Selective versus comprehensive neck dissection in the treatment of patients with a pathologically node-positive neck with or without microscopic extracapsular spread in oral squamous cell carcinoma

The objective of this study was to compare the prognosis and complications between selective neck dissection (SND) and comprehensive neck dissection (CND) for patients with a pathologically node-positive neck in squamous cell carcinoma of the tongue and the floor of the mouth. This was a retrospective cohort study. There was no significant difference between the SND group and the CND group in 3-year neck control rate (86.2% vs. 85.9%, P = 0.797) or disease-specific survival (DSS) rate (64.6% vs. 61.9%, P = 0.646). Further analyses of the respective 3-year DSS rates in the SND and CND subgroups were as follows: pN1 without extracapsular spread (ECS), 67.7% vs. 72.2%, P = 0.851; pN2b without ECS, 64.7% vs. 68.8%, P = 0.797; and pN+ with ECS, 57.1% vs. 60.0%, P = 0.939. Of note, there were significantly fewer complications in the SND group compared with the CND group (7.3% vs. 20.0%, P = 0.032). Multivariate analysis showed that the modality of neck treatment, pN+ status, and microscopic ECS did not serve as independent prognostic factors. SND plus adjuvant radiotherapy is a management strategy of high efficiency and minor morbidity for selected oral cancer patients with a pN+ neck with or without microscopic ECS.     

Changes in peripheral blood lymphocyte phenotypes distribution in patients with oral cancer/oral leukoplakia in Taiwan

Oral squamous cell carcinoma (OSCC) is common in many Asian countries. The immunopathogenesis of OSCC is unclear. The authors analyzed the lymphocyte subtypes and surface activation markers in healthy Taiwanese people (n = 130) and patients with OSCC (n = 97)/oral leukoplakia (OL, n = 28) using flow cytometry. Univariate analysis found an elevation in the percentage of CD56+ NK cells, CD4+/CD69+ T cells, CD19+/CD69+ B cells and CD56+/CD69+ NK cells in OSCC patients relative to healthy people. The CD19+ and CD19+/CD25+ lymphocyte subtypes decreased in OSCC patients. CD56+ NK cells increased in OL patients. CD56+/CD69+ NK cells were elevated in recurrent and advanced OSCC. Multivariate analysis revealed an increase in CD56+ NK and CD19+/CD69+ cells in OL patients relative to controls. CD19+ B cells declined during progression from OL to OSCC. Betel quid chewing, alcohol, smoking, tumour location and staging showed little effect on lymphocyte subtypes. These results suggest that alterations and activation of NK cells, T and B cells are important and associated with disease status in oral carcinogenesis.     

The utility of postoperative radiotherapy in intermediate-risk oral squamous cell carcinoma

The effectiveness of postoperative radiotherapy (PORT) in improving outcomes remains debatable for oral squamous cell carcinoma (OSCC) patients with pathological intermediate-risk factors (IRFs) after surgery. A retrospective analysis was conducted on 432 intermediate-risk OSCC patients defined by histological reporting of close margin (<5 mm), early nodal disease (pN1), depth of invasion/tumour thickness ≥5 mm, perineural invasion, and/or lymphovascular invasion. Outcomes measured were disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS). PORT was associated with an improvement in 5-year DFS on univariable analysis (80% vs 71%; P = 0.044), but this did not remain significant on multivariable analysis. PORT was not associated with differences in DSS or OS. The surgical salvage rate was similar in the PORT and surgery-only groups (41% vs 47%; P = 0.972). Perineural invasion was found to be an independent predictor of inferior DSS (hazard ratio (HR) 2.19), DFS (HR 1.89), and OS (HR 1.97). Significantly worse outcomes were observed for patients with ≥4 concurrent IRFs. The application of PORT was associated with lower rates of recurrence, but the benefit was less apparent on mortality. Patients with perineural invasion and multiple concurrent IRFs were found to be at greatest risk, representing a subset of intermediate-risk OSCC patients who may benefit from PORT.     

