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Tulika Shinghal,
Eric Bissada,
Hon Biu Chan,
Robert E Wood,
Eshetu G Atenafu,
Dale H Brown, Ralph W Gilbert,
Patrick J Gullane,
Jonathan C Irish,
John Waldron,
David P Goldstein
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ABSTRACT: Objectives
The objective of this study was to determine the frequency of complications in median and paramedian mandibulotomies. In addition, the interdental space in the median and paramedian region was calculated.Study designRetrospective study.SettingTertiary care center. METHODS: A retrospective chart review was performed for all cases where a mandibulotomy was performed from 2002 to 2010. 117 charts (61 paramedian and 56 median) were identified. We included data on complications, which fell in the following 2 categories: plate and dental complications. For our second objective, we evaluated 40 different patients with base of tongue or tonsillar cancer treated with intensity modulated radiation therapy (IMRT). The interdental space between the lateral incisors and the canines was electronically calculated on the digital Panorex images.Main outcome measuresDental and plate complications were evaluated. We also assessed interdental space. RESULTS: Patient characteristics were not significantly different. The median group had significantly more dental complications (p=0.0375, RD=0.19 and 95% CI (0.0139-0.3661)). The paramedian group had significantly more plate complications (p=0.0375, RD=0.082 and 95% CI (0.0131-0.1508). The distance between the central incisors was significantly less than the distance between the lateral incisors and canines both at the crestal and apical levels (p=0.0086 and p<0.001). CONCLUSIONS: There are significantly more dental complications in the median approach. There were significantly more plate complications in the paramedian group. In addition, there is significantly less space in the between the median region as compared to the paramedian region. This is the first study that documents the advantage of the paramedian approach for dental complications.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 05/2013; 42(1):32. · 0.71 Impact Factor
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ABSTRACT: Background The purpose of this study was to evaluate bony union and resorption after free fibular flap reconstruction for mandibular reconstruction.Methods A total of 112 patients with composite resection and reconstruction with a fibular free flap were included. Computed tomography scan images taken after the reconstruction and approximately 1 year postoperatively were assessed to evaluate union (n = 60) and bone resorption (n = 24) of the neomandible.Results Most of the fibulas healed well (n = 34) and there was radiologic nonunion in 20% of the neomandibles at the time of evaluation (mean = 15 months). There was a statistically significant reduction in bone height in the native mandible (p = 0.02) and the anterior part of the fibular graft (p = 0.02).Conclusions There was a statistically significant reduction in mandibular and fibular graft height. However, the bone resorption was clinically minimal. Sufficient maintenance of height and good bony union support the use of free fibular flap in mandibular reconstruction.
Journal of Reconstructive Microsurgery 04/2013; · 1.43 Impact Factor
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ABSTRACT: OBJECTIVES/HYPOTHESIS: Hard palate and maxillary alveolus are two commonly grouped oral cavity subsites due to their anatomic contiguity and oncologic disease behavior. Few studies have been conducted investigating clinical presentation, staging, prevalence of cervical metastases, and outcomes in this population. The primary objective of this study was to analyze predictors of disease-free survival (DFS) in surgically treated patients, particularly as it relates to the role of neck dissection. STUDY DESIGN: Cohort study with planned data collection. METHODS: This cohort study used planned data collection over 15 years (1994-2008) at a large tertiary care cancer center to study all patients presenting with squamous cell carcinoma of the maxillary alveolus and hard palate treated surgically. Univariate and multivariate Cox regression analyses were used to identify predictors of DFS. RESULTS: Ninety-seven patients met the inclusion criteria (54 male, 56%). The majority of patients (54, 56%) presented with locally advanced disease (cT3, cT4). Occult nodal metastases were noted in 26% (17 of 65) of patients clinically staged as N0. The 3-year DFS was 70% (95% confidence interval = 59%-78%) with a median time to failure of 1.1 years (range = 0.3-9.7 years). Cox regression multivariate model demonstrated that advanced pathologic T stage, hard palate tumor site, and poorly differentiated tumor grade were each independent predictors of DFS. CONCLUSIONS: A significant portion of the patients with hard palate and maxillary alveolus tumors harbor occult cervical metastases. Elective neck dissection in the high-risk patients may potentially be beneficial in providing more accurate staging and improving DFS. LEVEL OF EVIDENCE: 2b. Laryngoscope, 2013.
