Oral cancer in men and women: are there differences?

Introduction: Because female user habits for tobacco and alcohol are changing and the female incidence of oral squamous cell carcinoma (SCC) has increased, the aim of the study was to evaluate the possible differences between male and female patients suffering from oral SCC. Patients and methods: The files of 159 male and 119 female patients with oral SCC, who were treated between 1999 and 2008 with a minimum follow-up time of 12months, were evaluated retrospectively. Special attention was paid to tobacco and alcohol use, TN status, recurrence, and metastases rate, as well as to patients without the mentioned risk factors. Results: A higher female median age (65.36 vs. 61.04years) and female predominance was found in the group of patients older than 70years, with a gender distribution of 53:46. Out of 23 female patients with oral maxillary SCC, 15 (65%) were without the risk factors of tobacco and alcohol, and from the 16 male patients suffering from oral maxillary carcinoma, only three (19%) were without the mentioned risk factors. Conclusion: In summary, compared to earlier studies, there was a higher proportion of females in (1) the group without the risk factors of tobacco and alcohol, (2) those with SCC of the hard plate and maxillary alveolus, and (3) in patients older than 70years. There are fewer differences between metastases and recurrence rates. Further studies should be performed in female patients without risk factors and in maxillary cancer with emphasis on the human papilloma virus and infiltration rate

Oral squamous cell carcinoma in non-smoking and non-drinking patients

INTRODUCTION: Of the many different factors associated with an increased risk for oral squamous cell carcinoma (SCC), tobacco and alcohol seems to be the best studied. The aim of the current study was to evaluate the clinicopathologic characteristics of patients without the mentioned risk factors. Patients and Methods From 278 patients (159 male and 119 female patients) with oral SCC, 67 patients were without a history of tobacco or alcohol use. The minimum follow-up time was 12 months. RESULTS: Of the 67 patients, 45 (67.2%) were women and the mean age was 70 years. The most common tumor sites were mandibular alveolar ridge: 22 and maxilla: 18. Fifteen patients experienced a recurrence and 10 developed lymph node metastases during the follow-up period. CONCLUSION: The group of patients without tobacco and alcohol use tends to have a higher female portion, higher potion of patients being over 70 years and a higher number of oral maxillary SCC

A new method for closure of large donor side defects after raising the pectoralis major flap

Background: Although free flaps are reliable for head and neck reconstructions, the pectoralis major flap (PMF) is still often used. In cases of a large PMF, the closure of the donor side can be a challenge. Case report: A technique, originally developed for the treatment and prevention of abdominal ruptures after laparotomy, is presented as an alternative for closure of large donor side defects. Conclusion: The use of Ventrofil® is an additional option for large donor side defects and especially to bridge the period of postoperative swelling. If utilized special attention must be paid to possible pressure necrosis of the underlying ski

Plasma Cytokine and Growth Factor Profiling during Free Flap Transplantation

Ischemia and reperfusion (I/R) is an unavoidable condition during free flap transplantation. Restoration of blood flow is usually associated with a profound inflammatory response. Cytokines and growth factors are the functional proteins which exert their specific influence on injury or repair during the healing period. Plasma concentrations of 18 cytokines and growth factor proteins (IL6, IL8, IP10, TNFα, MCP1, Fractalkine, GRO, bFGF, GMCSF, IFNg, MIP1a, VEGF, sCD40L, IL10, TGFα, IL1β, IL12P40, and TNFβ) have been analyzed with respect to I/R status during microsurgery tissue transplantation in both, artery and vein, from patients by multiplexed immunoassay. Both technical feasibility and biostatistics data analysis approaches were thoroughly assessed. It has been found that, from all investigated proteins, the venous plasma levels of IL6 significantly increased during the ischemia period and mostly sustained their high levels during reperfusion, while venous plasma levels of IL8 showed in general a significant increase in the ischemia period followed by a rapid decrease in the reperfusion period. In conclusion, these findings direct toward an active involvement of tissue-resting leukocytes which may become therapeutic targets for concomitant medication in flap surgery to improve wound healing

Uptake and fate of surface modified silica nanoparticles in head and neck squamous cell carcinoma

BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) is currently the eighth leading cause of cancer death worldwide. The often severe side effects, functional impairments and unfavorable cosmetic outcome of conventional therapies for HNSCC have prompted the quest for novel treatment strategies, including the evaluation of nanotechnology to improve e.g. drug delivery and cancer imaging. Although silica nanoparticles hold great promise for biomedical applications, they have not yet been investigated in the context of HNSCC. In the present in-vitro study we thus analyzed the cytotoxicity, uptake and intracellular fate of 200-300 nm core-shell silica nanoparticles encapsulating fluorescent dye tris(bipyridine)ruthenium(II) dichloride with hydroxyl-, aminopropyl- or PEGylated surface modifications (Ru@SiO2-OH, Ru@SiO2-NH2, Ru@SiO2-PEG) in the human HNSCC cell line UMB-SCC 745. RESULTS: We found that at concentrations of 0.125 mg/ml, none of the nanoparticles used had a statistically significant effect on proliferation rates of UMB-SCC 745. Confocal and transmission electron microscopy showed an intracellular appearance of Ru@SiO2-OH and Ru@SiO2-NH2 within 30 min. They were internalized both as single nanoparticles (presumably via clathrin-coated pits) or in clusters and always localized to cytoplasmic membrane-bounded vesicles. Immunocytochemical co-localization studies indicated that only a fraction of these nanoparticles were transferred to early endosomes, while the majority accumulated in large organelles. Ru@SiO2-OH and Ru@SiO2-NH2 nanoparticles had never been observed to traffic to the lysosomal compartment and were rather propagated at cell division. Intracellular persistence of Ru@SiO2-OH and Ru@SiO2-NH2 was thus traceable over 5 cell passages, but did not result in apparent changes in cell morphology and vitality. In contrast to Ru@SiO2-OH and Ru@SiO2-NH2 uptake of Ru@SiO2-PEG was minimal even after 24 h. CONCLUSIONS: Our study is the first to provide evidence that silica-based nanoparticles may serve as useful tools for the development of novel treatment options in HNSCC. Their long intracellular persistence could be of advantage for e.g. chronic therapeutic modalities. However, their complex endocytotic pathways require further investigations

