Comparison of Three Postoperative Follow-up Methods in Patients with Oral Cancer

The goal of this research was to determine the existence of the significant time differences in the identification of the recurrences and neck metastases in the patients surgically treated for the oral cavity cancer by comparing three postoperative follow up methods. The study included 286 patients surgically treated for oral and pharyngeal cancer in period from 1991 to 2007 at three different institutions, divided into three groups based on the different postoperative follow up protocol. In this study we were able to show that the period of identification of recurrences and neck metastases was significantly shorter in the group of patients whose follow up included neck ultrasound, along with methods of inspection and palpation of the oral cavity and the neck. In conclusion, implementation of more contemporary methods such as the neck ultrasound is needed along with usual follow up methods, such as inspection and palpation of the oral cavity and the neck. Also, follow up of the patients surgically treated for the oral cavity cancer should be conducted systematically. Ultrasound examination of the neck should be recommended due to its low cost, harmlessness, possible frequent usage,high quality visual imaging and possibility of combination with the fine needle aspiration cytology (FNAC) of the suspicious lymph nodes

Carcinoma originating from branchiogenic cleft cyst – case report

Cilj: Prikazati rijedak slučaj pacijenta s karcinomom koji je nastao na bazi lateralne kongenitalne branhiogene ciste vrata, opisati dijagnostički postupak i konačni ishod nakon patohistološke analize. Prikaz slučaja: Osamdesetgodišnji pacijent primljen je na Kliniku za maksilofacijalnu kirurgiju zbog dijagnostike i terapije bezbolne otekline na lijevoj strani vrata, ispod donje čeljusti, koja se s vremenom povećavala. Ultrazvučni pregled ukazivao je na hipoehogenu promjenu, ispunjenu žućkastim sadržajem. Sadržaj je punktiran, a citološki razmaz ukazivao je na karcinoma pločastih stanica, te se u daljnjem tijeku ordinira operativni zahvat, a materijal prosljeđuje na patohistološku analizu. Patohistološka analiza potvrđuje branhio- geni karcinom koji je nastao na bazi kongenitalne branhiogene ciste. Zaključak: Kongenitalne branhiogene ciste vrata nisu česte, a pojava karcinoma unutar takve ciste je još rjeđa. Prikaz našeg slučaja ukazuje na važnost prepoznavanja branhiogenih karcinoma u sklopu cističnih lezija vrata. Dijagnoza se postavlja na temelju isključivanja u suradnji s kliničarima, odnosno na temelju literaturno opisanih kriterija za postavljanje dijagnoze branhiogenog karcinoma.Aim: To show a rare case of a patient with carcinoma originating from a lateral con- genital branchiogenic cleft cyst, describe the diagnostic pathway, treatment and the final diagnosis confirmed by the pathohistological analysis. Case report: An 80-year-old patient came to the Department of Maxillofacial Surgery, for diagnosis and treatment of a painless, slow growing mass on the left side of the neck, below the lower jaw. Ultrasound examination indicated a hypoechogenic mass filled with yellowish content. The content was aspirated and cytological smear showed squamous cell carcinoma. Furthermore, after surgery, the pathohistological analysis of the surgical material indicated branhiogenic carcinoma originating from a congenital branchiogenic cleft cyst. Conclusion: Congenital branchiogenic cysts are uncommon and carcinoma occurrence within cysts is even rarer. Our case emphasizes the importance of recognizing branhiogenic carcinoma arising within the cystic lesions of the neck. Diagnosis is based on exclusion in collaboration with clinicians, and based on the literature describing the criteria for the diagnosis of branhiogenic carcinoma