The Laryngoscope 04/2013; · 1.75 Impact Factor
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Jennifer R Wang,
Sarah J B Gramling,
David P Goldstein,
Dangxiao Cheng,
Duoduo Chen,
Abul K Azad,
Alvina Tse,
Henrique Hon,
Zhuo Chen,
Maryam Mirshams, [......],
Brian O'Sullivan,
Fei-Fei Liu,
Heidi Roberts,
Wei Xu,
Dale H Brown, Ralph W Gilbert,
Patrick J Gullane,
Jonathan C Irish,
David N Reisman,
Geoffrey Liu
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ABSTRACT: The SWI/SNF chromatin remodeling complex is an important regulator of gene expression that has been linked to cancer development. Expression of Brahma (BRM), a critical catalytic subunit of SWI/SNF, is lost in a variety of solid tumors. Two novel BRM promoter polymorphisms (BRM -741 and BRM -1321) have been correlated with BRM loss and elevated cancer risk. The aim(s) of this study were to examine BRM expression in head and neck squamous cell carcinoma (HNSCC) and to correlate BRM polymorphisms with HNSCC risk. BRM expression studies were performed on 8 HNSCC cell lines and 76 surgically resected tumor samples. A case-control study was conducted on 668 HNSCC patients (oral cavity, oropharynx, larynx, and hypopharynx) and 700 healthy matched controls. BRM expression was lost in 25% of cell lines and 16% of tumors. The homozygous genotype of each polymorphism was significantly associated with increased HNSCC risk (BRM -741: aOR 1.75, 95% CI 1.2-2.3, p<0.001; BRM -1321: aOR 1.65, 95% CI 1.2-2.2, p<0.001). Individuals that were homozygous for both BRM polymorphisms had a more than 2-fold increase in the risk of HNSCC (aOR 2.23, 95% CI 1.5-3.4, p<0.001). A particularly elevated risk was seen within the oropharynx, HPV+ sub-group for carriers of both homozygous variants (aOR 3.09, 95% CI 1.5-6.8, p=0.004). BRM promoter polymorphisms appear to act as susceptibility markers of HNSCC with potential utility in screening, prevention, and treatment.
Carcinogenesis 01/2013; · 5.70 Impact Factor
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Gideon Bachar,
David P Goldstein,
Emma Barker,
Jane Lea,
Brian O'Sullivan,
Dale H Brown,
Patrick J Gullane, Ralph W Gilbert,
Wei Xu,
Jie Su,
Jonathan C Irish
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ABSTRACT: The objective of this study was to analyze the patterns of failure and to determine clinical and pathologic factors predictive of recurrence and survival of patients treated for squamous cell carcinoma of the buccal mucosa at Princess Margaret Hospital.
Retrospective chart review.
A retrospective chart review of patients treated for buccal carcinoma between 1994 and 2004 was performed. Seventy patients with newly diagnosed and previously untreated squamous cell carcinoma of the buccal mucosa were included. Demographic, clinical, and pathological parameters were identified and correlated with outcomes.
The patient cohort consisted of 33 males and 37 females. Most patients presented with early-stage local disease (T1-T2). Surgery was the primary treatment in 61 patients. Twenty-three patients were treated with postoperative radiotherapy. Median follow-up was 3.3 years. The 5-year local, regional, and overall control rates were 57.5%, 83.5%, and 50%, respectively. The 5-year overall survival rate was 69%. The 5-year disease-specific and recurrence-free survival rates were 76.4% and 46%, respectively. The only significant predictors of survival were the nodal status and extranodal extension.
Carcinoma of the buccal mucosa is an aggressive disease, characterized by a high rate of locoregional failure. Transoral wide excision is an adequate treatment for early-stage lesions; however, a combined approach and an elective neck dissection should be considered in advanced lesions.
The Laryngoscope 06/2012; 122(7):1552-7. · 1.75 Impact Factor
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ABSTRACT: To present a technique for reconstruction of the vertical partial laryngectomy defect using a vascularized carrier consisting of a temporoparietal free flap, cartilage graft, and buccal mucosal graft; to evaluate the oncologic outcomes with respect to locoregional control and overall survival; and to provide an assessment of patient quality of life and functional outcomes.
Retrospective medical record review and prospective cross-sectional analysis of functional outcomes.
Princess Margaret Hospital-University Health Network and the Odette Cancer Centre-Sunnybrook Health Sciences Centre.
