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

Efficacy of ibuprofen versus lornoxicam after third molar surgery: a randomized, double-blind, crossover pilot study

Purpose: The aim of this study is to compare the analgesic efficacy and tolerability of a pre-emptive/post-surgery 4-day regimen of oral ibuprofen 400mg with that of lornoxicam 8mg. Methods: Sixteen patients received ibuprofen or lornoxicam, respectively, before and after surgery of impacted third molars in two separate appointments, in a double-blind, randomized, and crossover design. The postoperative analgesic and rescue medication consumption was recorded and pain scores were evaluated with a visual analogue scale at 2, 6, 24, 48, and 72h, postoperatively. Results: No statistically significant differences were found between ibuprofen 400mg and lornoxicam 8mg with respect to study medication (p = 0.34) or rescue analgesic consumption (p = 0.5) (SUMstudy and SUMrescue). Ibuprofen: SUMstudy median 7.5 interquartile range IQR (4.25-8), 95% CI (4.6-7.7); SUMrescue median and IQR 0, 95% CI (−0.6-4.6). Lornoxicam: SUMstudy median 7 IQR (3.75-9), 95% CI (7.7-4.9); SUMrescue median and IQR 0, 95% CI (−0.7-2.7). The area under the pain intensity curve (AUC2-72 PI) over the 4days of investigation did not reveal significant differences between the two medications (p = 0.32). AUC2-72 PI ibuprofen: median 1,509.7 IQR (712.36-2,444.65); 95% CI (1,078.7-2,156.5). AUC2-72 PI lornoxicam: median 1,166.9 IQR (783.4-2,221.2), 95% CI (1,032-2,130.6). Moreover, patient satisfaction and incidence of adverse events did not reveal any significant differences between treatment groups. Conclusion: Ibuprofen 400mg and lornoxicam 8mg were rated as equal and effective pain treatment medication after wisdom tooth surgery. In comparison, neither of the drugs provided clinical advantages nor did side effects occur more frequently after one of the analgesic

Cervical metastases of squamous cell carcinoma of the maxilla: a retrospective study of 9 years

Purpose: Metastases of squamous cell carcinoma of the tongue and the mouth floor have been well studied. Concerning maxilla squamous cell carcinomas, however, only a few studies have been performed. The question is whether a prophylactic neck dissection should be performed in these tumors. Patients and Material: In the Department of Craniomaxillofacial Surgery at the University Hospital of Zurich, 30 patients who had been treated for squamous cell carcinonoma of the maxilla were examined retrospectively. Special attention was paid to direct and late metastasis, survival rate, and treatment. RESULTS: Of the 59 patients with upper jaw carcinomas over a 9-year period, only about half (30 patients) had a squamous cell carcinoma of the upper jaw. Of those patients, 27% had an upper lesion on the right side, 33% on the left. Of the 11 patients (36.7%) presenting positive lymph nodes, 4 patients had direct positive lymph nodes while 7 patients had later positive lymph nodes; and 71.4% of the late metastasis appeared during the first year. CONCLUSION: Because of the 36.7% of patients presenting metastasis in the cervical lymph nodes, elective neck treatment should be considered in cases even with a negative clinical examination

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

Aggressive fibromatosis of the head and neck: a new classification based on a literature review over 40years (1968-2008)

Background: Fibromatosis is an aggressive fibrous tumor of unknown etiology that is, in some cases, lethal. Until now, there has been no particular classification for the head and neck. Therefore, the aim of the present study was to review the current literature in order to propose a new classification for future studies. Methods: An evidence-based literature review was conducted from the last 40years regarding aggressive fibromatosis in the head and neck. Studies that summarized patients' data without including individual data were excluded. Results: Between 1968 and 2008, 179 cases with aggressive fibromatosis of the head and neck were published. The male to female ratio was 91 to 82 with a mean age of 16.87years, and 57.32% of the described cases that involved the head and neck were found in patients under 11years. The most common localization was the mandible, followed by the neck. All together, 143 patients were followed up, and in 43 (30.07%), a recurrence was seen. Conclusion: No clear prognostic factors for recurrence (age, sex, or localization) were observed. A new classification with regard to hormone receptors and bone involvement could improve the understanding of risk factors and thereby assist in future studie

