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.     

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.     

The influence of 2020 coronavirus lockdown on presentation of oral and maxillofacial trauma to a central London hospital

The novel coronavirus COVID-19 was first identified in China in December 2019. Its spread resulted in a pandemic, with the United Kingdom entering a period of national lockdown on 23 March 2020 to reduce disease burden on the National Health Service (NHS). King’s College Hospital is a Major Trauma Centre serving an inner-city population of 700,000 with 120,000 patients attending the emergency department (ED) annually. We aimed to determine the effect of lockdown on OMFS trauma presentations and lessons learned from emergency service provision during a pandemic. All referrals to the oral and maxillofacial surgical (OMFS) team from ED during the first six weeks of the lockdown period – 23 March 2020 - 3 May 2020 – were compared with the same six-week period in 2019. A total of 111 referrals were made to OMFS during the first six weeks of the lockdown period in 2020 compared with 380 referrals in 2019. Of these, 50.5%, (n = 192) were related to facial trauma in 2019 vs (63.1%, n = 70) in 2020. Fewer patients were admitted under OMFS: 17.4% (n = 35) in 2019 vs 2.9% (n = 2) in 2020, and a greater number of patients were discharged from OMFS care directly from the ED: 63.2% (n = 127) in 2019 vs 82.9% (n = 58) in 2020. There was profound effect of the lockdown on referrals to OMFS from the ED, in number and type of diagnosis. This is potentially reflective of the increased availability of acute/emergency dental services in South-East London during the lockdown period. This gives us valuable insight for service planning in the event of further restrictions.     

Identification of appropriate outcome indices in head and neck cancer and factors influencing them

Audit of early postoperative outcomes adjusted for patient case mix is still in its infancy in head and neck surgery. Nevertheless the role for audit of early postoperative outcomes is obvious. The primary outcome measure of this study was to identify factors that are associated with early mortality or morbidity after surgery for head and neck squamous cell carcinoma (HNSCC). The secondary outcome measure was to develop a pilot score that allows for risk-adjustment of outcome data to facilitate departmental audit. In this series the mortality rate was low (2.8%), in keeping with other published series. Complications, including those causing death, occurred after 38.1% of operations. Independent risk factors for mortality on logistic regression were shown to be previous HNSCC (P = 0.03), estimated blood loss (l) (P = 0.03), and extracapsular spread (P = 0.05). Age (P = 0.01), tracheostomy (P < 0.01), estimated blood loss (l) (P = 0.05), and duration of anaesthesia (P < 0.01) were independent predictors of complications. Models predicting for risk demonstrated good discrimination (area under the curve statistics) for mortality (0.86) and morbidity (0.81). These pilot scores need external validation and may herald a means of facilitating risk-adjustment in the audit of early outcomes, allowing meaningful comparison of surgeons and their units over time.     

Head and neck cancer surgery in an elderly patient population: a retrospective review

Should advanced age be a contraindication to the surgical management of head and neck cancer patients? A retrospective chart review was performed of patients aged ≥80 years treated surgically for a head and neck malignancy during the period 1996–2011 in a tertiary care cancer centre. The average follow-up was 32 months. Fifty-three patients were identified (mean age 85 years). Cardiovascular disease was the most prevalent co-morbidity (43%). Forty-five patients (85%) had oral cavity/oropharynx squamous cell carcinoma. Surgeries performed included 40 neck dissections and 12 microvascular free flaps. The average length of hospital stay (LOS) was 6.4 days. An increased LOS was significant in patients requiring free flap reconstruction (P < 0.01). There were no perioperative deaths or free flap failures. The most common postoperative complications were cardiovascular (n = 8), infection (n = 10), and delirium (n = 6). Thirty-four patients were discharged directly home. Free flap reconstruction did not adversely affect discharge disposition (P > 0.05). More than 75% of patients did not report any major limitations to their activities of daily living. Major head and neck surgical procedures can be tolerated by patients of advanced age using careful patient selection. Age alone should not be a primary factor in the management of head and neck cancer patients.     

