Differential Diagnosis of Malignant Tumours of the Maxillofacial Region

U postavljanju dijagnoze anamneza i klinička slika imaju najvažniju ulogu, a kasnije dijagnostičke metode tek nadopunjuju prve spoznaje o bolesti. Na žalost, u svakodnevnom radu maksilofacijalnoga kirurga maligni su tumori češći od benignih tumora i netumorskih promjena s kojima ih možemo zamijeniti. Zbog toga se, dva osnovna puta koja stoje pred kliničarem: dijagnostiku voditi prema najčešćoj dijagnozi ili prema najopasnijoj, kod tumora glave i vrata stapaju u jedno. U izlaganju će biti prikazani ilustrativni slučajevi dijagnostike malignih tumora i stanja s kojima ih možemo zamijeniti. Prikazat će se patologija usne šupljine, sinusa, čeljusti, kože i slinovnica. Navedeni primjeri trebali bi osvježiti ili upotpuniti znanje i oralnih kirurga.For correct diagnosis case history and clinical appearance have the most important role, and diagnostic methods later merely supplement initial knowledge of the disease. Unfortunately, in the daily practice of the maxillofacial surgeon malignant tumours are more frequent than benign tumours and nontumorous lesions, with which they can be confused. Consequently, the two basic alternatives which confront the clinician - to conduct diagnostics in accordance with the most frequent diagnosis or in accordance with the most dangerous - merge into one in the case of tumours of the head and neck. The presentation will illustratively show cases of diagnoses of malignant tumours and conditions with which they may be confused. The pathology of the oral cavity, sinuses, jaws, skin and salivary glands will be presented. The examples presented are meant to refresh or supplement the oral surgeon\u27s knowledge

Dvanaest činjenica koje bi svaki doktor dentalne medicine trebao znati o karcinomu usne šupljine

The most frequent malignant tumor of the oral cavity is squamous cell carcinoma, tumor that should be easy recognizable and treated successfully if diagnosed at an early stage. Unfortunately, many of this tumors remain unrecognized until advanced stages when treatment demands extensive surgery or chemoradiotherapy. Treating oral cancer in late stages is often combined with poor outcomes, incomplete recovery and lower quality of life. The authors outline the most important questions necessary for early diagnosis and better understanding of the disease with a goal of preventing delayed diagnosis or misdiagnosis of an oral cavity cancer.Planocelularni karcinom, nesumljivo najčešći karcinom usne šupljine, vjerojatno je jedan od tumora koji bi se trebao najlakše prepoznati i uspješno liječiti. Nažalost, niti jedno nije stvarnost, mnogi od ovih tumora prepoznaju se u kasnim stadijima kada liječenje zahtjeva opsežan operativni zahvat ili kemoradioterapiju. Liječenje karcinoma usne šupljine u kasnim stadijima često je povezano sa visokom stopom smrtnosti, a u mnogim slučajevima znači nepotpun oporavak i smanjenu kvalitetu života. U ovom članku, autori žele naglasiti najvažnija pitanja koja su neophodna za rano prepoznavanje i bolje razumijevanje bolesti kako bi se preveniralo pogrešno dijagnosticiranje i kasno otkrivanje karcinoma usne šupljine

Dvanaest činjenica koje bi svaki doktor dentalne medicine trebao znati o karcinomu usne šupljine

The most frequent malignant tumor of the oral cavity is squamous cell carcinoma, tumor that should be easy recognizable and treated successfully if diagnosed at an early stage. Unfortunately, many of this tumors remain unrecognized until advanced stages when treatment demands extensive surgery or chemoradiotherapy. Treating oral cancer in late stages is often combined with poor outcomes, incomplete recovery and lower quality of life. The authors outline the most important questions necessary for early diagnosis and better understanding of the disease with a goal of preventing delayed diagnosis or misdiagnosis of an oral cavity cancer.Planocelularni karcinom, nesumljivo najčešći karcinom usne šupljine, vjerojatno je jedan od tumora koji bi se trebao najlakše prepoznati i uspješno liječiti. Nažalost, niti jedno nije stvarnost, mnogi od ovih tumora prepoznaju se u kasnim stadijima kada liječenje zahtjeva opsežan operativni zahvat ili kemoradioterapiju. Liječenje karcinoma usne šupljine u kasnim stadijima često je povezano sa visokom stopom smrtnosti, a u mnogim slučajevima znači nepotpun oporavak i smanjenu kvalitetu života. U ovom članku, autori žele naglasiti najvažnija pitanja koja su neophodna za rano prepoznavanje i bolje razumijevanje bolesti kako bi se preveniralo pogrešno dijagnosticiranje i kasno otkrivanje karcinoma usne šupljine

