1,720,980 research outputs found
Perimarginal lymph nodes: an undervalued entity in oral cancer
No full textPURPOSE:
In a previous study, we gave a surgical description of a group of lymph nodes in the submandibular area at risk of remaining undissected during neck dissection (ND) for which we have proposed the term "perimarginal nodes" (PMNs) due to their proximity to marginal mandibular nerve (MMN). The aim of this study is to evaluate prevalence of PMNs involvement in oral cavity squamous cell cancer (OCSCC) and to verify if metastases are related to primary tumor characteristics or to the state of the neck.
METHODS:
We recruited a total of 39 consecutive patients diagnosed with OCSCC candidate to ND. Histological characteristics of PMNs were analyzed and the incidence of metastases in relation to the primary tumor characteristics were noted.
RESULTS:
PMNs were found to be involved with metastases in 8 patients (20.5%). No characteristic of the primary tumor seems to influence the metastatic involvement of the PMNs.
CONCLUSIONS:
PMNs represent a frequent site of micro-metastases in patients diagnosed with OCSCC regardless of other characteristics of the primary tum
Lymph Nodes of the Perimandibular Area and the Hazard of the Hayes Martin Maneuver in Neck Dissection
No full textObjective To provide an anatomic description of submandibular nodes at risk of being left undissected during neck dissection (ND) and to assess whether the Hayes Martin maneuver is a safe procedure in oncologic surgery of level IB nodes. Study Design Prospective study. Setting Academic medical center. Subjects and Methods We recruited 62 patients who were candidates for level IB ND. Perifacial nodes (PFNs) were identified and their characteristics noted. The Hayes Martin maneuver was simulated, and its oncologic safety was tested. Results The study included 63 NDs. PFNs were identified in 84% of cases: their number ranged from 0 to 5, and their mean greatest diameter was 12.45 mm. Anterior PFNs were found to be in direct contact with the marginal mandibular nerve. In 59% of NDs, the Hayes Martin maneuver would have failed to remove all PFNs. Conclusions The PFNs were identified in 84% of cases and ranged in number from 0 to 5. In some cases, the distinction between retro- and preglandular nodes and PFNs is not useful. The Hayes Martin maneuver may not be oncologically sound for complete treatment of level IB nodes
Narrow-band imaging pattern classification in oral cavity
Full text linkNarrow-band imaging is widely used in the diagnostic work-up of oral lesions. Different oral subsites present three epithelial types (1, 2a and 2b), each with a different structure and function. The aim of this study was to analyse and describe the different vascular patterns seen on narrow-band imaging according to oral epithelial type and histology
Primary Adenoid Cystic Carcinoma of the Frontal Sinus: Case Description of a Previously Unreported Entity and Literature Review
No full textSinonasal adenoid cystic carcinoma is a rare malignant epithelial tumor characterized by slow growth, multiple local recurrences, and perineural invasion; surgery followed by radiotherapy provides the best overall survival by means of an endoscopic, craniofacial, or combined approach. We present a previously undescribed case of frontal sinus adenoid cystic carcinoma involving the subcutaneous tissue and the dura mater treated with an open technique, free flap reconstruction, and hadron therapy together with a summary of the state of the art
Evaluation of Surgical Outcome in Rhinoplasty: A Comparison Between Rasp and Osteotome in Dorsal Hump Removal
Full text linkDorsal hump reduction is a crucial point of rhinoplasty, as it has a great impact on the final shape of nasal pyramid. Depending on morphological features of the hump, its removal is usually obtained by the use of an osteotome or a rasp. In our study, we describe a closed rhinoplasty technique performed in 2 groups of patients: the only difference between the groups is the surgical tools used during the dorsal hump removal phase (rasp vs the 5-mm osteotome).We used 2 questionnaires of quality of life (QoL), Nasal Obstruction Symptom Evaluation (NOSE), and Rhinoplasty Outcome Evaluation (ROE) questionnaire, to evaluate postoperative outcome (6 months after surgery).Closed rhinoplasty was performed in 107 patients. Dorsal hump removal was carried out with rasp on 35 patients; while in 72 cases, it was performed using a 5-mm osteotome. All the patients were given 2 copies of NOSE and ROE questionnaires (1 month before surgery and 6 months after surgery) to evaluate postoperative QoL. In our study emerged that the use of osteotome in dorsal hump reduction is associated with a better aesthetic outcome (evaluated by analyzing patients QoL with ROE questionnaire) without any difference between the 2 groups in terms of functional outcome (expressed by NOSE questionnaire), major and minor complications and surgical procedure duration
NBI utility in oncologic surgery: An organ by organ review
No full textThe main aims of the oncologic surgeon should be an early tumor diagnosis, complete surgical resection, and a careful post-treatment follow-up to ensure a prompt diagnosis of recurrence. Radiologic and endoscopic methods have been traditionally used for these purposes, but their accuracy might sometimes be suboptimal. Technological improvements could help the clinician during the diagnostic and therapeutic management of tumors. Narrow band imaging (NBI) belongs to optical image techniques, and uses light characteristics to enhance tissue vascularization. Because neoangiogenesis is a fundamental step during carcinogenesis, NBI could be useful in the diagnostic and therapeutic workup of tumors. Since its introduction in 2001, NBI use has rapidly spread in different oncologic specialties with clear advantages. There is an active interest in this topic as demonstrated by the thriving literature. It is unavoidable for clinicians to gain in-depth knowledge about the application of NBI to their specific field, losing the overall view on the topic. However, by looking at other fields of application, clinicians could find ideas to improve NBI use in their own specialty. The aim of this review is to summarize the existing literature on NBI use in oncology, with the aim of providing the state of the art: we present an overview on NBI fields of application, results, and possible future improvements in the different specialties