Genetic polymorphism of interleukin-10 (-A592C) among oral cancer with squamous cell carcinoma

ObjectiveInterleukin-10 (IL-10) is a pleiotropic cytokine with either immunosuppressive or immunostimulative activities. It has been reported that in cancer, the promoter region polymorphism of IL-10 (-A592C) alters both the expression and serum levels of this cytokine. In the present study, we have addressed the question as to whether the single nucleotide polymorphisms (SNPs) at positions −592 A/C in the IL-10 gene promoter, could predispose an individual to oral squamous cell carcinoma (OSCC).DesignWe analyzed the genotype of the IL-10 (-A592C) gene, in 250 histopathologically confirmed OSCC patients and similar number of healthy volunteers taken as controls, in an Indian population by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Allele and genotype frequencies were analyzed by the Student's t-test and the chi-squared test, and strength of associations by the odds ratio (OR) with 95% confidence intervals.ResultsThe genotype and allele distribution of IL-10 (-A592C) gene polymorphism was significantly different between OSCC cases and controls (genotype AA vs AC: OR 2.87; 95 % CI 1.50–5.48; p = 0.0016 and AA vs CC: OR 4.08; 95 % CI 1.98–8.41; p = 0.0002). The −592 C alleles were found to be significantly different among OSCC cases and controls (OR: 1.44, 95% CI: 1.12–1.85, p < 0.0051).ConclusionsThe IL-10 gene promoter region (-592) A/C polymorphism is significantly associated with reduced risk of OSCC. The OSCC group had a significantly greater frequency of genotype AA as compared to control group.     

Extracapsular spread and FDG PET/CT correlations in oral squamous cell carcinoma

The purpose of this study was to evaluate the use of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) to identify extracapsular spread (ECS) with histologic correlations in oral squamous cell carcinoma (OSCC). The medical records of 80 patients who underwent of FDG PET/CT for OSCC before surgery were reviewed. ECS was present in 60% (24/40) dissected necks and in 55% (39/71) of dissected cervical levels. A significant difference was found between the maximum standardized uptake (SUV_max) values of cervical lymph nodes with ECS and without ECS (3.33 ± 1.91 vs. 1.12 ± 1.24, p < 0.001). When receiver operating characteristic (ROC) curve analysis and SUV_max values were used to detect ECS, the area under the ROC curve was 0.864 ± 0.045 (p < 0.001). At an optimal SUV_max cut-off value of 2.25 the sensitivity and specificity were 85% and 88%, respectively. The presence of ECS and a SUV_max > 2.25 had a significant adverse effect on 5-year disease specific survival. A SUV_max > 2.25 was found to be associated with a greater risk of cervical lymph node metastasis in OSCC.     

Evaluation of DNA methylation in matched oral swab and tissue specimens from Chinese patients with oral squamous cell carcinoma

The DNA methylation statuses of the paired box 1 (PAX1) and zinc finger protein 582 (ZNF582) genes have shown promise in the detection of oral squamous cell carcinoma (OSCC). The aim of this study was to investigate the ability of PAX1 and ZNF582 methylation to distinguish OSCC and the adjacent normal tissue among cancer patients. This study included 67 patients with OSCC. The methylation levels of these two genes were analysed in tissue specimens (lesion site and adjacent normal site) and in oral swabs (lesion site and contralateral normal site). Levels of DNA methylation were higher at lesion sites than at the corresponding normal sites. According to receiver operating characteristics curve analysis, the area under the curve for PAX1 and ZNF582 methylation ranged from 0.73 to 0.82. No significant difference was observed between tissue specimens and oral swabs (PAX1, P =  0.41; ZNF582, P = 0.28). For the oral swab, PAX1 methylation was more pronounced in bone invasion (Z = 1.988, P =  0.047), and ZNF582 methylation was more pronounced in early-stage (Z = 2.354, P =  0.02) and well-differentiated tumours (Z = 3.731, P =  0.0002). Hypermethylated PAX1 and ZNF582 are effective biomarkers to distinguish lesion sites and corresponding normal sites in tissue specimens and oral swabs from OSCC patients.     

