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Purpose Understanding how oral cancer treatment evolved can pave the way for future management. The literature holds an expansive collection of historical findings regarding oral cancer, yet the authors were unable to find a comprehensive review of oral cancer treatment throughout the ages. Materials A thorough literature review was carried out using multiple scientific databases and languages, as well as examination of historical archives. Articles were included for their relevance and their findings were assimilated. Results Part two of this article considers the development of specific surgical concepts relating to head and neck cancer over the previous two centuries, including neck dissection and reconstruction, as well as exploration of non-surgical cancer therapies. Conclusion This paper demonstrates historical landmarks made in oral cancer treatment and the prominent figures who pioneered them, confirming that head and neck cancer surgeons of today have valuable lessons to learn from their previous counterparts.

Purpose Understanding how oral cancer treatment evolved can pave the way for future management. The literature holds an expansive collection of historical findings regarding oral cancer, yet the authors were unable to find a comprehensive review of oral cancer treatment throughout the ages. Methods A thorough literature review was carried out using multiple scientific databases and languages, as well as examination of historical archives. Articles were included for their relevance and their findings were assimilated. Results Part one of this article reveals a rich history of oral cancer treatment commencing in ancient times, with discussion of Egyptian, Greek and Roman practices, and travelling through the age of discovery to arrive at the dawn of scientific medicine in the 19th century. Conclusion Part one demonstrates how fundamental concepts of oral cancer were discovered, and the significant impact medical innovation had on the success of oral cancer treatment.

BACKGROUND: Human facial bites are uncommon and usually cause a wound that presents major challenges for the reconstructive surgeon. PURPOSE: The purpose of this study is to present the advantages and disadvantages of using a superiorly based interpolated nasolabial flap for reconstruction of a nasal tip defect. METHODS: We present a case of serious injury of the nasal tip as a result of a human bite. Early maxillofacial surgical intervention resulted in restoration of the facial anatomy and function of the structures involved. RESULTS AND CONCLUSION: We present a serious mutilating injury of the tip of the nose in a young patient as a result of a human bite. These injuries can be rather destructive and cause a facial defect which may have a significant adverse psychological impact on the patient. Because of the proximity and the skin colour match of the melolabial fold to the nose, nasolabial flaps are a very attractive and reliable reconstructive choice for nasal tip defects. The relative advantages over other reconstructive options and the limitations of an interpolated superiorly based nasolabial flap are discussed. The elaborated use of a nasolabial peninsular pedicled skin flap may deliver a very satisfactory outcome from a functional and cosmetic point of view.

The recent eighth edition of the American Joint Committee on Cancer (AJCC) staging system has introduced depth of invasion (DOI) as one of its important components. DOI is also important for deciding neck management in superficial tongue cancers. Magnetic resonance imaging (MRI) is mainly used to assess DOI, and in this study we have evaluated the efficacy of MRI to detect it. This is a retrospective study consisting of 60 treatment-naive tongue cancer patients operated on between July 2017 and June 2019. Patients underwent MR imaging on an Optima MR450W 1.5T unit, and MRI was reported by two experienced ead and eck adiologistss. Postoperative histological DOI was considered the gold standard. The correlation coefficient was derived for postoperative DOI and MRI-detected DOI. A subgroup analysis of superficial tongue cancer was also done. The mean MRI DOI was 13.7 mm and the mean histological DOI 12.45 mm. The shrinkage factor was 0.6 mm. Pearson's correlation coefficient was 0.80 (p=

Scientific publications place much emphasis on postoperative outcomes such as recurrence, but little attention to patients' satisfaction. The purpose of this evaluation was to find out patients' reported outcomes after their initial consultation, treatment, and follow-up appointments for non-melanoma skin cancer of the head and neck. We used an adapted version of the European Organisation for Research and Treatment of Cancer (EORTC) validated questionnaire for patients' satisfaction to collect data prospectively from consenting patients between September and December 2015. A total of 179 questionnaires were completed (initial consultation n=51, treatment n=74, and follow up n=54). Patients were most satisfied with the appointments for treatment (Kruskal-Wallis p