Basaloid squamous cell carcinoma of the maxillary gingiva: A case report and review of the literature

Basaloid squamous cell carcinoma (BSCC) is a rare, but distinct histologic variant of squamous cell carcinoma in the head and neck region. It is considered to have a poor prognosis due to its aggressive behavior and tendency to metastasize. The usual sites of BSCC are the floor of the mouth, hypopharynx and base of the tongue, and according to the English-language literature its presentation in the gingiva is somewhat uncommon. In the current report, the unusual case of a 40-year-old male is presented; the patient exhibited a painless irregular mass in the maxillary gingiva, which infiltrated the maxillary sinus, as observed by computed tomography. Hematoxylin and eosin-stained sections revealed a diagnosis of BSCC with typical central necrosis in the cancer nests, which contained basaloid and squamous cells. Immunohistochemistry revealed that p63 was weakly positive, high molecular weight cytokeratin (CK) was focally positive, and S-100, CK7, CK14 and vimentin were negative. It must be noted that histopathology results may be incorrectly interpreted as adenoid cystic carcinoma, undifferentiated carcinoma and basal cell adenocarcinoma

Alloplastic total temporomandibular joint replacements: do they perform like natural joints? Prospective cohort study with a historical control

The aim of this study was to qualitatively and quantitatively describe the biomechanics of existing total alloplastic reconstructions of temporomandibular joints (TMJ). Fifteen patients with unilateral or bilateral TMJ total joint replacements and 15 healthy controls were evaluated via dynamic stereometry technology. This non-invasive method combines three-dimensional imaging of the subject's anatomy with jaw tracking. It provides an insight into the patient's jaw joint movements in real time and provides a quantitative evaluation. The patients were also evaluated clinically for jaw opening, protrusive and laterotrusive movements, pain, interference with eating, and satisfaction with the joint replacements. The qualitative assessment revealed that condyles of bilateral total joint replacements displayed similar basic motion patterns to those of unilateral prostheses. Quantitatively, mandibular movements of artificial joints during opening, protrusion, and laterotrusion were all significantly shorter than those of controls. A significantly restricted mandibular range of motion in replaced joints was also observed clinically. Fifty-three percent of patients suffered from chronic pain at rest and 67% reported reduced chewing function. Nonetheless, patients declared a high level of satisfaction with the replacement. This study shows that in order to gain a comprehensive understanding of complex therapeutic measures, a multidisciplinary approach is needed

Is Lymph-node Ratio a Superior Predictor than Lymph Node Status for Recurrence-free and Overall Survival in Patients with Head and Neck Squamous Cell Carcinoma?

Introduction: TNM status is questioned as an exact predictor of survival in different tumour entities. Recently, lymph node ratio (LNR) has been described as a predictor of survival in patients with HNSCC. The purpose of this study was to evaluate to which degree LNR could be used as a more accurate predictor than TNM staging? Methods: A total of 291 patients, with a follow-up of at least 3years, were analyzed using log-rank statistic, univariate and multivariate data analyzes, and p values, for prediction of lymph node ratio on overall and recurrence-free survival. Results: Survival differed significantly if patients were stratified for LNR. Impact of LNR on survival was significantly different even in patients with extracapsular spread. Patients with pN0 had no survival benefit compared with patients with pN1 or higher with a LNR lower than 6%. Conclusions: LNR is a prognostic tool in patients with a lymph node status pN0-pN2b. LNR remained significant even in patients with extracapsular spread, contrary to TNM status. With LNR, stratification for high-risk patients (higher than 6% LNR) can be evaluated easily. We would suggest using LNR in the clinical routine

Is lymph-node ratio a superior predictor than lymph node status for recurrence-free and overall survival in patients with head and neck squamous cell carcinoma?

INTRODUCTION: TNM status is questioned as an exact predictor of survival in different tumour entities. Recently, lymph node ratio (LNR) has been described as a predictor of survival in patients with HNSCC. The purpose of this study was to evaluate to which degree LNR could be used as a more accurate predictor than TNM staging? METHODS: A total of 291 patients, with a follow-up of at least 3 years, were analyzed using log-rank statistic, univariate and multivariate data analyzes, and p values, for prediction of lymph node ratio on overall and recurrence-free survival. RESULTS: Survival differed significantly if patients were stratified for LNR. Impact of LNR on survival was significantly different even in patients with extracapsular spread. Patients with pN0 had no survival benefit compared with patients with pN1 or higher with a LNR lower than 6 %. CONCLUSIONS: LNR is a prognostic tool in patients with a lymph node status pN0-pN2b. LNR remained significant even in patients with extracapsular spread, contrary to TNM status. With LNR, stratification for high-risk patients (higher than 6 % LNR) can be evaluated easily. We would suggest using LNR in the clinical routine