Lymphatic drainage patterns of head and neck cutaneous melanoma: does primary melanoma site correlate with anatomic distribution of pathologically involved lymph nodes?

The aim of this study was to analyse patterns of metastatic spread from cutaneous head and neck melanoma, which are said to be highly variable. The medical records of 145 patients with pathologically proven metastatic melanoma were reviewed retrospectively. The location of pathologically positive lymph nodes was compared with clinically predicted spread, and patients with metastatic disease in areas outside of predicted drainage patterns were considered aberrant. There were 33 curative and 73 elective neck dissections. 21 of 77 patients undergoing parotidectomy had positive results for metastases. Clinical prediction proved to be correct in 33 of 45 cases (73.3%). Two patients with lateralized melanomas were initially seen with contralateral metastases. Six of 45 patients (13.3%) developed contralateral metastases after neck dissection. Patients with clinical involvement of the parotid gland were at high risk of occult neck disease (40%). Patients undergoing neck dissection for primaries originating in face, forehead, coronal scalp, periauricular area, and upper neck should be considered for parotidectomy. Patients with posterior scalp and posterior neck primaries should be considered for selective neck dissection in conjunction with posterior lymphadenectomy. In patients with coronal scalp and periauricular primaries, a complete neck dissection including parotidectomy is the recommended approach

Unrecognised symptoms and mistreatment of nasal cavum and paranasal sinus neoplasms

Provedeno je retrospektivno istraživanje bolesnika liječenih od 1976. do 1997. zbog malignog tumora paranazalnih sinusa na Klinici za kirurgiju lica, čeljusti i usta u Zagrebu. Cilj istraživanja bio je odrediti učestalost i obrazac neprepoznavanja simptoma bolesti i pogrešnog liječenja. Korišteni su anamnestički podaci 75 bolesnika. Rezultati ukazuju da je u gotovo 50% bolesnika tumor neprepoznat i pogrešno liječen. Studija je otkrila da se najčešće ne prepoznaju inicijalni simptomi vezani za usnu šupljinu (32%), zatim nazalni simptomi (27%), facijalni simptomi u 24%, dok su okulami bili neprepoznati u 15% bolesnika. Najveći udio u pogrešnom liječenju ispitivane skupine imali su stomatolozi (41,5%) i otorinolaringolozi (23,3%). Ostale medicinske specijalnosti sudjelovale su u pogrešnom liječenju ispitivane skupine u manje od 20%, svaka. Rezultati ove studije ukazuju da svaki jednostrani "upalni" proces usne šupljine, nosa i/ili sinusa, orbite, u kojeg nakon dva tjedna liječenja ne dolazi do poboljšanja, zahtijeva dodatnu dijagnostičku obradu. Patognomonični simptomi zahtijevaju dijagnostičku obradu odmah.Retrospective study of the patients treated from 1976 to 1997 in Maxillofacial Department, University Hospital Dubrava, Zagreb due to malignant tumour of paranasal sinuses has been conducted. The aim of study was to evaluate the frequency of non-recognition of the initial symptoms and wrong treatment. The results revealed that, in almost 50% of patients the tumour was not recognised and mistreated. The vast majority of non-recognised symptoms were related to oral cavity (32%), followed by nasal symptoms (27%), facial symptoms (24%) and ocular symptoms in 15%. Dentists participated in mistreating of the studied group in 41,5%, otorhinolaryngologists in 23,3%. Other medical profiles participated in less than 20%, each. Results of this study suggest that any unilateral inflammatory process in the oral cavity, nasal cave and/or paranasal sinuses and orbit, in which after two weeks of treatment no improvement has been detected, requires further diagnostic analysis. Pathognomonic symptoms require diagnostic analysis immediately