Elective operations were significantly reduced in order to eliminate, as much as possible, the risks of SARS -CoV-2 virus infection for both patients and medical personnel and to leave the clinical facilities and intensive care available for access to COVID patients. We looked at the total number of patients treated for skin cancer surgery at both hospitals from the March 23, 2020 till the May 28, 2020, the demographic characteristics, the medical comorbidities, the pathologies operated on in day surgery regimens of care and the surgical outcomes. With regards to the site, more than one third of the patients were treated at a private hospital setting. Among the surgery complications identified there was one graft failure following excision of scalp lesion which histology confirmed regressed keratoacanthoma. Moreover, three infections associated with the lesions excised occurred and were treated with antibiotics. With regards to morbidity there was only one covid-19 infection among the patients that attended for skin cancer surgery and two deaths. The utilization of Covid-free locations, other than NHS hospitals, for elective surgery improved the efficiency of the service and together with the practical steps in theatre management and minimizing footfall, allowed the successful continuation of care during the pandemic.

The provision of a seven-day National Health Service (NHS) has been proposed as a means to halt the weekend delay in treatment that has been described in some studies. We tested the emergency services in the Oral and Maxillofacial Surgery Department at Northampton General Hospital to find out whether they provided a seven-day service. Data were collected prospectively and retrospectively for all patients admitted to the Oral and Maxillofacial Department at Northampton General Hospital with infections of the head and neck during a period of 29months (January 2014-May 2016). Duration of hospital stay and waiting time for operation were compared for weekday and weekend admissions to find out if there were changes in either outcomes or waiting times. The severity of infection between the two periods was also assessed using the serum C reactive protein (CRP) concentration as a marker. A total of 293 patients were admitted with head and neck infections, and the mean (range) duration of stay for those admitted on weekdays was 3 (1-14) days and for patients admitted at a weekend was 3 (1-17) days (p=0.14). However, the waiting times for operation were significantly longer during the week (mean (range) 0.6 (0-8) days) than at the weekend (0.5 (0-3) days, p=0.04). We know of no other published studies about provision of a seven-day service in oral and maxillofacial surgery. Our results show that we are already working to that standard, and this raises the question of whether any changes are required to current practice in the NHS, with their associated costs and upheaval.

BACKGROUND The anterolateral thigh flap has gained popularity over the last few decades for the reconstruction of various surgical defects. The anatomy of the main perforating vessel of the anterolateral flap, the descending branch of the lateral circumflex femoral artery (dbLCFA), has been well described in the literature, however only one study has investigated its patency in patients with significant comorbidities. The aim of this study is to assess the degree of vascular stenosis of the dbLCFA in patients with multiple comorbidities. PATIENTS AND METHODS A total of 128 sets of angiographic data were collected from 93 patients retrospectively over a 12-month period. The percentage stenosis of superficial femoral artery (SFA), LCFA, and dbLCFA was measured and converted into an established scoring system. RESULTS The rate of dbLCFA stenosis was 12.5%. Interestingly, 24.0% of patients without peripheral vascular disease (PVD) showed some degree of stenotic changes in the dbLCFA, whereas only 10.7% of those with PVD had some degree of stenosis. There was no correlation between dbLCFA stenosis and patient comorbidity. The SFA was significantly affected by smoking, hypercholesterolemia (p < 0.05), and diabetes mellitus (p < 0.01) CONCLUSIONS: This study shows that the dbLCFA is not affected by patient comorbidity including PVD when compared with medically fit controls. Even in individuals with severe disease of the superficial vascular system; there is often sparing of the deep system. Surgical reconstruction using the anterolateral thigh flap is a safe procedure for patients even with multiple comorbidities including significant PVD and no additional preoperative investigations are required.

To evaluate changes in demographics of patients undergoing third molar surgery (TMS).This retrospective study used the World Health Organization's International Classification of Diseases, Tenth Revision codes F091 and F093 to generate data on patients (N = 10,447) undergoing TMS from 1994 through 2012 at the authors' institution. The data is described in terms of mean, median, mode and were analyzed using analysis of variance and the Student t test.Fewer female patients were treated after implementation of the National Institute for Health and Care Excellence (NICE) guidelines. The mean patient age increased from 29 years (1994) to 36 years (2012), with the median increasing from 27 to 31 years (P.001). There was a significant difference in the age of patients treated before and after the introduction of the NICE guidelines (P.001).The increase in age appears to be influenced by the NICE guidelines. Given the increased risk of complications in older patients, consideration should be given to the removal of a similarly impacted, asymptomatic, contralateral third molar without obvious radiographic relation to the inferior dental canal, if a young patient is undergoing general anesthesia.