We collected data on patient demographic characteristics, tumor staging, initial treatment, recurrence, management, and follow-up. Prospectively, a cross-sectional study was performed using the European Organization for Research and Treatment of Cancer Quality of Life of Cancer Patients Questionnaire C30 and HN35 module and voice and swallowing results using the Voice Handicap Index and Swallowing Quality of Life index.
Local recurrence-free survival, cause-specific survival, and overall survival.
Forty men met inclusion criteria (median age, 65.0 years). Local recurrence-free survival was 84% at 3 years and 75% at 5 years. Cause-specific survival was 88% at 3 years and 78% at 5 years. Thirty-eight patients were successfully decannulated; all patients tolerated oral intake after the surgical procedure. The C30 and HN35 symptomatic results were comparable with patients with standardized stages I and II head and neck tumors. The Voice Handicap Index results were comparable with patients with functional dysphonia. Patients' swallowing was in the normal range.
Patients receiving vertical partial laryngectomy with temporoparietal free flap reconstruction for recurrent glottic carcinoma following radiation treatment failure have high rates of locoregional control. The use of the temporoparietal free flap in this patient population produces high-quality voice results and normal swallowing and has no major effect on quality of life.
Archives of otolaryngology--head & neck surgery 05/2012; 138(5):484-91. · 1.92 Impact Factor
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David P Goldstein,
Gideon Y Bachar,
Jane Lea,
Mark G Shrime,
Rajan S Patel,
Patrick J Gullane,
Dale H Brown, Ralph W Gilbert,
John Kim,
Jonathan Waldron,
Bayardo Perez-Ordonez,
Aileen M Davis,
Lu Cheng,
Wei Xu,
Jonathan C Irish
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ABSTRACT: BACKGROUND: The purpose of this study was to analyze the outcomes and treatment in patients with squamous cell carcinoma (SCC) of the oral tongue, as well as validate previously reported predictors of survival. METHODS: We retrospectively reviewed 259 patients treated with curative intent between 1994 and 2004. Kaplan-Meier estimates, log-rank test, and Cox regression models were used for statistical analysis. RESULTS: Two hundred fifty-nine patients were managed with surgery; 67 patients (25%) received adjuvant radiotherapy. Mean follow-up was 60 months. The 5-year local and regional control rates were 78% and 69.4%, respectively. The 5-year overall, disease-specific, and recurrence-free survival rates were 69%, 70.9%, and 53%, respectively. The only significant predictor of both overall survival (OS) and disease-free survival (DFS) on multivariable analysis was pathologic N classification. CONCLUSION: Treatment of early tongue SCC effectively achieves local control and DFS. Nodal disease remains to be 1 of the most important prognostic factors in terms of recurrence and survival. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
Head & Neck 04/2012; · 2.40 Impact Factor
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Brian O'Sullivan,
Shao Hui Huang,
Bayardo Perez-Ordonez,
Christine Massey,
Lillian L Siu,
Ilan Weinreb,
Andrew Hope,
John Kim,
Andrew J Bayley,
Bernard Cummings, [......],
Laura A Dawson,
B C John Cho,
Eric Chen,
Jonathan Irish, Ralph W Gilbert,
Angela Hui,
Fei-Fei Liu,
Helen Zhao,
John N Waldron,
Wei Xu
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ABSTRACT: To report outcome of HPV-related [HPV(+)] oropharyngeal cancer (OPC) managed predominantly by altered-fractionation radiotherapy-alone (RT-alone).
OPCs treated with RT-alone (n = 207) or chemoradiotherapy (CRT) (n = 151) from 2001 to 2008 were included. Overall survival (OS), local (LC), regional (RC) and distant (DC) control were compared for HPV(+) vs. HPV-unrelated [HPV(-)], by RT-alone vs. CRT, and by smoking pack-years (≤ 10 vs. >10). Multivariate analysis identified predictors.
HPV(+) (n = 277) had better OS (81% vs. 44%), LC (93% vs. 76%), RC (94% vs. 79%) (all p < 0.01) but similar DC (89% vs. 86%, p = 0.87) vs. HPV(-) (n = 81). HPV(+) stage IV CRT (n = 125) had better OS (89% vs. 70%, p < 0.01), but similar LC (93% vs. 90%, p = 0.41), RC (94% vs. 90%, p = 0.31) and DC (90% vs. 83%, p = 0.22) vs. RT-alone (n = 96). Both HPV(+) RT-alone (n = 37) and CRT (n = 67) stage IV minimal smokers had favorable OS (86% vs. 88%, p = 0.45), LC (95% vs. 92%, p = 0.52), RC (97% vs. 93%, p = 0.22), and DC (92% vs. 86%, p = 0.37). RT-alone and heavy-smoking were independent predictors for lower OS but not CSS in multivariate analysis.