Comparison of Three Postoperative Follow-up Methods in Patients with Oral Cancer

The goal of this research was to determine the existence of the significant time differences in the identification of the recurrences and neck metastases in the patients surgically treated for the oral cavity cancer by comparing three postoperative follow up methods. The study included 286 patients surgically treated for oral and pharyngeal cancer in period from 1991 to 2007 at three different institutions, divided into three groups based on the different postoperative follow up protocol. In this study we were able to show that the period of identification of recurrences and neck metastases was significantly shorter in the group of patients whose follow up included neck ultrasound, along with methods of inspection and palpation of the oral cavity and the neck. In conclusion, implementation of more contemporary methods such as the neck ultrasound is needed along with usual follow up methods, such as inspection and palpation of the oral cavity and the neck. Also, follow up of the patients surgically treated for the oral cavity cancer should be conducted systematically. Ultrasound examination of the neck should be recommended due to its low cost, harmlessness, possible frequent usage,high quality visual imaging and possibility of combination with the fine needle aspiration cytology (FNAC) of the suspicious lymph nodes

Detection of nodes metastases and tumors recurrences in patients with oral cancer

Cilj istraživanja: Cilj ovog istraživanja bio je utvrditi postojanje signifikantnih vremenskih razlika u otkrivanju recidiva i metastaza vrata kod bolesnika koji su operirani od karcinoma usne šupljine usporedbom tri načina poslijeoperacijskog praćenja. U istraživanje je uključeno 397 bolesnika kod kojih je učinjen kirurški zahvat u periodu od 1992. do 2008. godine na Klinici za oralnu i maksilofacijalnu kirurgiju u Kliničkom bolničkom centru Rijeka. Ispitanici i metode: U istraživanje je uključeno 397 bolesnika operiranih od karcinoma usne šupljine i ždrijela u periodu od 1992. do 2008. godine, podijeljenih u tri skupine prema načinu poslijeoperacijskog praćenja, a analiza se odnosi na one bolesnike kod kojih je došlo do pojave lokalnog recidiva i /ili metastaze vrata unutar dvije godine nakon operacije. Podaci su prikupljeni na Klinici za oralnu i maksilofacijalnu kirurgiju Kliničkog bolničkog centra Rijeka. U prvoj skupini, koja obuhvaća 92 bolesnika sa recidivom, poslijeoperacijsko praćenje nije bilo sustavno već se je provodilo po procjeni kirurga, uglavnom svaka 2-3 mjeseca inspekcijom i palpacijom usne šupljine i vrata. Druga skupina obuhvaća 105 bolesnika sa recidivom koji su bili praćeni sustavno, jednom mjesečno tijekom prve poslijeoperacijske godine i jednom u dva mjeseca tijekom druge godine. Metode pregleda su bile inspekcija i palpacija dok su ultrazvučna pretraga vrata, CT i MRI bile rađene samo kad su simptomi ili nalazi kliničkog pregleda ukazivali na mogućnost recidiva i/ili metastaze vrata. Treća grupa je obuhvaćala 89 bolesnika sa recidivom koji su praćeni sustavno, jednom mjesečno tijekom prve poslijeoperacijske godine i jednom u dva mjeseca tijekom druge. Osim inspekcije i palpacije rađena je i ultrazvučna pretraga vrata svakih 6-8 tjedana tijekom prve Vposlijeoperacijske godine i svakih 8-10- tjedana tijekom druge. Ako bi bio pronađen suspektni limfni čvor, učinjena bi bila i njegova citopunkcija pod kontrolom ultrazvuka ( USg FNAC ). CT i MRI su poduzimane ako se lokalni recidivi i metastaze vrata ne bi mogli dokazati ultrazvučnom pretragom vrata i citopunkcijom. Rezultati: Usporedba grupa I i III ukazuje na statistički značajno kraće vrijeme otkrivanja metastaza kod III i IV stadija bolesti u korist grupe III. Usporedba grupa II i III ukazuje na statistički značajno kraće vrijeme otkrivanja lokalnog recidiva i regionalnih metastaza kod IV stadija bolesti u korist grupe III Usporedba grupa I i II, I i III i II i III ukazuje na statistički značajno kraće vrijeme otkrivanja regionalnih metastaza na kontralateralnoj strani vrata kod III stadija bolesti u korist grupe II, kod usporedbe grupa I i II, u korist grupe III kod usporedbe grupa I i III te u korist grupe III kod usporedbe grupa II i III. Usporedba grupa I i III i II i III ukazuje na statistički značajno kraće vrijeme otkrivanja regionalnih metastaza na kontralateralnoj strani vrata kod IV stadija bolesti u korist grupe III. Zaključak: Usporedbom grupa I, II i III