1/289. Microsurgical reconstruction in recurrent oral cancer: use of a second free flap in the same patient.Primary microsurgical reconstruction is the treatment of choice for ablative defects of oral carcinoma. As a result of this trend, more and more patients with recurrent oral carcinoma who have been initially treated with surgical excision and reconstructed with free flaps are being seen. However, a second microsurgical reconstruction attempt in these cases raises questions about the flap choices, availability of recipient vessels, and effects of previous treatment modalities. Herein, 35 patients with perioral carcinoma who had two successive tumor resections and reconstruction with free flaps on each occasion are presented. A total of 75 free tissue transfers were carried out for the first and second reconstructions. After the first tumor resection, 28 radial forearm fasciocutaneous flaps, 7 fibula osteoseptocutaneous flaps, 1 iliac osteomyocutaneous flap, and 2 rectus abdominis myocutaneous flaps were used. For reconstruction after the recurrence, 17 radial forearm fasciocutaneous flaps, 13 fibula osteoseptocutaneous flaps, 3 rectus abdominis myocutaneous flaps, 2 anterolateral thigh flaps, 1 jejunum flap, and 1 tensor fasciae latae flap were used. More vascularized bone transfers were performed during the second reconstruction since the excision for the recurrence frequently required segmental mandibulectomy. The complete flap survival rate was 97.3 percent and 94.6 percent with a reexploration rate of 7.9 percent and 13.5 percent for the first and second free tissue transfers, respectively. The mean follow-up time throughout the procedures was 37.5 months. disease-free interval between reconstructions was 20.8 months. At the time of evaluation, 54.3 percent of the patients were surviving an average of 19 months since the second reconstruction. The results suggest that free flaps represent an important option in reconstruction of recurrent perioral carcinoma cases undergoing reexcision. When used in this indication they are as safe and effective as the initial procedure.- - - - - - - - - - ranking = 1keywords = carcinoma (Clic here for more details about this article) |
2/289. Free fibula osteoseptocutaneous-pedicled pectoralis major myocutaneous flap combination in reconstruction of extensive composite mandibular defects.Lateral composite mandibular defects resulting from excision of advanced oral carcinoma often require mandible, intra-oral lining, external face, and soft-tissue bulk reconstruction. Ignorance of importance soft-tissue deficit in those patients may cause significant morbidity and functional loss. Such defects, therefore, can be reconstructed best with a double free flap technique. However, this procedure may not be feasible for every patient or surgeon. An alternative procedure is a free fibula osteoseptocutaneous flap combined with a pedicled pectoralis major myocutaneous flap. This combination was used in reconstruction of extensive composite mandibular defects in 14 patients with T3/T4 oral squamous cell carcinoma. All patients were men, and the average age was 54.3 years. The septocutaneous paddle of the fibula flap was used for the mucosal lining of the defects while the bony part established the rigid mandibular continuity. The pectoralis major flap then covered the external skin defect in the face and cheek, and the dead spaces left by the extirpated masticator muscles, buccal fat, and parotid gland. One free fibula flap failed totally, and one pectoralis major flap developed marginal necrosis. At the time of final evaluation, nine patients (64.3 percent) were alive, surviving an average of 25.7 months. All patients eventually regained their oral continence and an acceptable cosmetic appearance. In conclusion, the fibula osteoseptocutaneous flap plus regional myocutaneous flap choice is a successful and technically less demanding alternative to the double free flap procedures in reconstruction of extensive lateral mandibular defects.- - - - - - - - - - ranking = 0.5keywords = carcinoma (Clic here for more details about this article) |
3/289. An unusual case of epithelial-myoepithelial carcinoma of the liver.The authors present an unusual case of an epithelial-myoepithelial carcinoma of the liver in a 67-year-old man who was admitted for resection of a gastric adenocarcinoma. At operation, a 3 x 3 cm mass in the right liver lobe was also removed. This mass consisted of duct-like structures with dual differentiation. The inner layer was composed of an epithelial lining, and the outer layer consisted of clear cells, all unrelated to the moderately well-differentiated gastric adenocarcinoma. The clear cells were positive for S-100 and alpha-smooth muscle actin, suggesting myoepithelial origin. The mass was considered to be low-grade epithelial-myoepithelial carcinoma. However, the patient had a history of an oral nodule present since childhood, resected 10 years previously. These slides were reviewed and revealed a mixture of clear cells and basal cells with squamous differentiation. In addition, there were duct-like structures with the two-layer pattern found in the liver tumor. This tumor had numerous mitotic figures and showed perineural invasion, suggesting a high grade of malignancy. These findings led to an interpretation of the oral tumor as also being epithelial-myoepithelial carcinoma, which had remained as "benign" for more than 50 years and subsequently underwent malignant transformation. During this long period, liver metastases may have occurred and remained low-grade. Alternatively, the liver and oral tumors may have arisen separately in the foregut during embryologic development, remaining low-grade until malignant transformation occurred.- - - - - - - - - - ranking = 2.260451113621keywords = carcinoma, adenocarcinoma (Clic here for more details about this article) |