Overall, HPV(+) RT-alone stage IV demonstrated lower survival but comparable disease control vs. CRT, but no difference was apparent among minimal smokers.
Radiotherapy and Oncology 03/2012; 103(1):49-56. · 5.58 Impact Factor
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ABSTRACT: To report a new approach to lower lip reanimation, which can be performed in the outpatient clinic setting.
Cross-sectional study.
Tertiary and quaternary care academic hospital, Toronto.
An evaluation of nine patients with marginal mandibular nerve injury, who underwent harvest of the palmaris longus tendon and static suspension of the lower lip, was performed in the outpatient setting. Outcome measures included subjective self-evaluation of the functional and aesthetic results using the Lip Reanimation Outcomes Questionnaire and postoperative photographic grading of symmetry at rest and during three smile poses. Medical records were reviewed for demographics and complications.
Seventy-eight percent of patients reported overall improvements in smiling, oral competence, and speech articulation following tendon transfer. Photographic grading by the judging panel found satisfactory smile symmetry postprocedure.
The palmaris longus tendon sling procedure provides an effective, additional option for reanimation of the paralyzed lower lip.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 12/2011; 40(6):481-8. · 0.71 Impact Factor
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ABSTRACT: To report on experience with the scapular angle osteomyogenous flap for maxillary reconstruction.
Retrospective review of patients undergoing scapular angle reconstruction for maxillary defects at the University Health Network from 2004 through 2010.
Medical research center.
Thirty-nine patients were included in the review.
Scapular angle reconstruction for maxillary defects.
Maxillary defects were classified prospectively according to Okay and coauthors. Early and late complications as well as demographic and outcome data was analyzed using SPSS version 16.0 statistical software. Shoulder disabilities were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.
Of the 39 patients included in the study, vein grafting was required in 3 (8%). The overall complication rate in the study was 18 of 30 (46%). A total of 16 patients (41%) in the review required revision procedures of some type. The rate of fistula formation was 21% (n = 8) in the study group. Fifty-one percent of patients received radiotherapy as part of the treatment as dictated by the tumor board. Statistical analysis did not reveal a correlation between the administration of radiotherapy and postoperative fistula formation (P = .13). Of the 8 fistulas, 1 patient required surgical closure and an additional patient opted for palatal prosthesis. Fifty percent of the fistulas closed spontaneously. Of the 39 patients, 18 (46%) obtained a normal diet and 21 (54%) maintained a soft diet. Regarding shoulder dysfunction, the mean (SD) DASH score obtained was 10.44 (10.33). Eight patients in the study group (21%) underwent neck dissection; the remaining 80% of patients did not have cranial nerve XI manipulation. Statistical analysis did not reveal any correlation between neck dissection and postoperative DASH scores.
This investigation indicates that the angular scapular flap has some advantages over other free-tissue transfer techniques for complex maxillary defect reconstruction. A considerable number (46%) of patients will experience some type of local complications after undergoing these challenging reconstructions, and many (41%) will require revision surgery. Postoperative fistula will often close spontaneously. Donor site morbidity is relatively low according to preliminary analysis.
Archives of otolaryngology--head & neck surgery 11/2011; 137(11):1130-5. · 1.92 Impact Factor
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ABSTRACT: Peripherally inserted central venous catheters (PICCs) do not interfere with surgical access during neck dissection and are used in patients undergoing head and neck surgery. However, severe complications associated with malpositioning of PICCs have been reported in these patients. We conducted a retrospective study to determine the incidence of aberrant positioning of PICCs in patients undergoing free flap reconstructive (FFR) surgery for head and neck malignancies.
We analyzed a database of 269 patients undergoing FFR surgery. After induction of general anesthesia, a PICC was inserted successfully in 130 patients (48%) at bedside without image guidance. A PICC was not used in 139 patients (52%). A chest x-ray was performed at admission to the postanesthetic care unit, stored digitally, and reviewed retrospectively by two independent observers. Based on the chest x-ray findings, the PICC position was classified as proper, suboptimal, or aberrant and defined according to the position of the PICC tip, i.e., proper, if situated in the ipsilateral innominate vein or in the superior vena cava; suboptimal, if situated in the subclavian vein; and aberrant, if situated in any other location.