bilo je moguće dokazati da su skraćenja vremenskog perioda proteklog do otkrivanja metastaza vrata rezultat efikasnosti primjenjenih poslijeoperacijskih metoda praćenja. Ova studija je pokazala da je kombinacija klasičnih metoda praćenja i sistematske ultrazvučne pretrage vrata superiorna u odnosu na samo klasične metode praćenja.Objectives: The goal of this research was to determine the existence of the significant time differences in the identification of the recurrences and neck metastases in the patients surgically treated for the oral cavity cancer by comparing three postoperative follow up methods. The study included 397 patients surgically treated for oral and pharyngeal cancer in period from 1992 to 2008 at Department of Oral and Maxillofacial Surgery, Rijeka University Hospital Center. Patients and methods: The study included 397 patients surgically treated for oral and pharyngeal cancer in period from 1992 to 2008, divided into three groups based on the different postoperative follow up protocol. I have analyzed the patients who had local recurrences and/or neck metastases within 2 years after the operation. Data were collected at Department of Oral and Maxillofacial Surgery, Rijeka University Hospital Center; In the first group, which consisted of 92 patients who had local/or regional reccurances, the postoperative follow up was not systematic and it was conducted upon surgeon’s estimation, mainly every 2 to 3 months. The postoperative follow up included inspection and palpation of the oral cavity and neck. The second group consisted of 105 patients who had local/or regional reccurances, the postoperative follow up was systematic, once a month during the first postoperative year, and once in 2 months during the second postoperative year. Examination methods were inspection VIIand palpation, whereas neck ultrasound, CT and MRI were performed only when symptoms or physical examination indicated a possibility of recurrences and/or neck metastases. The third group consisted of 89 patients who had local/or regional reccurances, the postoperative follow up was systematic, once a month during the first postoperative year, and once in 2 months during the second postoperative year. Besides inspection and palpation every physical examination included neck ultrasound every 6 to 8 weeks during the first postoperative year and every 8 to 10 weeks during second postoperative year. If the suspected lymph nodes were found the neck ultrasound was followed by ultrasound-guided fine-needle aspiration citology (USg FNAC). CT and MRI were conducted if recurrence and neck metastases could not be proven by ultrasound and USg FNAC. Results:. Comparison between groups I and III in order to show stastically significant shorter length of time in detection of local recurrences and neck metastases in stadium III and IV of desease in favour of group III. Comparison between groups II and III in order to show stastically significant shorter length of time in detection of local recurrences and neck metastases in stadium IV of desease in favour of group III. Comparison between groups I and II, I and III and II and III in order to show stastically significant shorter length of time in detection neck metastases of contralateral side in stadium III of desease in favour of group II in the first comparision and in favour of group III in the second and third comparision. Comparison between groups I and III and II and III in order to show stastically significant shorter length of time in detection neck metastases of contralateral side in stadium IV of desease in favour of group III. VIIIConclusion: Comparison between groups I, II and III based on the type of surgical procedure was performed in order to show that differences in the length of time passed until recurrences and neck metastases were discovered are result of efficacy of used postoperative follow up methods, and not a result of different surgical treatments since all three types of surgical procedures were performed on almost equal proportions of the patients in all three groups. The results are even better if the usual, above mentioned methods are supplemented with regular ultrasound examinations combined with ultrasound guided fine needle aspiration citology. This study showed that combination of the classic follow up methods and ultrasound examination are superior over classical check up methods alone

Detection of nodes metastases and tumors recurrences in patients with oral cancer

