Impact of tumour characteristic and treatment modality on the local recurrence and the survival in patients with oral squamous cell carcinoma

Purpose of the study. To evaluate the impact of tumour location, local and regional advancement, histological differentiation, status of the surgical margins and radiotherapy on the disease-free time and overall survival rates in patients with oral squamous cell carcinoma. Material and methods. A retrospective analysis of 67 patients treated with surgery (61 pts.), radiotherapy (6 pts.) and their combination (28 pts.). Follow time on average 40 months. The probabilities of survival were assessed using the Kaplan-Meier estimates, the differences were calculated with the log-rank test. An analysis of the infl uence of the neck recurrences on the prognosis was additionally performed. Relationship between independent categorical variables as: primary local advancement, location of the tumour, histological grading and lymph node metastases was evaluated with Fisher´s Exact Test. Results. Disease-free time rate amounted to 40,1%. There was no independent prognostic importance of primary location, T-staging and N-staging, histological grading of the tumour or radiation on disease-free time, just opposite to the status of the resection margins. However, the number of neck metastases was directly proportional to the tumour dimension and poor histological differentiation. Overall survival rate amounted to 87,5%. Posterior location in the oral cavity, involvement of cervical lymph nodes, surgical margins with the presence of tumour cells, poor histological differentiation and necessity of irradiation negatively correlated with the survival. Conclusions. A complete resection of the tumour was the most important independent prognostic parameter for the disease-free and overall survivals in oral squamous cell carcinomas in this study. An adjuvant radiation therapy could improve the results of treatment of oral squamous cell carcinoma also in cases were so far considered only for surgical management

Clinical and radiological features of nonfamilial cherubism : a case report

Background: Cherubism is an uncommon hereditary benign fibro-osseous disorder characterized by bilateral enlargement of the mandible and the maxilla that presents with varying degrees of involvement and a tendency toward spontaneous remission. On radiography cherubic lesions appear as cystic multilocular radiolucencies limited to the jaw bones. Case Report: A 5-year-old boy was referred to the Department of Maxillo-Facial Surgery due to deformation of the lower and middle section of the face and displacement or absence of teeth. A panoramic radiograph and a computed tomography revealed extensive multilocular, bilateral radiolucent areas and marked bony expansion in the mandible and maxilla, with sparing of the mandibular condyles. Histopathological evaluation of an incisional biopsy of the left maxilla and genotypic characterization confirmed the diagnosis of cherubism. Conclusions: The radiologic characteristics of cherubism are not pathognomonic but the diagnosis is strongly suggested by bilateral relatively symmetric jaw involvement that is limited to the jaw bones and, together with clinical and histopathologic findings, enables the diagnosis of cherubism. Genotypic characterization confirms the diagnosis

What Features on Routine Panoramic Radiographs Could Help Orthodontists to Estimate the Occurrence of Condylar Hyperplasia from Other Mandibular Asymmetries—Retrospective Analysis Study

Hemimandibular hyperplasia (HH) and elongation (HE) are the most common pathologies present in the mandible. Presented condylar hyperplasias have their own radiological and clinical features. In most cases, patients suffer from various forms of malocclusion. From a total of 150 asymmetrical jaw radiographs evaluated, 46 were evaluated and included in this study. A retrospective study on the data of 46 selected patients treated, diagnosed, and consulted from various forms of mandibular and skeletal asymmetry based on routine diagnostic panoramic radiographs evaluated typical and atypical radiological and anatomical symptoms of condylar hyperplasia. The presented evaluation focused on mandibular, maxillary, and other bones, in order to distinguish condylar hyperplasia from other forms of mandibular asymmetry. The degree of maxillary downward growth followed by the occurrence of an open bite on the affected side estimate the degree/presence or cessation of growth in the affected condyle. Mandibular asymmetry with incisor teeth inclination remains the most typical characteristic of condylar hyperplasia. Increased height of mandibular ramus differentiates between condylar hyperplasia and elongation, which also influences the position of the inferior alveolar nerve. Mentioned symptoms, described as the acronym “Go Moira!”, are useful in a quick and simple “glimpse of an eye” differential diagnostic approach. It is possible to quickly and accurately establish the first diagnosis simply by a careful evaluation of patients’ panoramic radiographs

What Features on Routine Panoramic Radiographs Could Help Orthodontists to Estimate the Occurrence of Condylar Hyperplasia from Other Mandibular Asymmetries—Retrospective Analysis Study

Hemimandibular hyperplasia (HH) and elongation (HE) are the most common pathologies present in the mandible. Presented condylar hyperplasias have their own radiological and clinical features. In most cases, patients suffer from various forms of malocclusion. From a total of 150 asymmetrical jaw radiographs evaluated, 46 were evaluated and included in this study. A retrospective study on the data of 46 selected patients treated, diagnosed, and consulted from various forms of mandibular and skeletal asymmetry based on routine diagnostic panoramic radiographs evaluated typical and atypical radiological and anatomical symptoms of condylar hyperplasia. The presented evaluation focused on mandibular, maxillary, and other bones, in order to distinguish condylar hyperplasia from other forms of mandibular asymmetry. The degree of maxillary downward growth followed by the occurrence of an open bite on the affected side estimate the degree/presence or cessation of growth in the affected condyle. Mandibular asymmetry with incisor teeth inclination remains the most typical characteristic of condylar hyperplasia. Increased height of mandibular ramus differentiates between condylar hyperplasia and elongation, which also influences the position of the inferior alveolar nerve. Mentioned symptoms, described as the acronym “Go Moira!”, are useful in a quick and simple “glimpse of an eye” differential diagnostic approach. It is possible to quickly and accurately establish the first diagnosis simply by a careful evaluation of patients’ panoramic radiographs