Proper, suboptimal, and aberrant PICC positions were found in 68 (52%), 17 (13%), and 45 (35%) patients, respectively. The proper position was confirmed more frequently with a left- than with a right-sided approach: 23/29 (79%) vs 45/101 (44%) patients, respectively (P < 0.001).
There is a high incidence of aberrant positioning when PICCs are inserted without image guidance. The left-sided approach might be preferable due to a lower incidence of malpositions. The risk-benefit ratio should be estimated carefully before using a PICC in patients undergoing FFR procedures.
Canadian Anaesthetists? Society Journal 05/2011; 58(8):709-13. · 2.31 Impact Factor
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ABSTRACT: to develop a clinically useful perioperative blood transfusion prediction model for patients undergoing a major head and neck surgical procedure requiring free-flap reconstruction.
retrospective observational study.
tertiary care university-affiliated teaching hospital (University Health Network, Toronto, Ontario, Canada).
all patients with a head and neck malignant neoplasm undergoing major head and neck surgery requiring free-flap reconstruction.
perioperative single-unit red blood cell transfusion.
all the preoperative variables were tested for an association with perioperative blood transfusion using univariable and multivariable analyses. After multivariable regression analysis, the following preoperative variables were found to be significantly associated with perioperative transfusion: sex, body mass index, T stage, preoperative hemoglobin level, and type of free-flap reconstruction used (ie, osseous vs nonosseous). The regression model was used to develop a transfusion risk score. Receiver operating characteristic curve analysis confirmed adequate discrimination of risk using the transfusion risk score.
we have developed a reliable model for predicting perioperative blood transfusion requirements in patients undergoing major head and neck surgery requiring free-flap reconstruction. This model can be used for accurate preoperative risk stratification.
Archives of otolaryngology--head & neck surgery 12/2010; 136(12):1199-204. · 1.92 Impact Factor
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ABSTRACT: The objective of the study was to evaluate the prognostic and therapeutic implications of an initial positive frozen section margin that was revised until negative (microscopic tumor cut-through), and to analyze the influence of microscopic margin status on oral carcinoma control.
The approach in our investigation was through a retrospective review of patients treated with primary surgery, with frozen section margin control in oral carcinoma. Inclusion criteria included availability of frozen and permanent section histology reports of resection margins and negative final resection margins.
Of 547 patients studied, 175 received adjuvant radiation. Local and regional control and disease-specific survival rates were 81.6%, 78.4%, and 76.3%, respectively. Tumor cut-through and pathologic nodal (pN) stage had an independently adverse effect on local control. Tumor cut-through adversely affected cancer control and survival, but this effect diminished significantly in the absence of regional disease.
Microscopic tumor cut-through revised to negative margins is a powerful prognosticator that is observed only when regional disease is also present. The value of adjuvant therapeutic regimens is questionable in patients with microscopic tumor cut-through, revised to negative margins, and with no regional disease.
Head & Neck 11/2010; 32(11):1444-51. · 2.40 Impact Factor
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ABSTRACT: We aimed to determine predictors of morbidity in patients undergoing microvascular free flap reconstruction of the head and neck.
We prospectively evaluated 796 cases between 1999 and 2007 using univariate and multivariate analysis to determine predictors of morbidity and prolonged hospital stay.
Two hundred thirty-nine patients (30%) developed major complications. Age, body mass index (BMI), American Society of Anesthesiology (ASA) score, Kaplan Feinstein comorbidity index (KFI) score, preoperative hemoglobin, and tracheostomy were independent predictors of major complication. Predictors of prolonged hospital stay included age, recent weight loss, alcohol excess, ASA, KFI, preoperative hemoglobin, mucosal surgery, anesthesia duration, and crystalloid replacement volume.
Several variables are associated with an increased risk of development of major complications following free flap reconstruction of the head and neck. Although many of these variables are irreversible, they aid risk stratification of patients undergoing free flap reconstruction, and assist clinicians in making treatment decisions, consenting, and providing patients with realistic expectations regarding their perioperative course.
Head & Neck 10/2010; 32(10):1345-53. · 2.40 Impact Factor
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ABSTRACT: Lip paralysis is associated with eating, speaking, and appearance impairments. The lip reanimation outcome questionnaire is designed to assess these functional impairments after lip reanimation.