Indications and outcomes for 100 patients managed with a pectoralis major flap within a UK maxillofacial unit

There are few studies reporting the role of the pedicled pectoralis major (PPM) flap in modern maxillofacial practice. The outcomes of 100 patients (102 flaps) managed between 1996 and 2012 in a UK maxillofacial unit that preferentially practices free tissue reconstruction are reported. The majority (88.2%) of PPM flaps were for oral squamous cell carcinoma (SCC), stage IV (75.6%) disease, and there was substantial co-morbidity (47.0% American Society of Anesthesiologists 3 or 4). The PPM flap was the preferred reconstruction on 80.4% of occasions; 19.6% followed free flap failure. Over half of the patients (57%) had previously undergone major surgery and/or chemoradiotherapy. Ischaemic heart disease (P = 0.028), diabetes mellitus (P = 0.040), and methicillin-resistant Staphylococcus aureus (MRSA) infection (P = 0.013) were independently associated with flap loss (any degree). Free flap failure was independently associated with total (2.0%) and major (6.9%) partial flap loss (P = 0.044). Cancer-specific 5-year survival for stage IV primary SCC and salvage surgery improved in the second half (2005–2012) of the study period (22.2% vs. 79.8%, P = 0.002, and 0% vs. 55.7%, P = 0.064, respectively). There were also declines in recurrent disease (P = 0.008), MRSA (P < 0.001), and duration of admission (P = 0.014). The PPM flap retains a valuable role in the management of advanced disease combined with substantial co-morbidity, and following free flap failure.     

Overexpression of immunosuppressive cytokines is associated with poorer clinical stage of oral squamous cell carcinoma

ObjectiveThe aim of this study was to evaluate the expression of IL-10 and TGF-β2 in oral squamous cell carcinoma (OSCC) and its relationship with prognostic clinical and microscopic parameters.DesignImmunohistochemistry was used to assess the expression of IL-10 and TGF-β2 in OSCC samples from 43 patients who had undergone surgical excision and neck dissection. Metastatic lymph nodes were included in the study (n = 23). Samples of healthy oral mucosa (n = 20) were used as controls. The sections were evaluated using a semi-quantitative method in conjunction with staining intensity.ResultsOur findings showed that the expression of IL-10 and TGF-β2 by neoplastic and stromal cells was high in most of the OSCC samples (>70% of samples), especially when compared to the controls (≅10% of samples) (P < 0.05). OSCC neoplastic cells in cervical lymph nodes were also positive for IL-10 and TGF-β2. An association between high expression of IL-10 by neoplastic cells and advanced clinical stage (T3-T4) was verified (P = 0.02). Although not statistically significant, the expression of TGF-β2 was also augmented in advanced stage tumours.ConclusionsThese data suggest that the ability of OSCC neoplastic cells to secrete immunosuppressive cytokines could contribute to clinical progression by maintaining a microenvironment conducive to evasion and tumour proliferation.     

Phospholipase C gamma 1 is a potential prognostic biomarker for patients with locally advanced and resectable oral squamous cell carcinoma

The aim of this study was to investigate the prognostic and predictive values of phospholipase C gamma 1 (PLCG1) expression in patients with locally advanced and resectable oral squamous cell carcinoma (OSCC), who were treated in a prospective, randomized, phase 3 trial evaluating standard treatment with surgery and postoperative radiation preceded or not by induction docetaxel, cisplatin, and 5-fluorouracil (TPF). Immunohistochemical staining for PLCG1 was performed on the biopsies of 232 out of 256 OSCC patients at clinical stage III/IVA; the PLCG1 positive score was determined by immunoreactive scoring system. The survival analysis was performed by Kaplan–Meier method; hazard ratios were calculated using the Cox proportional hazards model. Patients with a low PLCG1 expression had a significantly better overall survival (P = 0.022), and a trend towards better disease-free survival (P = 0.087), loco-regional recurrence-free survival (P = 0.058), distant metastasis-free survival (P = 0.053), and a high response rate to TPF induction chemotherapy with regard to clinical response (P = 0.052) and pathological response (P = 0.061), compared to those with high PLCG1 expression. Our results suggest that PLCG1 expression could be used as a prognostic biomarker for patients with advanced OSCC; however, it was not an adequate predictive biomarker for TPF induction chemotherapy.     