Hyaluronate effect on bacterial biofilm in ENT district infections: a review
No full textBacterial resistance is a growing phenomenon which led the scientific community to search for new therapeutic targets, such as biofilm. A bacterial biofilm is a surface-associated agglomerate of microorganisms embedded in a self-produced extracellular polymeric matrix made of polysaccharides, nucleic acids, and proteins. Scientific literature offers several reports on a biofilm's role in infections regarding various body districts. The presence of a bacterial biofilm is responsible for poor efficacy of antibiotic therapies along with bacterial infections in ear, nose, and throat (ENT) districts such as the oral cavity, ear, nasal cavities, and nasal sinuses. In particular, bacterial biofilms are associated with recalcitrant and symptomatically more severe forms of chronic rhinosinusitis. As of today, there are no therapeutic options for the eradication of bacterial biofilm in ENT districts. Hyaluronic acid is a glycosaminoglycan composed of glucuronic acid and N-acetylglucosamine disaccharide units. Its efficacy in treating rhinosinusitis, whether or not associated with polyposis, is well documented, as well as results from its effects on mucociliary clearance, free radical production and mucosal repair. This review's aim is to evaluate the role of bacterial biofilms and the action exerted on it by hyaluronic acid in ENT pathology, with particular attention to the rhinosinusal district. In conclusion, this paper underlines how the efficacy of hyaluronate as an anti-bacterial biofilm agent is well demonstrated by in vitro studies; it is, however, only preliminarily demonstrated by clinical studies
MRI and frozen section evaluation of mylohyoid muscle in determining surgical approach for T2-T3 floor of the mouth cancer
Full text linkPurpose: The choice of surgical approach for floor of the mouth (FOM) cancer, particularly for intermediate-stage tumors (cT2-cT3), remains controversial. This study aims to evaluate a method considering mylohyoid muscle (MM) invasion as a determinant for surgical approach selection, utilizing magnetic resonance imaging (MRI) preoperatively and frozen section (FS) analysis intraoperatively. Methods: This observational retrospective cohort study analyzed patients undergoing surgical resection of cT2 and cT3 FOM squamous cell carcinoma (SCC) between January 2013 and June 2023. MM infiltration assessed by preoperative MRI determined the surgical approach: clear infiltration led to compartmental surgery (CS), while doubtful or absent infiltration led to transoral surgery (TOS). Conversion from TOS to CS occurred intraoperatively based on macroscopic evidence or positive FS. Data collected included demographic, clinical, surgical, and pathological variables. Survival analysis was conducted using Kaplan-Meier method. Results: Among 44 patients included, majority had cT2 tumors (59.1%). MM resection was necessary in 22.7% of cases. Overall survival (OS) and progression-free survival (PFS) did not significantly differ between TOS and CS groups. Radiological depth of invasion (rDOI) 10 mm is correlated with MM resection only in 23.8% of cases. Pathological depth of invasion (pDOI) discrepancies were observed in the two groups: in CS group is shown a higher pDOI (> 10 mm) confirmation (90%). Surgical complications and functional outcomes differed between TOS and CS groups. Conclusion: Considering MM invasion for surgical approach selection in cT2-cT3 FOM tumors appears oncologically safe, with better functional outcomes in muscle preservation. Preoperative MRI for MM assessment combined with intraoperative FS analysis provides reliable guidance for surgical decision-making
Intraoperative monitoring of marginal mandibular nerve during neck dissection
No full textThe purpose of this study was to assess the efficacy of intraoperative nerve integrity monitoring (NIM) to prevent marginal mandibular nerve injuries during neck dissection.
METHODS:
This prospective study compared 36 patients undergoing NIM-assisted neck dissection from July 2014 to March 2015 to a cohort of 35 patients subjected to neck dissection over an identical period of time before the technique was introduced. We also assessed possible correlations between marginal mandibular nerve injuries and other factors, such as anthropometric measurements, presence of clinical neck metastases, type of neck dissection, and site of primary tumor.
RESULTS:
The incidence of marginal mandibular nerve paralyses was significantly lower among the group of patients undergoing NIM-assisted neck dissection (P = .021). There was no significant difference in the duration of the procedure, and the technique resulted in a limited increase of cost. No other factor seemed to influence the onset of marginal mandibular nerve palsy.
CONCLUSION:
In our opinion, NIM is a valuable aid for preventing marginal mandibular nerve injuries during neck dissectio
Impact of time-to-surgery on survival and quality of life in oral cancer
Full text linkPurpose: To investigate the association between time-to-surgery (TTS) and overall survival (OS), disease specific survival (DSS) and quality of life (QoL) in patients with oral squamous cell carcinoma (OSCC). Materials and methods: 116 patients with OSCC candidate to surgery were examined. TTS intervals starting from diagnosis (TTS-clinical-based) and from histological reports (TTS-biopsy-based) were calculated. The effects of TTS intervals and prognostic factors on 5-year OS and DSS were explored. Results: In our cohort advanced T-categories OSCCs with TTS 10 mm, invasive surgery and extra-capsular extension in pN+ were found to be significantly associated with a poor OS and DSS. Conclusions: TTS ≥ 30 days can adversely affect DSS, especially in the advanced T categories. Short TTS intervals resulted associated with a better postoperative QoL
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