Quality assessment of clinical practice guidelines used in oral and maxillofacial surgery

An assessment of the quality of oral and maxillofacial surgery clinical practice guidelines is lacking. The aim of this investigation was to assess the quality of guidelines using the RIGHT (Reporting Items for practice Guidelines in HealThcare) checklist. The primary outcome was to assess the score (quality) of guidelines based on the RIGHT checklist and to identify predictors (region, type, single or multi-centre, and speciality/non-speciality) influencing the quality score. In this review, following a search of electronic databases and national society websites, a total of 25 guidelines were independently assessed by two assessors against the 22-item RIGHT checklist. Inter-assessor reliability was assessed. Deficiencies in the reporting of items relating to limitations, funding, declaration and management of interests, healthcare questions, and quality assurance were evident. The median overall score for the guidelines was 28 (range 14–66). Guidelines produced by multiple centres (β = 57.15, 95% confidence interval −26.62 to 87.68, P =  0.001, multivariate analysis) and non-speciality societies (β = 20, 95% confidence interval −0.03 to 40.03, P = 0.05, univariate analysis) tended to have higher quality scores. Overall, the quality of clinical practice guidelines used in oral and maxillofacial surgery was deemed suboptimal. If clinical practice guidelines are to be used in making treatment decisions for patients, clinicians should be aware of their possible limitations.     

The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: a systematic review and meta-analysis

Reconstructive surgery with a free vascularised tissue flap is indicated in large defects in the head and neck region, which arise mostly because of head and neck cancer. Tobacco smoking is a major risk factor for head and neck cancer, and many patients undergoing reconstructive surgery in the head and neck have a history of smoking. The objective of this meta-analysis was to determine the impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap. A systematic review was undertaken for articles reporting and comparing the incidence of overall surgical complications after reconstructive surgery with a free vascularised tissue flap between smokers and nonsmokers. Relevant articles were searched using PubMed, Cochrane, and Embase databases, and screened for eligibility according to the PRISMA guidelines. The risk of bias analysis was conducted using the Newcastle-Ottawa quality assessment scale. A meta-analysis was performed to quantitatively compare the incidence rate of overall surgical complications, flap failure, surgical site infection, fistula, and haematoma between smokers and nonsmokers using OpenMetaAnalyst (open source) software. Only qualitative analysis was performed for wound dehiscence, bleeding, nerve injury, and impaired wound healing. Forty-six articles were screened for eligibility; 30 full texts were reviewed, and 19 studies were included in the quantitative meta-analysis. From the 19 studies, 18 were retrospective and 1 was a prospective study. In total, 2155 smokers and 3124 nonsmokers were included in the meta-analysis. Smoking was associated with a significantly increased risk of 19.12% for haematoma (95% Confidence Interval (CI): 4.75–33.49; p < 0.01), and of 4.57% for overall surgical complications (95% CI: 1.97–7.15; p < 0.01). No significant difference in risk was found for flap failure (95% CI: ?4.33–9.90; p = 0.44), surgical site infection (95% CI: ?0.88–2.60; p = 0.33) and fistula formation (95% CI: ?3.81–3.71; p = 0.98) between smokers and nonsmokers. Only for flap failure was a significant heterogeneity found (I² = 63.02%; p = 0.03). Smoking tobacco was significantly associated with an increased risk of overall surgical complications and haematoma, but did not seem to affect other postoperative complications. Encouraging smoking cessation in patients who need reconstructive head and neck surgery remains important, but delaying surgery to create a non-smoking interval is not needed to prevent the investigated complications. More high-quality retrospective or prospective studies with a standardised protocol are needed to allow for definitive conclusions.     

Head and neck surgery is a risk factor for atrial fibrillation: incidence and outcomes

Atrial fibrillation (AF) is the most common postoperative arrhythmia and can cause increased length of stay, costs, morbidity, and mortality. Little information exists about postoperative AF after major head and neck surgery, but it is thought to occur more frequently than after surgery at other extra-thoracic sites. A retrospective cohort study was implemented, including patients who had undergone major head and neck surgery and who had follow-up records covering a minimum of 60 days postoperative. The main outcome was the incidence of new onset postoperative AF after major head and neck surgery; secondary outcomes were the incidence of any AF, the role of cardiology, predictors of AF postoperatively, and clinical outcomes. A total 337 patients were included. Twenty-four patients experienced AF postoperatively (7.1%), of whom 12 (3.6%) had new onset AF. New onset AF was associated with advanced age of ≥65 years (odds ratio 11.6, P = 0.027) and having a laryngectomy (odds ratio 9.9, P = 0.003). Postoperative AF following major head and neck surgery is not a rare phenomenon and can be associated with considerable morbidity and costs due to the need for intensive care, specialty consultations, additional testing and laboratory studies, and cardiology follow-up.     

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.     