Cilj istraživanja: Cilj ovog istraživanja bio je utvrditi postojanje signifikantnih vremenskih razlika u otkrivanju recidiva i metastaza vrata kod bolesnika koji su operirani od karcinoma usne šupljine usporedbom tri načina poslijeoperacijskog praćenja. U istraživanje je uključeno 397 bolesnika kod kojih je učinjen kirurški zahvat u periodu od 1992. do 2008. godine na Klinici za oralnu i maksilofacijalnu kirurgiju u Kliničkom bolničkom centru Rijeka. Ispitanici i metode: U istraživanje je uključeno 397 bolesnika operiranih od karcinoma usne šupljine i ždrijela u periodu od 1992. do 2008. godine, podijeljenih u tri skupine prema načinu poslijeoperacijskog praćenja, a analiza se odnosi na one bolesnike kod kojih je došlo do pojave lokalnog recidiva i /ili metastaze vrata unutar dvije godine nakon operacije. Podaci su prikupljeni na Klinici za oralnu i maksilofacijalnu kirurgiju Kliničkog bolničkog centra Rijeka. U prvoj skupini, koja obuhvaća 92 bolesnika sa recidivom, poslijeoperacijsko praćenje nije bilo sustavno već se je provodilo po procjeni kirurga, uglavnom svaka 2-3 mjeseca inspekcijom i palpacijom usne šupljine i vrata. Druga skupina obuhvaća 105 bolesnika sa recidivom koji su bili praćeni sustavno, jednom mjesečno tijekom prve poslijeoperacijske godine i jednom u dva mjeseca tijekom druge godine. Metode pregleda su bile inspekcija i palpacija dok su ultrazvučna pretraga vrata, CT i MRI bile rađene samo kad su simptomi ili nalazi kliničkog pregleda ukazivali na mogućnost recidiva i/ili metastaze vrata. Treća grupa je obuhvaćala 89 bolesnika sa recidivom koji su praćeni sustavno, jednom mjesečno tijekom prve poslijeoperacijske godine i jednom u dva mjeseca tijekom druge. Osim inspekcije i palpacije rađena je i ultrazvučna pretraga vrata svakih 6-8 tjedana tijekom prve Vposlijeoperacijske godine i svakih 8-10- tjedana tijekom druge. Ako bi bio pronađen suspektni limfni čvor, učinjena bi bila i njegova citopunkcija pod kontrolom ultrazvuka ( USg FNAC ). CT i MRI su poduzimane ako se lokalni recidivi i metastaze vrata ne bi mogli dokazati ultrazvučnom pretragom vrata i citopunkcijom. Rezultati: Usporedba grupa I i III ukazuje na statistički značajno kraće vrijeme otkrivanja metastaza kod III i IV stadija bolesti u korist grupe III. Usporedba grupa II i III ukazuje na statistički značajno kraće vrijeme otkrivanja lokalnog recidiva i regionalnih metastaza kod IV stadija bolesti u korist grupe III Usporedba grupa I i II, I i III i II i III ukazuje na statistički značajno kraće vrijeme otkrivanja regionalnih metastaza na kontralateralnoj strani vrata kod III stadija bolesti u korist grupe II, kod usporedbe grupa I i II, u korist grupe III kod usporedbe grupa I i III te u korist grupe III kod usporedbe grupa II i III. Usporedba grupa I i III i II i III ukazuje na statistički značajno kraće vrijeme otkrivanja regionalnih metastaza na kontralateralnoj strani vrata kod IV stadija bolesti u korist grupe III. Zaključak: Usporedbom grupa I, II i III bilo je moguće dokazati da su skraćenja vremenskog perioda proteklog do otkrivanja metastaza vrata rezultat efikasnosti primjenjenih poslijeoperacijskih metoda praćenja. Ova studija je pokazala da je kombinacija klasičnih metoda praćenja i sistematske ultrazvučne pretrage vrata superiorna u odnosu na samo klasične metode praćenja.Objectives: The goal of this research was to determine the existence of the significant time differences in the identification of the recurrences and neck metastases in the patients surgically treated for the oral cavity cancer by comparing three postoperative follow up methods. The study included 397 patients surgically treated for oral and pharyngeal cancer in period from 1992 to 2008 at Department of Oral and Maxillofacial Surgery, Rijeka University Hospital Center. Patients and methods: The study included 397 patients surgically treated for oral and pharyngeal cancer in period from 1992 to 2008, divided into three groups based on the different postoperative follow up protocol. I have analyzed the patients who had local recurrences and/or neck metastases within 2 years after the operation. Data were collected at Department of Oral and Maxillofacial Surgery, Rijeka University Hospital Center; In the first group, which consisted of 92 patients who had local/or regional reccurances, the postoperative follow up was not systematic and it was conducted upon surgeon’s estimation, mainly every 2 to 3 months. The postoperative follow up included inspection and palpation of the oral cavity and neck. The second group consisted of 105 patients who had local/or regional reccurances, the postoperative follow up was systematic, once a month during the first postoperative year, and once in 2 months during the second postoperative year. Examination methods were inspection VIIand palpation, whereas neck ultrasound, CT and MRI were performed only when symptoms or physical examination indicated a possibility of recurrences and/or neck metastases. The third group consisted of 89 patients who had local/or regional reccurances, the postoperative follow up was systematic, once a month during the first postoperative year, and once in 2 months during the second postoperative year. Besides inspection and palpation every physical examination included neck ultrasound every 6 to 8 weeks during the first postoperative year and every 8 to 10 weeks during second postoperative year. If the suspected lymph nodes were found the neck ultrasound was followed by ultrasound-guided fine-needle aspiration citology (USg FNAC). CT and MRI were conducted if recurrence and neck metastases could not be proven by ultrasound and USg FNAC. Results:. Comparison between groups I and III in order to show stastically significant shorter length of time in detection of local recurrences and neck metastases in stadium III and IV of desease in favour of group III. Comparison between groups II and III in order to show stastically significant shorter length of time in detection of local recurrences and neck metastases in stadium IV of desease in favour of group III. Comparison between groups I and II, I and III and II and III in order to show stastically significant shorter length of time in detection neck metastases of contralateral side in stadium III of desease in favour of group II in the first comparision and in favour of group III in the second and third comparision. Comparison between groups I and III and II and III in order to show stastically significant shorter length of time in detection neck metastases of contralateral side in stadium IV of desease in favour of group III. VIIIConclusion: Comparison between groups I, II and III based on the type of surgical procedure was performed in order to show that differences in the length of time passed until recurrences and neck metastases were discovered are result of efficacy of used postoperative follow up methods, and not a result of different surgical treatments since all three types of surgical procedures were performed on almost equal proportions of the patients in all three groups. The results are even better if the usual, above mentioned methods are supplemented with regular ultrasound examinations combined with ultrasound guided fine needle aspiration citology. This study showed that combination of the classic follow up methods and ultrasound examination are superior over classical check up methods alone

