Neck dissection versus “watchful-waiting” in early squamous cell carcinoma of the tongue our experience on 127 cases

Background Early oral squamous cell carcinoma (EOSCC) represents about 90% of the oral cancers especially in older males. The etiology is multifactorial, strongly related to tobacco and alcohol abuse, but also infective agents, Human papillomaviruses (HPV16-18), genetic factors and pre-neoplastic lesions seem to be implicated. There is no consensus in the literature for the treatment of early squamous cell carcinoma of the tongue (stages I–II); both an elective neck dissection policy and a watchful-waiting policy have their proponents in the different centers. Methods The records of 127 patients with EOSCC of the tongue treated in our Department between 2007 and 2011, with cN0 neck staging, who underwent resection of the primary tumor with or without elective neck dissection, were reviewed. Results We divided the patients into two groups, in Group 1 the 66 patients who received an elective neck dissection 30 days later from the primary surgery have been included, and in Group 2 the 61 patients undergoing “watchful waiting” observation for the development of nodal metastases have been collected. Statistical calculations were performed using Chi-square and t student test. Conclusions A significant difference was found between the two groups as concerns tumor stage and pathologic tumor classification (p < 0.001). No significant differences were present between the two groups as concerns mean follow up (P = 0.2), relapse rate (p = 0.3) and relapse-free survival time (p = 0.2). In T1 stage tumors with depth of infiltration ≤4 mm, or low grade (G1-G2), the “watchful waiting” strategy for cervical metastases is appropriate, given the low regional recurrence rate (15%) and overall survival of 100%. In case of T2 lesions with depth of infiltration ≥4 mm or high grade (G3) we prefer to perform the elective neck dissection, with 13% of local recurrence and 100% of survival at 6 years

Surgical evolution in the treatment of mandibular condyle fractures

Background: In Literature fractures of the mandible that involve the condyle ranges from 20% to 35% and various possible surgical options are described according to the varying pathological situations. Up to the present, numerous techniques have been used for the surgical treatment of condylar fractures. In this article we are proposing the combination of two surgical techniques as therapy for extra-capsular condylar fractures with dislocation. Methods: From June 2003 to July 2007 30 patients were treated for condylar fractures with the application of a Rigid External Fixator under endoscopic assistance. This method includes a surgical reduction of the fracture with the aid of an endoscope, performing a transcutaneous insertion of a Rigid External Fixator to stabilize the fracture. Results: Out of the total number of patients, 28 reached an optimal result without the need for temporary immobilization of the temporal mandibular joint and pre-auricular cutaneous access, thanks to the decisive aid of the video-endoscope. Conclusions: The endoscope allows perfect control over both the positioning of the external fixator and the surgical reduction, restoring the normal movement of the mandible with a return to full anatomical functioning of the temporo-mandibular joint. This approach avoids possible damages to the facial nerve branches. The rigid external fixation system is better than an internal one, because it is less restrictive in precise anatomical reduction, since with an REF the condylar fragment is kept in the correct anatomical position but is not obliged to maintain that exact position, and therefore it is possible to carry out all the repair mechanisms listed above. Endoscopic assistance allows a good positioning control of the REF although the endoscopy permits an optimal control of the condylemeniscal complex mobility after REF application

Titanium Internal Fixator Removal in Maxillofacial Surgery: Is It Necessary? A Systematic Review and Meta-Analysis

: Titanium plates and screws are essential devices in maxillofacial surgery since late 1980s, but despite their wide use there is no consensus in titanium internal fixators removal after bone healing. A systematic literature review and meta-analysis were conducted on seventeen retrospective studies. Effect size and 95% confidence intervals were calculated for plate removal (per plate and per patient) and for removal causes (infection, pain, screws complications, exposition, palpability). Odds ratio, 95% confidence intervals, and χ 2 test were measured for sex, smoking, and implant site. Heterogeneity was evaluated with Cochran and Inconstancy test. Obtained data were used to design Forest and Funnel plots. The aim of the study is to identify and clarify reasons and risk factors for plates and screws removal. Infection is the most frequent reason; the habit of tobacco usage and implant site (mandibula) are the main risk factors. The administration of antibiotic prophylaxis is essential, and patients must quit smoking before and after surgery. In conclusion there is no scientific evidence supporting the removal of internal devices as mandatory step of the postoperative procedure

Bilateral hypertrophy of masseteric and temporalis muscles, our fifteen patients and review of literature

OBJECTIVE: The association of bilateral hypertrophy of temporalis and masseteric muscles is a rare clinical entity. The origin of the condition is unclear, causing cosmetic problems, pain, and functional impairment. PATIENTS AND METHODS: In this paper we analyzed 15 patients treated at the Department of Maxillo-Facial Surgery of the University of Naples Federico II, from 2000 to 2013, for temporalis and/or masseteric muscle hypertrophy, and in particular, a rare case of a patient with a marked bilateral swelling of the temporalis and masseteric region, in conjunction with a review of the literature. RESULTS: Fourteen patients have not any kind of postoperatively problems. The last patient had been aware of the swelling for many years and complained of recurrent headaches. We adopted a new protocol fort these patients and the patient was very pleased with the treatment resul ts, and reported a reduct ion in headaches and a continuation of his well-being, in addition to greater self-confidence. The last follow-up was performed three years after the first treatment, and the patient showed a complete resolution of his symptoms, and just a small increase of the swelling. CONCLUSIONS: The treatment of temporalis and masseteric hypertrophy with Botulin toxin could be an effective option compared to conservative treatment or surgical intervention although the review of the literature shows that this is only a temporary treatment. In fact, surgery still remains the best option. The treatment must be repeated every 4/6 months for 2-3 consecutive years before having stable benefits. To overcome this problem, an association with a bite treatment allowed us to achieve more lasting and more stable results over time without a recurrence of symptoms between the treatments. Furthermore, this association has enabled us to obtain a more rapid reduction of the hypertrophy