The value of reconstructive surgery in the management of refractory jaw osteoradionecrosis: a single-center 10-year experience

Mandibular osteoradionecrosis (mORN) is a severe complication of head and neck irradiation. International consensus on the management of mORN is currently lacking. The present study sought to evaluate the effectiveness and benefits of early reconstructive surgery (resection of the diseased bone and immediate reconstruction with a free flap) in treatment-refractory mORN. A single-center retrospective study was carried out of operations performed in a French university medical center between 2003 and 2013 inclusive. For each patient, the surgical modalities and postoperative outcomes were recorded. A total of 55 operations (19 marginal resections and 36 segmental resections) were performed, and the overall success rate was 92.3%. Relative to marginal resections, segmental resections were associated with longer operating times (440 ± 62 min vs. 531 ± 72 min, respectively; P < 0.05 in Student’s t-test), a longer length of hospital stay (16.5 ± 6.5 days vs. 25.6 ± 11.3 days, respectively; P < 0.05), and a higher complication rate (26.3% vs. 63.9%, respectively; P < 0.05 in Fisher’s test). Given the unpredictable progression of treatment-refractory mORN and the risk–benefit ratio observed here, the value of early reconstructive surgery with curative intent should be reassessed.     

Airway changes and prevalence of obstructive sleep apnoea after bimaxillary orthognathic surgery with large mandibular setback

This study used three-dimensional computed tomography and polysomnography to evaluate the effect of a large mandibular setback on the postoperative pharyngeal airway space and obstructive sleep apnoea (OSA). Twelve patients who underwent bimaxillary surgery for a mandibular setback movement of >9 mm were included in this study. Changes in the pharyngeal airway space and polysomnography parameters based on the surgical movements were analyzed. The median mandibular setback movement was 11.08 mm. The total pharyngeal, oropharyngeal, and hypopharyngeal volumes, and the retroglossal cross-sectional area were significantly decreased postoperatively (P = 0.006; P = 0.005; P = 0.012; P = 0.005, respectively). The apnoea–hypopnoea index (AHI) increased significantly after surgery (P = 0.021). There were significant positive correlations between the preoperative inferiorly located hyoid bone and both AHI and respiratory disturbance index (RDI) postoperative (P = 0.008 and P = 0.027) and between the postoperative inferiorly dislocated retropalatal level and both AHI and RDI postoperative (P = 0.002 and P = 0.014). Four patients (33.3%) developed new onset OSA postoperatively. Large mandibular setback movements significantly reduced the pharyngeal airway space in the setting of bimaxillary surgery (P = 0.006).     

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.     

Incidence of bleeding after minor oral surgery in patients on dual antiplatelet therapy: a systematic review and meta-analysis

Bleeding is a feared complication of minor oral surgery in patients on treatment with antiplatelet agents and there is no agreed strategy regarding the cessation or not of antiplatelet treatment. The aim of this systematic review was to evaluate bleeding with minor oral surgery in patients on dual antiplatelet therapy (DAPT), single antiplatelet therapy (SAPT), or no antiplatelet therapy (no APT). The PubMed, Embase, Web of Science, and Cochrane Library databases were screened. Sixteen studies were included. DAPT was continued in all studies. The perioperative bleeding risk was significantly higher for DAPT than for SAPT (risk ratio (RR) 10.16, P =  0.010; risk difference (RD) 0.35, P =  0.269), but not higher compared to no APT (RR 6.50, P =  0.057; RD 0.19, P =  0.060). The postoperative bleeding risk was significantly elevated for DAPT compared to SAPT (RR 2.61, P =  0.010) and no APT (RR 3.63, P =  0.035), but only by 1% (RD 0.01, P =  0.103) and 1% (RD 0.01, P =  0.421), respectively. Clinically, this may be considered quite similar. Additionally, local haemostatic measures could control all reported bleeding and no lethal events occurred. Therefore, DAPT interruption is not advised before minor oral surgery.     

Study on the lateral pterygoid muscle status after artificial temporomandibular joint replacement

The purpose of this study was to explore the status of the lateral pterygoid muscle (LPM) after detachment in artificial temporomandibular joint replacement (TJR) surgery. Patient clinical and computed tomography imaging data were collected before and after unilateral artificial TJR with LPM detachment. The volume of the LPM on the operated and unoperated sides was measured before and after surgery (at 1, 3, 6, 12 months) using ProPlan CMF 3.0 software. The volumes of the LPM on both sides, the patient’s mandibular movements, quality of life (QoL), and pain and diet scores (visual analogue scales) were evaluated and compared at the different follow-up stages. Ten patients were included in the study. After surgery, the volume of the operated LPM was significantly reduced to 60.78% at 3 months (P = 0.007), and gradually stabilized to 51.58% at 6 months (P = 0.025) and 54.68% at 1 year postoperative (P = 0.002). There were no significant LPM volume changes on the unoperated side (P = 0.67). Lateral movement of the operated joint was significantly reduced (P = 0.021) and correlated with the LPM volume change after surgical detachment (P = 0.042). The LPM shrank after detachment in the artificial TJR surgery and the muscle detachment affected the movement of the replaced joint.     

