Evaluation of A Post-Treatment Follow-Up Program in Patients with Oral Squamous Cell Carcinoma

Objectives The duration and the frequency of follow-up after treatment of oral squamous cell carcinoma are not standardized in the current literature. The purpose of this study was to evaluate our local standard post-treatment and follow-up protocol. Materials and methods Overall, 228 patients treated curatively from 01/2006 to 07/2013 were reviewed. To evaluate the follow-up program, data on the secondary event were used. To determine risk groups, all patients with tumor recurrence were specifically analyzed. Relapse-free rate were estimated by the Kaplan-Meier product limit method. The chi-square test was used to identify independent risk factors for tumor relapse. Results In total, 29.8 % patients had a secondary event. The majority of the relapse cases (88.2 %) were detected within 2 years postoperatively, 61.8 % of them within the first year. Most events were local recurrences (34.7 %). UICC-stage IV was significantly associated with tumor recurrence (p = 0.001). Gender (p = 0.188), age (p = 0.195), localization (p = 0.739), T-stage (p = 0.35), N-stage (p = 0.55), histologic grade (p = 0.162), and tobacco and alcohol use (p = 0.248) were not significantly associated with tumor recurrence. Patients with positive neck nodes relapsed earlier (p = 0.011). The majority of relapses (86.3 %) were found in asymptomatic patients at routine follow-up. Conclusions The results of this study suggest an intensified follow-up within the first 2 years after surgery. Clinical relevance Given the higher relapse rate of patients exhibiting an UICC-stage IV and/or positive neck nodes, it seems to be from special interest to perform in this group a risk-adapted follow-up with monthly examinations also in the second year

Longterm quality of life after oncologic surgery and microvascular free flap reconstruction in patients with oral squamous cell carcinoma

Background: Quality of life (QoL) has become increasingly important in cancer treatment. It refers to the patient’s perception of the effects of the disease and therapy, and their impact on daily functioning and general feeling of well being. Material and Methods: In this prospective study, a total of 100 patients treated at our institution, completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire and the specific EORTC QLQ-H&N35 module. The questionnaires were distributed to the patients between 12 and 60 months postoperatively. Results: Global QoL score was 58.3 and mean score for functioning scale was 76.7. Fatigue (28.7 ± 26.1), followed by financial problems (27.7 ± 33.5), insomnia (26.7 ± 34.5) and pain (26.3 ± 29.9) had highest symptom score on QLQ-C30. Fatigue (r=-0.488), insomnia (r=-0.416) and pain (r =-0.448) showed highest value for significantly negative correlation to global QoL. In the H&N35 module, restriction of mouth opening (43.3 ± 38.6), dry mouth (40.7 ± 36.9), sticky saliva (37.3 ± 37.1) and eating in public (33.8 ± 31.9) were the four worst symptoms. Swallowing problem (r=-0.438), eating in public (r=-0.420) and persistent severe speech (r=-0.398) ranked as the three worst symptoms with highest value for significantly negative correlation to global QoL. Conclusions: Longterm QoL after oncologic surgery and microvascular free flap reconstruction in patients with oral cancer is satisfactory. Measuring QoL should be considered as part of the evaluation of cancer treatment

Salivary MMP-9 in the detection of oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) is the most common malignant tumour of the oral cavity. Detection of OSCC is currently based on clinical oral examination combined with histopathological evaluation of a biopsy sample. Direct contact between saliva and the oral cancer makes measurement of salivary metalloproteinase- 9 (MMP-9) an attractive alternative. In total, 30 OSCC patients and 30 healthy controls were included in this prospective study. Saliva samples from both groups were collected, centrifuged and supernatant fluid was subjected to ELISA for assessment of MMP-9. The median salivary MMP-9 values with interquartile range (IQR) of OSCC patients and the control group were statistically analysed using the Mann-Whitney U-test. The receiver operating characteristic (ROC) curve was constructed and the area under curve (AUC) was computed. The median absorbance MMP-9 value of the OSCC group was 0.186 (IQR=0.158) and that of control group was 0.156 (IQR=0.102). MMP-9 was significantly increased in the OSCC patients than in the controls by +19.2% (p=0.008). Median values in patients with recurrence and in patients with primary event were 0.233 (IQR=0.299) and 0.186 (IQR=0.134) respectively. MMP-9 was significantly increased in patients with primary event (p=0.017) compared to controls by +19.2%. No significant increase of MMP-9 level was detected when comparing patients with recurrence and healthy controls (+49.4%; p=0.074). The sensitivity value of MMP-9 was 100% whereas the specificity value was 26.7% with AUC of 0.698. The present data indicates that the elevation of salivary levels of MMP-9 may be a useful adjunctive diagnostic tool for detection of OSCC. However, further studies are necessary to provide scientific and clinical validation

Zur Zellproliferation und Apoptose von nicht kollagenen Knochenproteinen auf anodischen Konversionsschichten mit unterschiedlicher Kalzium-Phosphorrelation

