mandibular defects, large studies of human populations are needed to further assess the use of this technology and its role in the treatment framework for mandibular neoplasms.
The Lancet Oncology 04/2007; 8(4):323-30. · 22.59 Impact Factor