Prognostic value of elective neck dissection in adenoid cystic carcinoma of head and neck: a meta-analysis: A call for randomized trials and international consensus

Adenoid cystic carcinoma of head and neck (AdCCHN) is an uncommon salivary gland cancer characterized for infrequent neck metastases, and high rate of local and distant recurrence. The aim of this meta-analysis was to analyse the significance of elective neck dissection (END) in terms of overall survival (OS) in patients with AdCCHN. A systematic literature search and meta-analysis was performed. Endpoint assessed by this meta-analysis included 5-year OS (death from any cause). Statistical heterogeneity was assessed using the Cochrane Q test and I² statistic. A pooled odds ratio (OR) was reported with 95% confidence interval (CI). There were 1934 patients in the END arm and 3083 in the observation group. The pooled OR, calculated for END vs. observation, was 0.94. Patients receiving END had similar risk for death compared to observation cohort (P = 0.76). No significant difference in final outcome after patient stratification based on T stage was identified (OR for T1/T2 1.27, P = 0.39; OR for T3/T4 0.95, P = 0.90). Observation for cN0 neck is a reasonable option in AdCCHN. These findings suggest the need for prospective trials on indications and extent of END in AdCCHN.     

Predictive factors in temporomandibular joint arthroscopy: a prospective cohort short-term outcome study

Improving the outcomes of surgical treatment of the temporomandibular joint (TMJ) is beneficial from a patient and health-economy perspective. Optimizing conditions for a successful result can be reached using validated, strict diagnostic criteria and by identifying patient-specific factors predicting the outcome. The aim of this study was to investigate possible predictive factors in TMJ arthroscopy. A prospective cohort study including 93 patients undergoing arthroscopy was conducted. The outcome was graded as successful (53%, n = 49), good (25%, n = 23), intermediate (20%, n = 19), or deteriorated (2%, n = 2) using a predefined set of objective and subjective outcome measures. The outcome was correlated with preoperative and perioperative variables and the diagnosis. Preoperative bilateral masticatory muscle tenderness on palpation was the only variable significantly correlated with a negative outcome in the adjusted regression analysis (odds ratio (OR) 2.56, P = 0.048). Low age (OR 1.03, P = 0.05) and bilateral joint surgery/operated side (OR 0.24, P = 0.05) were found to correlate with an unsuccessful outcome in the unadjusted analysis. Eighty-nine percent of the patients with osteoarthritis benefited from arthroscopy, while corresponding figures were 80% for disc displacement without reduction and 64% for chronic inflammatory arthritis. Preoperative bilateral masticatory tenderness might be a useful predictive factor suggesting the consideration of revised non-invasive therapy before surgery.     

Oral squamous cell carcinoma with microscopic extracapsular spread in the cervical lymph nodes

The purpose of this study was to determine the detailed background of cases of oral squamous cell carcinoma (OSCC) with microscopic extracapsular spread (ECS) in the cervical lymph nodes. The cases of 78 patients with primary OSCC, who attended hospital from October 2007 to July 2011 and underwent resection of the primary tumour with neck dissection, were reviewed. The subjects were classified into three categories: pN0, pN+/ECS−, and pN+/ECS+; the outcomes of pN+/ECS+ patients were compared in detail with those of the other categories. Thirty-one cases (39.7%) were pN0, 25 cases (32.1%) were pN+/ECS−, and 22 cases (28.2%) were pN+/ECS+. The 3-year overall survival rate was 82.1% in pN0, 74.1% in pN+/ECS−, and 39.8% in pN+/ECS+ (pN0 vs. pN+/ECS+, P = 0.0004; pN+/ECS− vs. pN+/ECS+, P = 0.0086). The 3-year disease-specific survival rate was 96.2% in pN0, 77.2% in pN+/ECS−, and 39.8% in pN+/ECS+ (pN0 vs. pN+/ECS+, P < 0.0001; pN+/ECS− vs. pN+/ECS+, P = 0.0038). Patients with poorly differentiated carcinoma, those with three or more ECS+ nodes, and those with ECS+ node(s) located at levels III, IV, and V, had the worst prognosis among pN+/ECS+ subjects.     