Das Ziel der vorliegenden Arbeit war es, die Wachstumsbedingung der nicht kollagenen Knochenproteine auf unterschiedlichen Konversionsoberflächen zu untersuchen. Dazu wurde das Proliferations- sowie Apoptoseverhalten der Knochenproteine in vitro bestimmt. Es kamen neben dem Probekörper Titan als Negativstandard und Ticer als Positivstandard, vier weitere Probekörper auf Titanbasis mit unterschiedlicher Kalzium-Phosphorrelation zur Anwendung. Diese wurden mit humanen Knochenzellen beschickt und über einen Zeitraum vom 3., 5., 7., und 10. Versuchstag ausgewertet. Die Zellkerne und Apoptosefragmente wurden immunhistochemisch markiert und fluoreszenzoptisch untersucht. Desweiteren wurden die relativen Grauwerte ermittelt, welche die Intensität des Bildes wiedergeben. Es zeigte sich in überwiegenden Fällen eine Zunahme der Zellanzahlen auf den verschiedenen Probekörpern. Dagegen verhielt sich die Zahl der apoptotischen Fragmente invers, indem sie auf ein Minimum absanken. In unserer Arbeit kommen wir zu der Annahme, dass Oberflächenmodifikationen die Knochenmineralisierung in der Phase der Knochenneubildung um das Implantat herum, respektive um die Oberflächenstruktur des Implantates, signifikant verbessern. Durch die Beschichtung der Implantatoberflächen mit Kalzium-Phosphor wird einerseits die Oberflächenrauigkeit erhöht, andererseits die Anbindung vom Implantat an die Knochenstruktur verbessert

Zur Zellproliferation und Apoptose von nicht kollagenen Knochenproteinen auf anodischen Konversionsschichten mit unterschiedlicher Kalzium-Phosphorrelation

Das Ziel der vorliegenden Arbeit war es, die Wachstumsbedingung der nicht kollagenen Knochenproteine auf unterschiedlichen Konversionsoberflächen zu untersuchen. Dazu wurde das Proliferations- sowie Apoptoseverhalten der Knochenproteine in vitro bestimmt. Es kamen neben dem Probekörper Titan als Negativstandard und Ticer als Positivstandard, vier weitere Probekörper auf Titanbasis mit unterschiedlicher Kalzium-Phosphorrelation zur Anwendung. Diese wurden mit humanen Knochenzellen beschickt und über einen Zeitraum vom 3., 5., 7., und 10. Versuchstag ausgewertet. Die Zellkerne und Apoptosefragmente wurden immunhistochemisch markiert und fluoreszenzoptisch untersucht. Desweiteren wurden die relativen Grauwerte ermittelt, welche die Intensität des Bildes wiedergeben. Es zeigte sich in überwiegenden Fällen eine Zunahme der Zellanzahlen auf den verschiedenen Probekörpern. Dagegen verhielt sich die Zahl der apoptotischen Fragmente invers, indem sie auf ein Minimum absanken. In unserer Arbeit kommen wir zu der Annahme, dass Oberflächenmodifikationen die Knochenmineralisierung in der Phase der Knochenneubildung um das Implantat herum, respektive um die Oberflächenstruktur des Implantates, signifikant verbessern. Durch die Beschichtung der Implantatoberflächen mit Kalzium-Phosphor wird einerseits die Oberflächenrauigkeit erhöht, andererseits die Anbindung vom Implantat an die Knochenstruktur verbessert

Maxillary tooth displacement in the infratemporal fossa

Wisdom tooth operations are sometimes accompanied by complications. This case report shows complications during upper jaw third molar removal. Expectable problems during oral surgery should be planned to be solved in advance. Displacement of the third molar during oral surgeries as a considerable complication is rarely discussed scientifically. A good design of flap, adequate power for extraction, and clear view on the surgical field are crucial. Three-dimensional radiographic diagnostics in terms of cone beam computed tomography is helpful after tooth displacement into the infratemporal fossa

Management of dental extraction in a female patient with fanconi anemia.

Oral surgery in patients with bleeding disorders is associated with a high risk of bleeding during and after surgery. This article is aimed to present the case of an eight-year-old girl suffering from severe Fanconi anemia with pancytopenia who underwent a dental extraction. The hemostatic effect of local administration of tranexamic acid in combination with a primary suture seems to be extremely helpful in order to reduce the necessity of blood products and the risk of postoperative bleeding

Cross-Sectional Study of Four Serological Bone Turnover Markers for the Risk Assessment of Medication-Related Osteonecrosis of the Jaw

Background: Despite the benefits related to the use of bisphosphonates and denosumab, medication-related osteonecrosis of the jaw (MRONJ) is a serious complication. The purpose of this study was to investigate the utility of 4 biochemical markers including serum c-terminal telopeptide cross-link of type I collagen (s-CTX), serum osteocalcin (s-OC), serum parathormon (s-PTH), and serum bone-specific alkaline phosphatase (s-BAP) as useful clinical tools to help assess the risk for MRONJ prior to invasive oral surgery. Materials and Methods: Twenty patients diagnosed with MRONJ and 20 controls who have been on antiresorptive therapies with no occurrence of MRONJ were included in this 2-arm cross-sectional study. The s-CTX, s-OC, s-PTH, and s-BAP values were measured. Mann–Whitney U test compared the s-CTX, s-OC, s-PTH, and s-BAP values of the MRONJ group and the controls (P \u3c 0.05). Results: Lower values were observed in the MRONJ group compared with the control group for s-CTX (130.00 pg/mL versus 230.0 pg/mL; P = 0.12) and for s-OC (10.6 ng/mL versus 14.80 ng/mL; P = 0.051) both without significance and for s-BAP (0.23 μkat/L versus 0.31 μkat/L; P = 0.002) with significance. By contrast, the median s-PTH value of the MRONJ group was higher (30.65 ng/L versus 25.50 ng/L; P = 0.89), but without significance. Conclusions: The evaluation of the 4 biochemical markers showed that only the value of s-BAP was significantly decreased in the MRONJ patients compared with the controls. Presently, because of the lack of evidence, a routine check prior to oral surgery for the risk assessment of MRONJ cannot be recommended