Schwannoma of the tongue in a child

A schwannoma or neurilemmoma is a benign, slow growing, usually solitary and encapsulated tumour originating from Schwann cells of the nerve sheath. Approximately 25-40% of all schwannomas are seen in the soft tissues of the head and neck, often originate from the acoustic nerve. Intraoral schwannomas are rare and account for 1% of schwannomas of the head and neck region. We report the case of a 10-year-old boy diagnosed with a schwannoma of the tongue. The purpose of this report is to emphasize the possibility of diagnosing schwannoma among all other lingual lesions in children. The disease itself was diagnosed histologically after complete surgical excision. Five years after surgical treatment, the patient is without signs of recurrence. This paper highlights the importance of a multidisciplinary approach in the diagnosis and surgical treatment of this very rare entity

Evaluation of the M andibular Fractures Treated with »Instrumentarija« Mini-plate System

U suradnji s »Instrumentarijom« iz Zagreba 1987. godine izrađena je na Klinici za kirurgiju lica, čeljusti i usta vlastita modifikacija seta za osteosintezu kostiju lica minipločicom. Cilj rada jest da se ocijeni uspješnost liječenja prijeloma donje čeljusti minipločicom »Instrumentarija« te da se ona usporedi s »klasičnim« metodama liječenja - intermaksilarnom fiksacijom i osteosintezom žičanom ligaturom. U radu je primijenjena vlastita metoda u ocjeni uspješnosti liječenja prijeloma donje čeljusti. Metoda se koristi ocjenom liječnika i samoocjenjivanjem. Pet osnovnih parametara za ocjenu uspješnosti liječenja: okluzija, žvakanje, izgled nakon liječenja, trajanje intermaksilarne fiksacije i komplikacije, raščlanjeno je i bodovano, što nam je omogućilo objektivizaciju uspjeha liječenja pojedinom metodom. Obrađeno je 124 bolesnika s prijelomom donje čeljusti koji su zadovoljavali zadane kriterije. Iz rezultata zaključujemo da intraoralni pristup ima prednosti pred ekstraoralnim. Pregledom uspješnosti svih triju metoda zaključujemo da se najbolji uspjeh liječenja kod prijeloma donje čeljusti postiže osteosintezom minipločicom, te je smatramo metodom izbora kod prijeloma koji zahtijevaju osteosintezu, a zbog brze uspostave funkcije i malog broja komplikacija dajemo joj prednost pred konzervativnom terapijom ako nema kontraindikacija za njezinu primjenu.In 1987, a modification o f the miniplate system for facial bone fixation was developed at the Department o f Maxillofacial Surgery, Zagreb University Hospital, in cooperation with Instrumentarija, Zagreb. The aim o f this study was to evaluate the success o f the lower jaw treatment with mini-plates and to compare it to two »traditional « methods o f treatment, intermaxillary fixation and wire fixa-tion. In the evaluation, an original method based on the physician\u27s and self-evaluation was used. Five basic parameters: occlusion, masticatory ability, appearance, duration o f intermaxillary fixation and complications, were scored, providing objective information on the therapeutic success o f the methods. The study included 124 patients with mandible fractures. The results suggested the intraoral approach to the fracture site to be advantageous over the extraoral approach. The mini-plate fixation shows the best results o f treatment for all the parameters observed, thus it should be considered the method o f choice when internal fixation o f fragments is required. Due to fast achievement o f the function and a small number o f complications, we preferred the mini-plate fixation in comparison with intermaxillary fixation when there were no contraindications for its use