4/289. Adenosquamous carcinoma of the mouth: a rare variant of squamous cell carcinoma.Adenosquamous carcinoma is a rare tumour in the oral cavity and is characterised histologically by carcinomatous change in surface epithelium, in association with adenocarcinoma affecting the ducts of minor salivary glands. Only a dozen cases have previously been reported in the oral cavity, but all have shown an aggressive course with 60% of patients dying of disease. We report three further cases and review the literature, which suggests that this lesion should be regarded as a high-grade variant of squamous cell carcinoma.- - - - - - - - - - ranking = 3.0052255568105keywords = carcinoma, adenocarcinoma (Clic here for more details about this article) |
5/289. Customized mold brachytherapy for oral carcinomas through use of high-dose-rate remote afterloading apparatus.OBJECTIVE: The aim of this study was to investigate the role of the combined use of customized molds and recently available remote afterloading brachytherapy apparatus with more flexible catheters in the treatment of superficial oral carcinomas. STUDY DESIGN: Four patients with oral squamous cell carcinoma who were treated through use of this combined technique were analyzed retrospectively. The molds were made from transparent acrylic resin through use of a dental technique. The combined approach was applied as a boost therapy after external irradiation. RESULTS: The 4 patients had had no recurrence of tumor or radiation injury by the end of the follow-up period. CONCLUSIONS: The combined technique could be an excellent method of treating superficial carcinomas of the oral cavity.- - - - - - - - - - ranking = 1.75keywords = carcinoma (Clic here for more details about this article) |
6/289. Basaloid squamous cell carcinoma of oral cavity and oropharynx.Basaloid squamous cell carcinoma is a variant of squamous cell carcinoma with distinctive histological and immunohistochemical characteristics and aggressive behaviour involving predominantly the upper aerodigestive tract. We describe the clinicopathological findings, along with immunohistochemical investigations, in 5 new cases with carcinoma localized in oral cavity and oropharynx.- - - - - - - - - - ranking = 1.75keywords = carcinoma (Clic here for more details about this article) |
7/289. Proliferative verrucous leukoplakia: report of two cases and a discussion of clinicopathology.Proliferative verrucous leukoplakia (PVL) is a recently delineated but poorly recognized form of multifocal leukoplakia that is premalignant and of unproven origin. PVL generally presents as a simple benign form of hyperkeratosis that tends to spread and become diffuse. Although slow-growing, the disease is persistent and irreversible. Clinically, PVL often presents as an exophytic wart-like form of leukoplakia that appears to be resistant to nearly all forms of therapy. PVL of the oral cavity is best-defined as a continuum of oral epithelial disease with hyperkeratosis at one end of a clinical and microscopic spectrum and verrucous carcinoma or squamous cell carcinoma at the other. The microscopic findings associated with PVL are dependent on the stage of the disease and the adequacy of the biopsy. Microscopic findings can be markedly variable. PVL is a clinicopathologic disorder that includes the microscopic entity known as verrucous hyperplasia as a component of its histopathologic progression. This article reports on two cases of PVL, describes the clinicopathology of the disease process, and presents therapeutic and etiologic considerations.- - - - - - - - - - ranking = 0.5keywords = carcinoma (Clic here for more details about this article) |
8/289. High dose rate microselectron mould ratiotherapy of a widespread superficial oral cancer.Treatment of a case of widespread superficial oral squamous cell carcinoma with external beam irradiation, followed by high dose rate Microselectron mould radiotherapy, is reported. The tumor disappeared macroscopically after treatment, but there was infield recurrence in the buccogingival sulcus where the radiation dose might have been inadequate. Apart from some radiation mucositis within the treated area, edema and a superficial ulcer were observed in the tongue. These were considered to be due to radiation overdose. Although there is room for improvement, this mode of treatment has something to offer patients with hard-to-cure cancer.- - - - - - - - - - ranking = 0.25keywords = carcinoma (Clic here for more details about this article) |
9/289. Osteosynthesis and bony healing between two consecutive free fibular bone grafts.This case report describes a recurrent squamous cell carcinoma in the oral cavity requiring two consecutive free fibula transfers at different times. In a unique application of the fibula, rigid miniplate fixation was used between the two independent free flaps to reconstitute the contour of the mandible for an extensive composite oromandibular defect, extending from the left angle to the right ascending ramus. This application underscores the utility of the free osteocutaneous fibular flap for reconstruction of complex mandibular defects.- - - - - - - - - - ranking = 0.25keywords = carcinoma (Clic here for more details about this article) |
10/289. Intraoral papillary cystadenoma lymphomatosum.The literature related to intraoral papillary cystadenoma lymphomatosum is critically reviewed and the reported cases analyzed to determine the average age, sex, and race of patients, and the site distribution of this curious lesion. Two new cases are reported. The histogenesis and differential diagnosis from cystadenocarcinoma are briefly discussed.- - - - - - - - - - ranking = 0.25522555681052keywords = carcinoma, adenocarcinoma (Clic here for more details about this article) |
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