Effects of postoperative chemotherapy and radiotherapy on patients with squamous cell carcinoma of the oral cavity and multiple regional lymph node metastases

Nodal metastasis in oral squamous cell carcinoma (OSCC) is considered to be a predictor of a poor prognosis. The aim of this study was to investigate the relationship between the number of positive lymph nodes and the prognosis in OSCC patients with nodal metastases and to assess the effects of postoperative radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) on this patient group. A retrospective investigation of 98 patients with OSCC who underwent radical neck dissection and had at least three pathologically positive lymph nodes was performed. The 5-year disease-specific survival rate was 66.7% for patients with 3 positive nodes, while it was significantly lower for those with 4 positive nodes and those with ≥5 positive nodes (21.5% and 46.1%, respectively; P < 0.01). The loco-regional control and disease-specific survival rates for the surgery alone, surgery plus RT, and surgery plus CCRT groups were 46.2% and 40.5%, 66.3% and 54.4%, and 81.7% and 52.4%, respectively. For patients with ≥4 positive nodes, the loco-regional control rate after surgery plus CCRT was better than that observed after surgery alone (77.5% vs. 32.6%, P = 0.01). Postoperative RT and CCRT have positive impacts on the prognosis of OSCC patients with advanced stage neck disease.     

Factors influencing relative speech intelligibility in patients with oral squamous cell carcinoma: a prospective study using automatic,computer-based speech analysis

Oral squamous cell carcinoma (OSCC) and its treatment impair speech intelligibility by alteration of the vocal tract. The aim of this study was to identify the factors of oral cancer treatment that influence speech intelligibility by means of an automatic, standardized speech-recognition system. The study group comprised 71 patients (mean age 59.89, range 35–82 years) with OSCC ranging from stage T1 to T4 (TNM staging). Tumours were located on the tongue (n = 23), lower alveolar crest (n = 27), and floor of the mouth (n = 21). Reconstruction was conducted through local tissue plasty or microvascular transplants. Adjuvant radiotherapy was performed in 49 patients. Speech intelligibility was evaluated before, and at 3, 6, and 12 months after tumour resection, and compared to that of a healthy control group (n = 40). Postoperatively, significant influences on speech intelligibility were tumour localization (P = 0.010) and resection volume (P = 0.019). Additionally, adjuvant radiotherapy (P = 0.049) influenced intelligibility at 3 months after surgery. At 6 months after surgery, influences were resection volume (P = 0.028) and adjuvant radiotherapy (P = 0.034). The influence of tumour localization (P = 0.001) and adjuvant radiotherapy (P = 0.022) persisted after 12 months. Tumour localization, resection volume, and radiotherapy are crucial factors for speech intelligibility. Radiotherapy significantly impaired word recognition rate (WR) values with a progression of the impairment for up to 12 months after surgery.     

Association of the XPD and XRCC3 gene polymorphisms with oral squamous cell carcinoma in a Northeastern Brazilian population: A pilot study

Objectiveto evaluate the association between XPD and XRCC3 polymorphisms and oral squamous cell carcinoma (OSCC).Designthe sample consisted of 54 cases of OSCC and 40 cases of inflammatory fibrous hyperplasia (IFH). Genotypes were determined by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.ResultsXPD-Lys/Gln was more common in IFH (n = 28; 70%) than in OSCC (n = 24; 44.4%) (OR: 0.3; p < 0.05). XPD-Gln was more frequent in high-grade lesions (0.48) than in low-grade lesions (0.21) (OR: 3.4; p < 0.05). The Gln/Gln genotype was associated with III and IV clinical stages (OR: 0.07; p < 0.05). XRCC3-Met was more frequent in OSCC (0.49) than in IFH (0.35) (OR: 2.6; p < 0.05). The Met/Met genotype was associated with the presence of metastases (OR: 8.1; p < 0.05) and with III and IV clinical stages (OR: 0.07; p < 0.05).Conclusionsin this sample, the frequency of XPD-Gln in IFH suggests that this variant may protect against OSCC. The presence of the XRCC3-Met allele seems to contribute to the development of OSCC, metastases and more advanced stages in these lesions.     