Objective The purpose of our study was to determine the level of accuracy provided by clinical diagnosis in head and neck cutaneous malignancy as confirmed by histopathologic examination of the specimen in a skin cancer referral center. Positive predictive value was selected as a reliable measure of diagnostic accuracy. We also aimed to audit our surgical outcomes and record and present the completeness of excision, the rates of recurrence and metastasis, and the reconstructive method. Study Design We reviewed the electronic charts of 867 consecutive patients with skin tumors and calculated the positive and negative predictive values of clinical diagnosis. Results The positive predictive value was 91% for basal cell carcinoma and 78.8% for squamous cell carcinoma. Of the 178 histologically diagnosed squamous cell carcinomas, 15 were metastatic. Conclusions In a skin cancer referral center, expert clinical diagnosis may safely overcome the need for preoperative biopsy. Relying on clinical diagnosis to formalize a treatment plan for head and neck nonmelanoma skin cancer is safe and efficient. This is more reliable in cases of basal cell carcinoma compared with suspected squamous cell carcinomas.

Leiomyosarcoma of the tongue is an extremely rare malignant mesenchymal neoplasm and only 25 cases have been described in the English-language literature, 22 of which were primary lesions. A case is presented of a 54-year-old female patient diagnosed with primary leiomyosarcoma of the tongue with lung and multiple soft tissue metastases. This case is especially unusual because widespread soft tissue metastases resulted, involving the lung and skeletal muscle in 3 separate sites. Unfortunately, curative treatment was not possible. Chemotherapy using a combination of ifosfamide and doxorubicin was, therefore, provided as palliation, with a good response after a 3-week cycle of therapy. Currently available literature on primary and secondary leiomyosarcoma of the tongue was reviewed for a better understanding of this rare mesenchymal neoplasm. To the investigators' knowledge, there are no other reported cases in the literature that have previously been managed with chemotherapy alone.

Cutaneous squamous cell carcinoma (CSCC) is the second most common skin cancer in whites, with a relatively low metastatic potential and a general amenability to local treatment. However, patients with high-risk CSCC is more likely to develop local and distant metastases that could be fatal. We present a case of an 82-year-old white man who initially presented with a solitary squamous cell carcinoma (SCC) of the scalp and subsequently developed more than 40 primary CSCC lesions and metastases to the right parotid lymph nodes and thoracic vertebrae within 14 months of the primary diagnosis. Our report highlights the challenges that aggressive SCC can bring in the elderly population and describes some of the treatment modalities of CSCC.

c i d a good doctor should be aware of all available aproaches to therapy. This applies equally to surgeons nd physicians. Cryotherapy is frequently used by ermatologists to treat mucocutaneous disease but any head and neck surgeons, while seeing some of he same diseases, do not have confidence in the use f this technique. This review is intended to rewaken interest in cryosurgery and show that it can e the most appropriate treatment for some condiions. The modern consent form demands that alterative methods of treatment have been discussed. his is another factor that should persuade maxillofaial surgeons to be aware of cryosurgery as a treatent option.

It is common surgical practice to take a specimen for microbial culture and sensitivity when incising and draining infections of odontogenic origin in the head and neck. We aimed to find out if routine testing has any therapeutic value. We retrospectively studied 90 patients (57 male and 33 female) admitted to Northampton General Hospital for treatment of odontogenic infections, and reviewed admission details, antimicrobial treatment, microbiological findings and their sensitivity or resistance, and complications. Specimens were sent from 72 (80%) patients of which 61 (85%) were infected. The most commonly isolated organism was Streptococcus viridans. Interim reports were published after a mean of 3 days (range 1-4), and 94% of patients were discharged within a mean of 2 days (range 0-9) postoperatively. Almost 95% of patients were discharged before results were available, and there were no reported complications. We therefore suggest that microbial culture has little therapeutic value in the management of these patients. With culture and sensitivity tests costing £25 - £30, omission of this practice in the case of uncomplicated (single tissue space) odontogenic infections could save resources in the National Health Service without affecting the care of patients.