Cross-sectional validation study.
Tertiary care academic center.
Patients who underwent lip reanimation and control subjects. A disease-specific instrument was created by systematic literature review and expert opinion. The 15-item patient completed subscale was administered to 20 lip reanimation patients. Photographs of 19 patients and three control subjects were taken in four poses and rated by six raters (2 surgeons, 2 residents, and 2 novices) by the use of a external rater subscale, and reliability was determined by the use of intraclass correlation coefficients (ICC). Content and construct validity were assessed.
Internal consistency (ICC range 0.813-0.915 for each domain), test-retest reliability (ICC range 0.616-0.981 for each item) for the patient completed subscale, and interrater (ICC = 0.852) and interlevel reliability (ICC = 0.929) for the external rater subscale were substantial to excellent. The content validity index was 0.87. Construct validity was demonstrated by poorer scores in patients with transected nerves versus intact nerves for appearance (P = 0.04) and oral competence (P = 0.011). Photographs of control patients had lower asymmetry scores (P < 0.001), and the instrument detected greater asymmetry in patients with progressively more exaggerated smile (P < 0.001).
The lip reanimation outcome questionnaire has promising reliability and validity in this preliminary study, but additional psychometric testing with larger samples is required before the survey can be recommended for clinical use.
Otolaryngology Head and Neck Surgery 09/2010; 143(3):361-6. · 1.72 Impact Factor
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ABSTRACT: The purpose of this article is to review current microvascular mandibular reconstruction techniques and recent literature on the advances of tissue engineering as they relate to mandibular reconstruction.
Microvascular reconstruction continues to be the standard of care for complicated mandibular reconstruction in major ablative defects of the head and neck. Several recent modifications of current microvascular techniques offer significant improvement in the quality of reconstructions currently being performed. Advances in tissue engineering are currently not widely applicable clinically due to a number of factors; however, the technology offers promising advances in the management of mandibular continuity defects in the future.
Microvascular reconstruction of the mandible represents the most significant advancement in technique in the current era. Tissue engineering offers a promising future to improve outcomes and decrease patient morbidity. Future investigations regarding this new technology will provide information on the utility and feasibility of tissue engineering in mandibular reconstruction.
Current opinion in otolaryngology & head and neck surgery 08/2010; 18(4):317-22.
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ABSTRACT: Limited follow-up data on aesthetic outcome and survival after microsurgical reconstruction of complex scalp and forehead defects are available. These data are important to improve reconstruction quality and patient counseling. The purpose of this study was to evaluate surgical, aesthetic, and oncologic outcome of free flap scalp and forehead reconstructions in the patient population of two academic centers.
Retrospective data analysis of patients with a microsurgical reconstruction of the scalp or forehead between January of 1999 and June of 2008 was performed. Aesthetic outcome was assessed on a five-point Likert scale for flap color match, contour, and overall aesthetic result.
The group consisted of 84 patients with a mean follow-up time of 27 months (range, 1 to 95 months). Mean defect size was 134 cm (range, 20 to 340 cm), with 46 percent full-thickness bone defects and 16 percent dura defects. The most commonly used free flaps were latissimus dorsi (n = 34) and anterolateral thigh (n = 24). Total flap failure occurred in five patients (6 percent). Disease-free survival and overall survival rates at 5 years were 57 and 65 percent, respectively. Additional operations for aesthetic reasons were performed in 19 patients (23 percent). Panel scores showed a significant lower satisfaction with reconstruction of defects that were located over the frontal scalp compared with other locations (p = 0.004).
Microsurgical reconstruction in complex scalp and forehead defects is a safe procedure. From the authors' experience, they suggest an algorithm for reconstruction of these complex reconstructive defects that will most likely result in the best aesthetic result.
Plastic and reconstructive surgery 08/2010; 126(2):460-70. · 2.74 Impact Factor
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Jerry Machado,
Patricia P Reis,
Tong Zhang,
Colleen Simpson,
Wei Xu,
Bayardo Perez-Ordonez,
David P Goldstein,
Dale H Brown, Ralph W Gilbert,
Patrick J Gullane,
Jonathan C Irish,
Suzanne Kamel-Reid
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ABSTRACT: Increasing evidence shows that Human Papillomavirus (HPV) is preferentially associated with some head and neck squamous cell carcinomas (HNSCCs), with variable infection rates reported.