Genetic variants in microRNA-146a (C > G) and microRNA-1269b (G > C) are associated with the decreased risk of oral premalignant lesions,oral cancer,and pharyngeal cancer

ObjectiveTo investigate the relationships between two single-nucleotide polymorphisms at miR-146a C > G (rs2910164) and miR-1269b G > C (rs7210937) and the risk of developing oral premalignant lesions (OPLs), oral squamous cell carcinoma (OSCC), pharyngeal SCC (PSCC), and oral and pharyngeal SCC (OPSCC).DesignGenotyping of miR-146a C > G and miR-1269b G > C was performed in two case-control studies using the TaqMan assay. A total of 197 healthy control subjects, 241 OPLs patients, and 188 OPSCC patients who habitually chewed betel quid (BQ) were recruited into one case-control study. Additionally, 668 cancer-free control subjects and 658 OPSCC patients were recruited into the other case-control study.ResultsThe G/G genotype at miR-146a C > G was associated with the decreased risk of OSCC [adjusted odds ratio (AOR) = 0.66, P = 0.040], PSCC (AOR = 0.42, P = 0.013), and OPSCC (AOR = 0.63, P = 0.020). Additionally, the C allelic type and C/C genotype at miR-1269b G > C decreased the risk of BQ-related oral leukoplakia (C vs. G: AOR = 0.68, P = 0.012; C/C vs. G/G: AOR = 0.43, P = 0.009), BQ-related OPLs (C vs. G: AOR = 0.69, P = 0.008; C/C vs. G/G: AOR = 0.44, P = 0.005), and BQ-related OPSCC (C vs. G: AOR = 0.65, P = 0.003; C/C vs. G/G: AOR = 0.47, P = 0.011). In OPSCC patients, the G/G genotype of miR-146a was correlated with well-differentiated cells (P = 0.041), and the G/C and C/C genotypes of miR-1269b were correlated with the absence of lymph node involvement (P = 0.031), especially in OSCC patients (P = 0.038 and P = 0.007, respectively).ConclusionThe genetic variants of miR-146a and miR-1269b are biomarkers against the development of OPLs and OPSCC.     

Determinants of level Ib involvement in oral squamous cell carcinoma and implications for submandibular gland-sparing neck dissection

Traditional neck dissection for oral squamous cell carcinoma (OSCC) involves removal of the submandibular salivary gland. Several studies have cited the low incidence of direct gland invasion by tumours and have recommended gland-sparing neck dissection. In this study, a detailed audit of level Ib involvement in OSCC was performed in order to assess the feasibility of submandibular gland-sparing in neck dissection; the rate of direct involvement by the primary tumours, the involvement of periglandular level Ib nodes, and their determinants were investigated. A total of 586 neck dissection specimens obtained between 2005 and 2014 from patients operated on at the study institution for floor of mouth, tongue, and buccal primaries, were evaluated for direct invasion of the gland and periglandular lymphadenopathy. Of 226 node-positive patients, 21 (9.3%) had direct gland invasion by tumour. Risk factors were tumour diameter >4 cm (P = 0.002) and depth of invasion >10 mm (P = 0.003). Determinants of periglandular lymphadenopathy were depth of invasion >10 mm (P < 0.001), perineural invasion (P = 0.02), lymphovascular invasion (P = 0.014), and moderate/poor differentiation (P < 0.0001). Gland-sparing neck dissection is safe in early tumours (pT1pN0–1), with a good chance of minimizing xerostomia without radiotherapy. Larger tumours without clear evidence of submandibular gland invasion or suspicious level Ib lymphadenopathy may be considered for gland preservation, however the oncological safety is unclear.     

