Rekonstruktion von Oberkieferdefekten mit einem freien Skapula-angle-Lappen

Zusammenfassung: Hintergrund: Neben der prothetischen Versorgung von Maxilladefekten gibt es Möglichkeiten der chirurgischen Rekonstruktion: die Weichgeweberekonstruktion mit einem Radialis- oder Latissimus-dorsi-Lappen und die knöcherne Rekonstruktion mittels Fibula, Beckenkamm oder Skapulalappen. Die Rekonstruktion mit einem Skapulalappen wird unterteilt in den traditionellen Skapulalappen mit der A.scapularis circumflexa und den Skapula-angle-Lappen mit der A.angularis aus der A.thoracodorsalis als versorgendem Gefäß. Material und Methoden: Wir berichten über 4Patienten, die zwischen 2009 und 2011 aufgrund von malignen Tumoren der Maxilla nach erfolgter Resektion eine Rekonstruktion mit einem freien Skapula-angle-Lappen erhalten haben. Ergebnisse: Die Möglichkeit vertikaler Positionierung des Skapula-angle-Lappens erlaubt die Rekonstruktion der fazialen Kontur. Bei horizontaler Ausrichtung des mikrovaskulär anastomosierten Skapula-angle-Lappens ist eine zusätzliche knöcherne Rekonstruktion des Gaumens möglich. Schlussfolgerung: Der Skapula-angle-Lappen eignet sich wegen seiner Variabilität, geringer Donormorbidität und aufgrund seiner Form, die der des Hartgaumens ähnelt, gut zur plastischen Rekonstruktion. Die knöcherne Beschaffenheit für eine dentale Rehabilitation mithilfe von Implantaten wird kontrovers diskutiert. Er stellt eine Alternative zur Versorgung ausgewählter Maxilladefekte ≥ GradI nach Okay mit einer Obturatorprothese da

Rekonstruktion von Oberkieferdefekten mit einem freien Skapula-angle-Lappen [Reconstruction of maxillary defects using a free scapular angle flap].

BACKGROUND: In addition to prosthetic rehabilitation, maxillary defects can also be surgically reconstructed. Soft-tissue reconstruction employs a radial forearm or latissimus dorsi muscle flap, while bony reconstruction can be achieved using a fibula, iliac crest, or scapular flap. Reconstruction using a scapular flap is further divided into two subgroups: the traditional scapular flap with the circumflex scapular artery as the donor vessel and the scapular angle flap with the angular artery originating from the thoracodorsal artery as the donor vessel. MATERIALS AND METHODS: We report on four patients who underwent successful reconstruction with a free scapular angle flap between 2009 and 2011, following maxillary resection due to malignancy. RESULTS: Vertical positioning of the scapular angle flap enables reconstruction of the facial contour, whereas its horizontal alignment and microvascular anastomosis makes a bony reconstruction of the hard palate possible. CONCLUSIONS: The versatility, low rate of donor site morbidity and shape of the scapular angle flap--which resembles that of the hard palate--render it ideal for plastic reconstruction. The suitability of bone quality for dental rehabilitation with implants is a topic of controversial discussion. The scapular angle flap represents an alternative to obturator prosthesis for the reconstruction of maxillary defects ≥ grade I according to Okay et al

Clinical and molecular characteristics of HNSCC patients with brain metastases: a retrospective study.

Among the metastasis patterns of head and neck squamous cell carcinoma (HNSCC), intracranial spread is a rare but dreaded event. To date only very few cases have been reported and clinical and molecular data are sparse. We screened our archives for HNSCC patients from 1992 to 2005 who were diagnosed with brain metastases (BM). For retrospective analysis, all clinico-pathological data including disease-free survival (DFS), local progression-free survival (LPFS), and overall survival (OS) were compiled. Additionally, we assessed the mutational status of the TP53 gene and the prevalence of HPV serotypes by PCR and Sanger sequencing. Immunohistochemistry was applied to detect p16INK4A expression levels as surrogate marker for HPV infection. The prevalence rate of BM in our cohort comprising 193 patients with advanced HNSCC was 5.7 %. Of 11 patients with BM, 3 were female and 9 were male. Seven of the primary tumors were of oropharyngeal origin (OPSCC). LPFS of the cohort was 11.8 months, DFS was 12.1 months and OS was 36.0 months. After the diagnosis of BM, survival was 10.5 months. Five tumors showed a mutation in the TP53 gene, while five of the seven OPSCC tumors had a positive HPV status displaying infection with serotype 16 in all cases. Compared with patients who harbored TP53wt/HPV-positive tumors, patients with TP53 mutations showed a poor prognosis. Compared with the whole cohort, the interval between diagnosis of the primary and the detection of BM was prolonged in the HPV-infected OPSCC subgroup (26.4 vs. 45.6 months). The prognosis of HNSCC patients with BM is poor. In our cohort, most tumors were OPSCC with the majority being HPV positive. Our study points toward a putatively unusual metastatic behavior of HPV-positive OPSCC

Epstein-Barr virus induces expression of the LPAM-1 integrin in B cells in vitro and in vivo.

Epstein-Barr virus (EBV) infects the oropharynx but, surprisingly, frequently induces B cell proliferation in the gut of immunosuppressed individuals. We found that EBV infection in vitro induces the expression of the LPAM-1 integrin on tonsillar B cells and increases it on peripheral blood cells. Similarly, LPAM-1 was induced in the tonsils of patients undergoing primary infectious mononucleosis. EBV-induced LPAM-1 bound to the MAdCAM-1 addressin, which allows B cell homing to the gastrointestinal mucosa-associated lymphoid tissue (GALT). Thus, we hypothesized that EBV-induced LPAM-1 could induce relocation of infected B cells from the tonsil to the GALT. In situ hybridization with an EBER-specific probe revealed the frequent presence of EBV-infected cells in the pericolic lymph nodes of healthy individuals. Relocation of infected B cells into the GALT would expand the EBV reservoir, possibly protecting it from T cells primed in the oropharynx, and explain why EBV induces lymphoid tumors in the gut. IMPORTANCE EBV causes tumors in multiple organs, particularly in the oro- and na-sopharyngeal area but also in the digestive system. This virus enters the body in the oropharynx and establishes a chronic infection in this area. The observation that the virus causes tumors in the digestive system implies that the infected cells can move to this organ. We found that EBV infection induces the expression of integrin beta 7 (ITGB7), an integrin that associates with integrin alpha 4 to form the LPAM-1 dimer. LPAM-1 is key for homing of B cells to the gastrointestinal tract, suggesting that induction of this molecule is the mechanism through which EBV-infected cells enter this organ. In favor of this hypothesis, we could also detect EBV-infected cells in the lymph nodes adjacent to the colon and in the appendix