Systematic review and meta-analysis of tracheostomy outcomes in COVID-19 patients

A systematic review and meta-analysis of the entire COVID-19 Tracheostomy cohort was conducted to determine the cumulative incidence of complications, mortality, time to decannulation and ventilatory weaning. Outcomes of surgical versus percutaneous and outcomes relative to tracheostomy timing were also analysed. Studies reporting outcome data on patients with COVID-19 undergoing tracheostomy were identified and screened by 2 independent reviewers. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Outcome data were analysed using a random-effects model. From 1016 unique studies, 39 articles reporting outcomes for a total of 3929 patients were included for meta-analysis. Weighted mean follow-up time was 42.03 ± 26 days post-tracheostomy. Meta-analysis showed that 61.2% of patients were weaned from mechanical ventilation [95%CI 52.6%–69.5%], 44.2% of patients were decannulated [95%CI 33.96%–54.67%], and cumulative mortality was found to be 19.23% [95%CI 15.2%–23.6%] across the entire tracheostomy cohort. The cumulative incidence of complications was 14.24% [95%CI 9.6%–19.6%], with bleeding accounting for 52% of all complications. No difference was found in incidence of mortality (RR1.96; p = 0.34), decannulation (RR1.35, p = 0.27), complications (RR0.75, p = 0.09) and time to decannulation (SMD 0.46, p = 0.68) between percutaneous and surgical tracheostomy. Moreover, no difference was found in mortality (RR1.57, p = 0.43) between early and late tracheostomy, and timing of tracheostomy did not predict time to decannulation. Ten confirmed nosocomial staff infections were reported from 1398 tracheostomies. This study provides an overview of outcomes of tracheostomy in COVID-19 patients, and contributes to our understanding of tracheostomy decisions in this patient cohort.     

Influence of tumour necrosis factor alpha on epithelial–mesenchymal transition of oral cancer cells in co-culture with mesenchymal stromal cells

Tumour progression in head and neck squamous cell carcinoma (HNSCC) is influenced by the surrounding stroma and inflammatory cytokines such as tumour necrosis factor alpha (TNF-α). The aim of this study was to test the hypothesis that TNF-α modulates the interactions of HNSCC cell line PCI-13 and bone marrow mesenchymal stromal cells (BMSCs) and influences markers of epithelial–mesenchymal transition (EMT). Following induction with TNF-α, mono- and co-cultures of BMSCs and the established HNSCC cell line PCI-13 were analyzed; protein expression of E-cadherin and vimentin and qRT-PCR expression of Snail, Twist, MMP14, vimentin, E-cadherin, and β-catenin were examined, and changes in cellular AKT signalling were analyzed. TNF-α induced a significant decrease in E-cadherin (64.5 ± 6.0%, P = 0.002) and vimentin (10.4 ± 3.5%, P = 0.04) protein expression in co-cultured PCI-13, while qRT-PCR showed a significant increase in β-catenin (BMSCs P < 0.0001; PCI-13 P = 0.0005) and Snail (BMSCs P = 0.009; PCI-13 P = 0.01). TNF-α also resulted in a down-regulation of AKT downstream targets S6 (38.7 ± 20.9%, P = 0.01), p70S6 (16.7 ± 12%, P = 0.05), RSK1 (23.6 ± 28.8%, P = 0.02), and mTOR (27.4 ± 17.5%, P = 0.004) in BMSC co-cultures. In summary, while reducing the expression of vimentin and AKT-signalling in PCI-13 and BMSC, respectively, TNF-α introduced an inflammatory-driven tumour–stroma transition, marked by an increased expression of markers of EMT.     

Impact of the COVID-19 lockdown on the epidemiology of maxillofacial trauma activity: a French multicentre comparative study

The coronavirus disease 2019 (COVID-19) outbreak has had a major impact on medical and surgical activities. A decline in facial trauma incidence was noticed during the lockdown period. The aim of this study was to evaluate the decline in maxillofacial trauma in France during this particular period. A retrospective multicentre comparative study was initiated in 13 major French public hospital centres. The incidence of facial trauma requiring surgery during the first month of lockdown was compared to that during equivalent periods in 2018 and 2019. Differences in the types of trauma were also analysed. Thirteen maxillofacial departments participated in the study. A significant decline in maxillofacial trauma volumes was observed when compared to equivalent periods in 2018 and 2019 (106 patients compared to 318 and 296 patients, respectively), with an average reduction of 65.5% (P = 0.00087). The proportion of trauma due to sports and leisure was reduced when compared to reports in the literature. As a consequence, in the context of a pandemic, the material and human resources related to this activity could be reallocated to the management of other pathologies that cannot be postponed.