Fresh–Frozen Allogenic Bone Graft Usage in Treatment of an Odontogenic Keratocyst in the Mandible

There are many cysts and tumors which might occur in the mandibular and maxillary bones. Their origin can be either odontogenic or non-odontogenic. One of the most common odontogenic cysts is the odontogenic keratocyst (OKC). Its nomenclature and classification have changed many times over years, from a tumor to, finally, a cyst. Nowadays, its treatment has not greatly changed, however, it is related to a potential recurrence rate more than any other cyst of odontogenic origins. OKC size, localization, and possible cortical expansion towards adjacent soft tissues might influence the scope of treatment and possible reoccurrence in time. Each case is quite individual, and after removal of the pathology in some cases there can be a necessity for either bone grafting or any other reconstruction method to restore proper bone continuity. The size and the placement of OKC might influence pathological fracture occurrence or inappropriate healing if the bone cavity after cyst removal is not properly treated. A good healing potential can be achieved with xenograft bone substitutes or allograft fresh–frozen bones. On rare occasions, a titanium plate is used to ensure mandibular stability. In the following case report, an atypical case of a large OKC treated with fresh–frozen bone grafts, supported with collagen barrier material in the anterior mandible with buccal cortical expansion, will be presented

Unilateral Condylar Hyperplasia in Surgeons’ Perspective—A Narrative Review

The following paper focuses on the topic of mandibular unilateral condyle hyperplasia (UCH). This form of mandibular asymmetry (MA) is one of the less common but still known pathologies that requires detailed surgical and orthodontic planning and treatment. Since this pathology is mostly related to a high number of individual dental, bone, and overgrowth factors, until now the treatment methods were individually driven. It seems that the scope of surgical intervention is greatly dependent on the degree of bone overgrowth and the occurrence of asymmetry. Many treatment modalities and possible surgical perspectives are known, yet, so far, no adequate detailed guidelines are known. This detailed review of this type of mandibular asymmetry will focus on diagnostics and treatment plans and outcomes. The following paper underlines the authors’ own clinical experiences in MA and UCH treatment, which are compared with the literature review. The authors intend to investigate what has changed in the treatment and diagnostics of one-sided mandibular condyle and bone overgrowth

A Retrospective Study on Silent Sinus Syndrome in Cone Beam-Computed Tomography Images—Author Classification Proposal

Introduction. Facial asymmetry might have many etiological factors. Most known and recognized factors are related to hemimandibular hyperplasia, elongation, condyle-related pathologies hemifacial microsomia, laterogenia, and others. In some cases, however, facial asymmetry has a different origin within the maxillary sinus (MS) bones. This rare entity as a silent sinus syndrome (SSS) causes secondary midfacial and maxillary asymmetry because of the retraction of the sinus walls. The authors present their own proposal for SSS/CMA (chronic maxillary atelectasia) classification and possible maxillary sinus disease alterations related to the scope of changes in the maxillary sinus walls, asymmetry, opacification, and related features. Material and Methods. The study consisted of 131 CBCT images which were evaluated. The authors focus on fourteen retrospective cone beam-computed tomography studies (CBCT) performed to establish and evaluate sources of facial asymmetry. Results. Neither presented maxillary and facial asymmetry cases correspond to the typical SSS/CMA findings. Asymptomatic maxillary sinusitis co-existing in maxillary asymmetry cases in patients suffering from skeletal malocclusion remains atypical for SSS pure and in-pure cases. The osteomeatal complex (OMC) patency is more common for pure forms. Conclusions. Computed tomography quite easily can identify the source of the problems in the maxillary sinus and identify SSS. Coexistent chronic rhinosinusitis might correspond with another MS pathology, CMA—chronic maxillary atelectasia. The scope and the degree of MS cause midfacial asymmetry; however, the scope of sinus opacification, osteomeatal complex drainage, and occurrence of other symptoms might be more or less present. The OMC patency is more common for pure forms

Unilateral Condylar Hyperplasia in Surgeons’ Perspective—A Narrative Review

The following paper focuses on the topic of mandibular unilateral condyle hyperplasia (UCH). This form of mandibular asymmetry (MA) is one of the less common but still known pathologies that requires detailed surgical and orthodontic planning and treatment. Since this pathology is mostly related to a high number of individual dental, bone, and overgrowth factors, until now the treatment methods were individually driven. It seems that the scope of surgical intervention is greatly dependent on the degree of bone overgrowth and the occurrence of asymmetry. Many treatment modalities and possible surgical perspectives are known, yet, so far, no adequate detailed guidelines are known. This detailed review of this type of mandibular asymmetry will focus on diagnostics and treatment plans and outcomes. The following paper underlines the authors’ own clinical experiences in MA and UCH treatment, which are compared with the literature review. The authors intend to investigate what has changed in the treatment and diagnostics of one-sided mandibular condyle and bone overgrowth