Because of the growing concern about antibiotic resistance, we aimed to investigate whether the microbiological picture and antibiotic sensitivity of infections in the head and neck have changed in the last 30-40 years. We retrospectively studied 150 patients admitted for inpatient treatment of infections in the head and neck, and searched published reports from the last 30 – 40 years for comparison. There were 85 male and 65 female patients (mean age 39 years, range 1-95). Most infections originated from the teeth (n = 111) and skin (n = 16), and the submandibular (69%) and buccal (67%) spaces were involved most often. Multiple spaces were involved in 94 patients. Swabs were taken for culture and sensitivity in 102 cases, and microorganisms were isolated in 91 (89%), of which 67 (74%) were aerobic infections and 24 (26%) were anaerobic. Bacteria were isolated in 87 (96%) cultures of which 60 (69%) were Gram-positive. Gram-positive cocci were isolated in 62% of cultures. The most common bacteria isolated were streptococci. Seventy percent of the bacteria were sensitive to amoxicillin and 84% to amoxicillin and metronidazole; 14% (Staphylococcus aureus from infections of the skin) were resistant to penicillin. A comparison of our results with those found in previous reports shows no significant change in the microbiological picture and antibiotic sensitivity of odontogenic infections in the head and neck over the last 30 – 40 years. Amoxicillin still treats these infections effectively. © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Background and objectives Due to a growing concern regarding antibiotic resistance, we aim to investigate if there has been a change in the microbiology and antibiotic sensitivity of head and neck space infections over the last 30–40 years. Patients and method A retrospective study was undertaken of 100 patients admitted for inpatient management of head and neck infections. A literature search of the data from the last 30–40 years was performed for comparative purposes. Results There were 57 male and 43 female patients (average age 37 years). The most common infections were of odontogenic (67) and skin (14) origin. The submandibular (69%) and buccal (60%) spaces were more commonly involved. Sixty-six cases had multiple space involvement. Seventy-eight cases had swabs taken for microbiology culture and sensitivity, with 67 (85.9%) having microorganisms isolated. Fifty (74.6%) of these were aerobic infections and 17 (25.4%) anaerobic. Bacteria were isolated in 64 (95.5%) cultures. 70.1% of the bacteria were gram positive. Gram-positive cocci were isolated in 65.4% of cultures. The most common bacteria isolated were streptococcus. 73.4% of the bacteria were sensitive to amoxicillin and 81.3% sensitive to both amoxicillin and metronidazole. 15.6% were resistant to penicillin, which were Staphylococcus aureus from skin infections. Conclusion Comparing our results with a review of the literature shows no significant change in the microbiology and antibiotic sensitivity of odontogenic head and neck infections over the last 30–40 years. Amoxicillin is still shown to be an effective empirical drug for odontogenic head and neck infections.

In patient-centred medical practice, consideration of the patients’ expectations is vital to the planning and delivery of service. Modern medicine must use the continuing advances in information technology to disseminate knowledge and raise awareness among patients and the public. People increasingly use the Internet to search for information on health, and the online presence of an organisation or a profession is known to bring a wide range of benefits. We aimed to find out what patients expect from the website of an Oral and Maxillofacial Surgery (OMFS) unit and to assess the online presence of OMFS units in the United Kingdom. Results from 100 self-administered questionnaires showed that there were 18 common domains that patients would like to see on OMFS websites. When ranked according to the number of times they were mentioned, a map of the department was mentioned most and the complaints policy least. Of the 156 OMFS units in the UK, only 51% have websites and of these, 80% are in London. There were none in Wales and Northern Ireland. Only half of the websites contained information that related to patients’ expectations. Strategies to improve the content of websites for OMFS units and to improve their online presence are urgently needed.

Clinicians face numerous challenges when managing psychiatric patients who self-inflict injuries within the maxillofacial region. In addition to a complex clinical examination, there are both surgical and psychiatric factors to consider, such as the risk of damaging vital structures, the exacerbation of the patient's psychiatric status, and the long-term psychosocial and esthetic sequelae. We present 2 cases of adolescents who repeatedly self-inflicted wounds and/or inserted foreign bodies (FBs) into the face, scalp, and neck. The different treatment modalities were based on full evaluation of the patient's clinical, medical, and diagnostic test findings coupled with a psychiatric assessment. The decision for conservative management or surgical intervention was made according to the presence and location of the FBs, degree of hemorrhage, signs and symptoms of infection, and unpleasant scars that could lead to long-term psychological impairment. In most cases, the FBs were removed and the wounds were toileted and closed under local or general anesthesia. We advocate a holistic approach via a multidisciplinary team, which is deemed essential to provide the highest quality of care for patients to reduce the risk of further relapses. Lastly, a satisfactory esthetic outcome is always paramount to achieve long-term psychological and physical welfare.