Peripheral blood dendritic cells and vascular endothelial growth factor in oral squamous cell carcinoma: correlation analysis and in vitro study

Vascular endothelial growth factor (VEGF) may cause functional deficiency in dendritic cells (DCs) in vitro. The roles of peripheral blood dendritic cells (PBDCs) and VEGF in patients with oral squamous cell carcinoma (OSCC) are not well understood. The authors analysed the correlation between VEGF and PBDC in 81 OSCC patients. They assessed the effect of VEGF on DC function in vitro. VEGF levels were significantly increased in OSCC patients compared with control subjects (P < 0.05), but PBDC levels were significantly lower (P < 0.05). VEGF expression in TNM I–II (67%) and T1–T2 (74%) was significantly lower, compared with TNM III–IV (88%, P < 0.05) and T3–T4 (89%, P < 0.05). Increased VEGF expression in primary tumours was significantly correlated with elevated serum VEGF levels, but reduced PBDC levels. In vitro cultured DC exposed to VEGF showed significantly decreased expression of functional proteins, enhanced endocytosis activity, and elicited weaker proliferation of T cells, compared with that of free VEGF (P < 0.01). These findings suggest that decreased PBDC and elevated VEGF occur in OSCC patients. Higher VEGF levels may affect precursor cells, resulting in decreased numbers of functional DC.     

Detection of mutation-specific epidermal growth factor receptor (E746–A750del) and lack of detection of human papillomavirus in oral squamous cell carcinoma

The clinical impact of epidermal growth factor receptor (EGFR) (E746–A750del) mutation and human papillomavirus (HPV) in oral squamous cell carcinoma (OSCC) is unclear. EGFR (E746–A750del) expression was analyzed in OSCC specimens (n = 161) by immunohistochemistry. The expression results were correlated with clinical characteristics and impact on survival. Using INNO-LiPA Extra, high-risk HPV types were genotyped and analyzed in 211 OSCC specimens. Positive EGFR (E746–A750del) expression (n = 40/161, 25%) was not associated with any clinicopathological characteristics, prognostic factors, social habits (smoking, alcohol consumption), or tumour-specific survival. HPV16 DNA was detected in three out of 211 samples (HPV16-positive: n = 3/211, 1.4%). This study shows that mutation-specific EGFR (E746–A750del) expression and HPV do not appear to be relevant to the survival of patients with OSCC.     

Changing face of orofacial pain: The diagnostic impact of working with Neurology on an orofacial pain clinic

This study assessed the impact of collaborative working with a headache neurologist on diagnoses of patients attending orofacial pain (OFP) clinic. Patient diagnostic data was collected from adult patients attending an Orofacial Pain Service from January 2013 to January 2017. A liaison headache neurologist was appointed late 2015; OFP clinics were co-run with the neurologist specialist thereafter. Overall, 639 patients attended the service; 315 in 2013–2015 and 324 in 2016–2017. Compared to 2013–2015, there were increased rates of diagnoses related to neurovascular (27.5% vs. 19.0%; P = .012) and musculoskeletal pain (36.9% vs. 26.0%; P = .003) in the 2016–2017 cohort and decreased rates of neuropathic (55.6% vs. 70.2%; P < .001) and atypical/idiopathic pain (1.3% vs. 5.4%; P = .003) diagnoses. There was a trend towards an increased rate of comorbid diagnoses (26.3% vs. 20.3%; P = .077), especially those relating to headache conditions. The findings suggest that introduction of a specialist headache neurologist into the OFP clinic widened its remit of assessment, increasing recognition of (co-morbid) neurovascular-related pain and decreasing atypical/idiopathic pain diagnoses in patients with complex OFP. The increase rate of musculoskeletal pain diagnosis in the later cohort is likely attributable to service expansion and normalisation of diagnostics reportedly seen in other OFP services.Statement of clinical relevance: Orofacial pain is a complex diagnosis, it requires a multidisciplinary approach that includes neurological input.     