We assessed HPV involvement in HNSCC using the Roche Linear Array HPV Genotyping Test, which can detect 37 different HPV types. We examined the prevalence of HPV infection in 92 HNSCCs (oropharynx, oral cavity, and other HNSCC sites).
HPV was frequently detected in oropharyngeal cancers (OPCs) (16/22, 73%), but was uncommon in oral cavity cancers (2/53, 4%), and in other HNSCC subsites (1/17, 6%). HPV positive tumors were associated with patients that were 40-60 years old (p = 0.02), and node positive (p = < 0.0001). HPV 16 was the most prevalent type, but other types detected included 6, 18, 33, 35, 45, and 52/58.
Our results show that in contrast to oropharyngeal cancers, oral cancers and other HNSCCs infrequently harbor HPV.
Head & Neck Oncology 03/2010; 2:6. · 3.13 Impact Factor
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ABSTRACT: To evaluate the survival impact of postoperative radiation therapy (RT) in patients with early T stage (T1-2) oral cavity squamous cell carcinoma (OCSCC) and a single positive lymph node.
Between 1983 and 2004, a total of 1539 patients were treated with surgery for T1-2N1 OCSCC.
The Surveillance, Epidemiology, and End Results database was used to determine whether postoperative RT improves survival in patients with T1-2N1 OCSCC.
Postoperative RT improved the 5-year overall survival rate (41.4% for surgery alone vs 54.2% for surgery plus RT [P < .001]). Improvement in overall survival in patients with T1N1 disease did not achieve statistical significance with the addition of RT in contradistinction to that in patients with T2N1 disease. Adjuvant RT improved survival in patients with T2 tongue and floor of mouth disease (52.3% vs 37.9% [P = .002] and 39.9% vs 17.7% [P = .003], respectively).
In cases involving T1-2N1 OCSCC in the Surveillance, Epidemiology, and End Results database, the use of RT is associated with statistically significant improved overall survival and cause-specific survival in patients with T2 disease, most strongly in the oral tongue and the floor of the mouth.
Archives of otolaryngology--head & neck surgery 03/2010; 136(3):225-8. · 1.92 Impact Factor
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Patricia P Reis,
Miranda Tomenson,
Nilva K Cervigne,
Jerry Machado,
Igor Jurisica,
Melania Pintilie,
Mahadeo A Sukhai,
Bayardo Perez-Ordonez,
Reidar Grénman, Ralph W Gilbert,
Patrick J Gullane,
Jonathan C Irish,
Suzanne Kamel-Reid
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ABSTRACT: The tumor suppressor Programmed Cell Death 4 (PDCD4) has been found to be under-expressed in several cancers and associated with disease progression and metastasis. There are no current studies characterizing PDCD4 expression and its clinical relevance in Oral Squamous Cell Carcinoma (OSCC). Since nodal metastasis is a major prognostic factor in OSCC, we focused on determining whether PDCD4 under-expression was associated with patient nodal status and had functional relevance in OSCC invasion. We also examined PDCD4 regulation by microRNA 21 (miR-21) in OSCC.
PDCD4 mRNA expression levels were assessed in 50 OSCCs and 25 normal oral tissues. PDCD4 was under-expressed in 43/50 (86%) OSCCs, with significantly reduced mRNA levels in patients with nodal metastasis (p = 0.0027), and marginally associated with T3-T4 tumor stage (p = 0.054). PDCD4 protein expression was assessed, by immunohistochemistry (IHC), in 28/50 OSCCs and adjacent normal tissues; PDCD4 protein was absent/under-expressed in 25/28 (89%) OSCCs, and marginally associated with nodal metastasis (p = 0.059). A matrigel invasion assay showed that PDCD4 expression suppressed invasion, and siRNA-mediated PDCD4 loss was associated with increased invasive potential of oral carcinoma cells. Furthermore, we showed that miR-21 levels were increased in PDCD4-negative tumors, and that PDCD4 expression may be down-regulated in OSCC by direct binding of miR-21 to the 3'UTR PDCD4 mRNA.
Our data show an association between the loss of PDCD4 expression, tumorigenesis and invasion in OSCC, and also identify a mechanism of PDCD4 down-regulation by microRNA-21 in oral carcinoma. PDCD4 association with nodal metastasis and invasion suggests that PDCD4 may be a clinically relevant biomarker with prognostic value in OSCC.
Molecular Cancer 01/2010; 9:238. · 3.99 Impact Factor