Malignant minor salivary gland tumors: a retrospective study of 27 cases

Purpose: Malignant tumors of the intra-oral minor salivary glands are uncommon. The aim of this study was to give information concerning the clinical features of these tumors, the distribution of location, treatment opportunities, and outcome. Methods: Twenty-seven patients with malignant salivary gland tumors that were treated between January 1999 and December 2008 were evaluated retrospectively. Results: Of the 27 minor salivary gland carcinomas, 48.1% were adenoid cystic carcinomas (ACC), 29.7% mucoepidermoid carcinomas (MEC), 22.2% adenocarcinomas (ADCA). The most common first symptom was a painless swelling in 60% of the cases, with the second most common symptom being ulcers (28%). Four recurrences and two metastases were found. No recurrence was observed in ADCA. All four patients experiencing a recurrence developed it in the first 3years after treatment. Conclusion: Wide excision with a clinical margin of 1cm and in large tumors, positive surgical margins or perineural infiltration and postoperative radiotherapy (RT) can be recommended; but in order to give exact information concerning the possible benefit from postoperative RT, it needs large prospective multicenter studies. Long-term follow-up controls and in particularly longer than 5years in ACC including yearly chest X-rays should be offered to these patients because of late metastasis and recurrence

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

Needle breakage during local anesthesia in the oral cavity—a retrospective of the last 50years with guidelines for treatment and prevention

Needle breakage in the oral cavity after local anesthesia is a common complication with possible serious complications of injuring vital structures. There are different possible reasons for needle breakage, with a main focus on preventable mistakes in treatment. In this study, an analysis of literature of the last 50years as well as own cases has been performed to renew knowledge and prevention and therapy strategies for this serious complication. A systematic, multilingual review of medical literature from 1900 until today was conducted and information was evaluated systematically. In the majority of cases needle fracture happened during inferior alveolar nerve block. It is mainly a problem due to inadequate technique or the use of too thin needles for the performance of inferior alveolar nerve block. Different arguments about possible therapy strategies and methods exist. Basically, if a hypodermic needle fractures, it should be removed surgically under general anesthesia. To localize the fragment, use of either multi-plane X-rays or fluoroscopy with at least two reference needles in place or, if possible, of three-dimensional CT scans is recommended. This article shows, that despite progression in material, needle fracture is still an existing, preventable problem, if some basic rules are followe

Osteopathology induced by bisphosphonates and dental implants: clinical observations

Objectives: Although there are many reports about risk factors for the development of BP-associated osteonecrosis of the jaws, the role of dental implants as a local risk factor is still discussed, especially in patients with oral BP treatment. Until now, a few case reports and surveys display a possible minor risk in patients with oral BP therapy, whereas the avoidance of implant placement is generally accepted in patients with intravenous BP therapy. Patient and methods: In this study, the cases of 14 patients with osteonecrosis of the jaws in association with BP therapy and dental implant placement were analyzed carefully with a detailed literature review. Results: Of 14 patients, nine had underlying malignant disease and five patients had osteoporosis. In ten patients, implants were placed either in the posterior mandible or maxilla; the mean interval between implant insertion and disease onset was 20.9 months. Pain (n12) and signs of infection (n10) were the most common symptoms. Histologically, signs of infection were found in nine of 11 analyzed patients with presence of Actinomyces in six patients. Two patients turned out to have infiltration of underlying malignant disease. Conclusions: Posteriorly placed implants seem to be of higher risk of development of osteonecrosis of the jaws. Not only the implant placement but also the inserted implant itself seems to be a continuous risk factor. Clinical relevance: The herein elaborated risk factors help dentists plan dental rehabilitation with implants in this high-risk group of patients and indicate careful and regular dental recal

An evaluation of the preoperative hemoglobin level as a prognostic factor for oral squamous cell carcinoma

BACKGROUND: Hypoxia seems to be an influencing factor for oral squamous cell carcinomas (SCC), and several immunohistochemical markers have been discussed in this regard. The aim of the present study was to evaluate preoperative hemoglobin levels as a prognostic factor for oral SCC. MATERIALS AND METHODS: The files of 287 patients who had been treated for oral SCC between 1999 and 2008 were studied retrospectively. Hemoglobin levels between 1 and 5 days prior to surgical treatment were compared to Tumor (T)- and Nodal (N)- status, local recurrence, and lymph node metastases rate. The minimum follow-up period was 12 months. RESULTS: From a total of 287 patients with oral SCC, 205 (71.4%) were in the normal hemoglobin (Hb) group (female Hb ≥ 12.0 g/dl; male Hb ≥ 13.0 g/dl), 53 (18.5%) in the mild anemia (female Hb = 11.0-11.9 g/dl; male Hb = 11.0-12.9 g/dl), and 29 (10.1%) in the severe anemia group (female & male Hb<11.0 g/dl). Anemia was significant for the development of lymph node metastasis (p = 0.005) as well as for local recurrence (p = 0.001). No significant correlation was found to the initial T status (p = 0.183). CONCLUSION: Our data suggests that an Hb of below 11 g/dl contributes to and is an indicator for a poor prognosis. Consequently, pre-treatment Hb corrections may significantly improve outcome, but further investigations, including blood transfusion/application of erythropoietin due to tumor anemia, independent of intraoperative blood-loss are necessary to ascertain their role in an improved survival