Surgical treatment of malignant head and neck skin tumors

Regija glave i vrata najčešća je lokalizacija malignih tumora kože. Među malignim tumorima prevladavaju tzv. nemelanomski tumori (bazeocelularni i planocelularni karcinom) te melanom. Kirurgija je dominantan način liječenja s najvećom stopom izlječenja. Kirurškom ekscizijom resecira se tumor s adekvatnim rubom zdravog tkiva čija zahtijevana debljina varira ovisno o tipu tumora. Budući da se regija glave i vrata sastoji od većeg broja estetskih jedinica, važno ih je poštovati pri kirurškom liječenju, da se ne naruši izgled i funkcija. Mogućnosti rekonstrukcije defekta nastalog ekscizijom tumora su brojne. Cilj je ovog članka istaknuti važnost kirurškog liječenja malignih tumora kože te specifičnosti regije glave i vrata, kao i dati uvid u različite tehnike ekscizije i rekonstrukcije.Head and neck region is the most common site of malignant skin tumors. The predominant tumors among malignant tumors are the non-melanoma tumors (basal cell carcinoma and squamous cell carcinoma) and melanoma. Surgery is the dominant mode of treatment with the highest cure rate. The tumor is resected by surgical excision which includes an adequate rim of healthy tissue, the thickness of which varies depending on the type of tumor. As the head and neck region consists of a number of important aesthetic units it is important to respect them and not violate their appearance and function. The possibility of reconstructing defects resulting from excision of the tumor is numerous. The aim of this paper is to emphasize the importance of surgical treatment of malignant skin tumors and specificities of the head and neck regions, as well as to provide insight into the different techniques of excision and reconstruction