Perioperative evaluation of glycaemic status in neck dissection: a retrospective analysis at a single hospital centre

Diabetes mellitus is generally considered a risk factor for impaired wound healing. This study aimed to evaluate the glycaemic status of patients undergoing neck dissection and describe its impact on postoperative outcomes, especially wound healing. A retrospective analysis was performed of the preoperative, intraoperative, and postoperative glycaemic data obtained from the medical charts of 60 adult patients who had undergone 64 neck dissections. Nine of the 64 procedures were performed in diabetic patients (14.1%). The average glucose values were: preoperative 5.99 ± 1.25 mmol/l, intraoperative 8.90 ± 2.62 mmol/l, and postoperative 10.01 ± 2.49 mmol/l. All registered preoperative hyperglycaemia cases (eight cases) were diabetic. Postoperative insulin therapy was done in 14 procedures (21.9%). Wound healing complications were found in five patients (7.8%); there was no wound infection. There was no association of wound healing complications with preoperative diabetic status (P = 1.000), preoperative glucose control (P = 1.000), preoperative (P = 0.469), intraoperative (P = 0.248), and postoperative (P = 0.158) glucose values, or with postoperative glucose control (P = 0.577). These data do not support the association of stress-induced hyperglycaemia or diabetes mellitus with postoperative wound healing problems in neck dissection.     

Early intra-articular injection of alendronate reduces cartilage changes and subchondral bone loss in rat temporomandibular joints after ovariectomy

This study investigated the effects of intra-articular injection of alendronate on the mandibular condyle in ovariectomized rats. Sixty rats were divided into five groups: ovariectomy with vehicle treatment alone, early alendronate treatment at ovariectomy, late alendronate treatment at 4 weeks after ovariectomy, sham-operation with vehicle treatment, and normal controls. The changes in cartilage and subchondral bone were evaluated by micro-computed tomography, histology, tartrate-resistant acid phosphatase (TRAP) staining, immunohistochemistry, and real-time quantitative polymerase chain reaction. Compared with late alendronate treatment, early alendronate treatment completely inhibited cartilage thickening (727.6 ± 39.3 vs. 1013.3 ± 51.6; P = 0.017) and improved microstructural properties of the subchondral bone, with a higher bone volume ratio (46.4 ± 2.5 vs. 37.5 ± 2.1; P = 0.038), trabecular thickness (47.3 ± 1.7 vs. 34.6 ± 1.4; P = 0.029), and trabecular number (8.5 ± 0.6 vs. 6.2 ± 0.3; P = 0.041) and lower trabecular separation (30.2 ± 1.6 vs. 37.7 ± 2.6; P = 0.034). Fewer TRAP-positive cells (4.2 ± 0.2 vs. 6.8 ± 0.4; P = 0.019) and a higher OPG/RANKL ratio (0.38 ± 0.01 vs. 0.25 ± 0.03; P = 0.043) in the subchondral bone were observed in the animals with early treatment compared to late treatment or ovariectomy/vehicle treatment. In addition, early alendronate treatment blocked the up-regulation of matrix metalloproteinase (MMP)-13 expression in the chondrocytes, whereas late alendronate treatment attenuated the up-regulation of MMP-13 expression. Our results suggest the therapeutic potential of intra-articular alendronate injection in the treatment of osteoporosis-associated temporomandibular disorders.     

Sinonasal squamous cell carcinomas: Clinical outcomes and predictive factors

This was a retrospective study of 33 patients treated for sinonasal squamous cell carcinoma between 1995 and 2008. Epidemiological, clinical, histological, and therapeutic aspects of this series of patients were analysed, and their impacts on overall survival and disease-free survival established using the Kaplan–Meier method. A search for prognostic factors was made using a log-rank test. There were 27 men. The average age at diagnosis was 64.7 years. Tobacco-smoking was found to be a risk factor in 24 patients (72.7%). The median follow-up was 66 months (range 0–99 months). Tumours were classified as T1 in 18.3%, T2 in 27.3%, T3 in 6%, and T4 in 48.5% of cases. Disease-free survival rates at 1 and 5 years were 58.5% and 46.1%, respectively, and overall survival rates were 70.3% and 40%, respectively. Overall survival was correlated to tumour status (TNM, American Joint Committee on Cancer) (P = 0.010) and involvement of key structures (skull base, dura mater, brain, orbit, cavernous sinus, infratemporal fossa, skin) (P = 0.049). Surgery followed by radiotherapy improved overall survival (P = 0.005) and disease-free survival (P = 0.028) when compared to other treatment modalities. When compared to surgery alone, it improved disease-free survival (P = 0.049) regardless of tumour stage.