Lifestyle Habits and the Risk of Head and Neck Cancer in Zagreb Region

In 2002, International Agency for Research on Cancer launched a multicentric case-control study of head and neck cancer in 15 centres in 11 European countries, Croatia included. The Alcohol-related Cancers and Genetic Susceptibility in Europe (ARCAGE) study database with approximately 2500 case-control pairs is currently the largest head and neck cancer patients database in Europe. The aim of the present study was to estimate the risk of smoking and alcohol consumption in head and neck cancer patients from Zagreb region recruited in scope of the ARCAGE study. The cases (45 males, 9 females) and the controls (37 males, 9 females) were recruited from University Hospital Dubrava and Merkur University Hospital. A blood sample and a lifestyle questionnaire were collected from all study subjects. Data were analysed by logistic regression analysis. The distribution of cases was: 43 oral, 9 pharyngeal and 2 laryngeal cancer cases. Ever-smokers had a 4-fold higher cancer risk (adjusted OR 4.3 (CI 1.20–15.4)) compared to never-smokers. The adjusted odds ratio for alcohol consumption more than once a week was 4.1 (CI 1.5–11.2). The results are in keeping with previously published data from other countries

The modification of rotation - advancement flap made in 1950

The early techniques of cleft lip repair involved the straight-line technique, the triangular flap technique or some kind of geometric line (triangular, quadrangular closure). A turning point in cleft lip surgery was in 1955 when doctor. Millard presented his method: the rotation-advancement technique or flap, at the First International Congress of Plastic Surgery in Stockholm. Today, the technique, with or without some modifications, is used by more than 85% of cleft surgeons around the world. We are presenting a patient with complete unilateral cleft lip and palate who underwent surgery sixty-five years ago. The scar on his lip was similar to rotation advancement line. Cheiloplasty was performed by Professor Šercer in 1950, five years before Millard's publication. Professor Ante Šercer was an internationally recognized Croatian scholar in the area of ear, nose and throat diseases. He also gave a significant contribution to surgical management of velopharyngeal insufficiency and plastic surgery of the nose and ear

Salivary and Serous Values of Interleukin 6 and Basic Growth Factor of Fibroblasts in Patients with Planocellular Carcinoma

U literaturi postoje podatci o ulozi interleukina 6 (IL-6) i bazičnoga čimbenika rasta fibroblasta (bFGF) u bolesnika s oralnim karcinomima, ali nema podataka o salivarnom IL-6 i bFGF u tih bolesnika. Svrha ovoga ispitivanja bila je odrediti vrijednosti salivarnog i serumskog IL-6 i bFGF u 35 bolesnika s planocelularnim karcinomom usne šupljine, dobi od 40-73 godine, prosječne dobi 54 godine. Kontrolna se je skupina sastojala od 23 zdrava sudionika, u dobi od 25 godina. Dobiveni podatci analizirani su Mann-Whitney U testom i vrijednosti manje od 0,001 smatrale su se statistički znatnima. Serumske vrijednosti IL-6 i bFGF nisu se znatno razlikovale između ispitne i kontrolne skupine. Povišene vrijednosti salivarnog IL-6 i bFGF ustanovljene su u oboljelih od planocelularnoga karcinoma u usporedbi s kontrolnom skupinom (p<0,001). Možemo zaključiti da povišene vrijednosti salivarnog IL-6 i bFGF u oboljelih od planocelularnoga karcinoma potječu od lokalne proizvodnje.Data can be found in the literature on the roles of interleukin 6 (IL-6) and basic growth factor of fibroblasts (bFGF) in patients with oral carcinomas, although there are no data on salivary IL-6 and bFGF in such patients. The aim of this study was to determine the values of salivary and serum IL-6 and bFGF in 35 patients with planocellular carcinoma of the oral cavity, aged 40 - 73 years (mean age 54 years). A control group consisted of 23 healthy participants, aged 25 years. The data obtained were analysed by Mann-Whitney U test and values of less than 0.001 were considered statistically significant. Serum values IL-6 and bFGF did not significantly differ between the examined and the control group. Increased values of salivary IL-6 and bFGF were determined in the patients with planocellular carcinoma compared with the control group (p<0.001). We can conclude that the increased values of salivary IL-6 and bFGF in patients with planocellular carcinoma originated from local production