Purpose The impact of oral cancer and its treatment is well documented; therefore, oral rehabilitation (OH; eg, with prosthetics, osseointegrated implants, etc) can be indicated to restore some level of form, function, and well-being. The purpose of this study was to review the current literature and evaluate the impact of OH on quality of life (QoL) after ablative surgery. Materials and Methods A systematic literature search was conducted using EMBASE, MEDLINE, and PsychINFO. The study population was composed of all articles published from 2000 to 2015. To be included, studies had to use validated, specific head and neck QoL measurements (European Organization for Research and Treatment of Cancer QoL Head and Neck Module or University of Washington QoL Questionnaire). Only 8 articles met these inclusion criteria. In this review, OH was the primary predictor variable and QoL was the primary outcome variable. Results The 8 articles reviewed used a range of designs, including 1 randomized controlled trial, 3 prospective cohort studies, 3 case series, and 1 single-measurement cross-sectional descriptive study. Sample sizes were small (n = 26 to 102), and there was limited randomization and control of intervention and comparator groups. The overall level of evidence was weak. All studies showed a link between OH and QoL, but the results varied in significance ( P P = .95). Conclusion Overall, there appears to be improvement in QoL to varying degrees after OH. However, a more systematic use of QoL measurements is needed before any definitive conclusions can be drawn.

During maxillofacial operations there is inevitably a lot of blood shed, which soils the patients hair. The cleaning of blood stained hair is a laborious and time-consuming task, particularly after a long operation. To prevent this we advocate using a standard swimming cap to protect the hair.

Background: Approximately 40-50% of oral cavity and oropharyngeal squamous cell carcinomas affect the tongue. The nodal metastasis can be affected by tumour thickness, site, size, differentiation, perineural and perivascular invasion. There is increasing evidence between close correlation of tumour thickness and nodal metastasis. We carried out a retrospective study of a 12 year period. Patients and Methods: 81 patients with anterior tongue SCC were involved in this study with a median age of 57 years. The follow-up period fluctuated between 24 to 84 months. Tumours exceeding T2 stage and spreading to other parts of the oral cavity were excluded. Surgery treatment was the only method employed. Results: 65 patients underwent local excision with selective neck dissection. Occult metastasis was present in 29 patients. In four of these patients tumour thickness was less than 5 mm (6%), whilst 25 (38%) patients illustrated thickness of more than 5 mm. The remaining 16 patients underwent local excision only. Four patients developed neck metastasis after a period of 6-18 months. Tumour thickness in one patient was less than 5 mm (6%) and remaining three patients more than 5 mm (18%). Conclusion:The results of our study support the evidence of close association between tumour thickness and nodal disease. Although local excision alone may be sufficient for cases with the tumour thickness of less than 5 mm, selective neck dissection is indicated when thickness exceeds 5 mm. There should be a standardised system among pathologists to record the tumour thickness at the time of initial diagnosis.

Introduction The vast majority of cancers affecting the head and neck are squamous cell carcinomas. Patients often present late, with advanced stages of disease and thus possess an increased risk of presenting with distant metastases, the knowledge or presence of which dramatically alter the treatment and reduce prognosis. The most common site for metastatic spread is the lung. SIGN advise that all patients with a H&N SCC should under go screening CT of chest and thorax to identify distant metastases, regardless of primary tumour stage site or size. The incidence of synchronous tumours of distant metastases is higher in individuals with advanced primary tumours (T3/T4). However there is limited evidence regarding patients with less advanced tumours. Aims - objectives Assess the incidence of chest metastases at initial staging in patients with H&N SCC at NGH between January 2010 and June 2013 (40 months) and to investigate the relationship between tumour size, site, histological features, regional lymph node metastases and distant chest metastases. Method 250 patients presenting with newly diagnosed H&N SCC who underwent staging and chest CT were identified and their imaging, radiological and histopathology reports reviewed retrospectively. Inclusion: Newly diagnosed primary, biopsy proven, H&N SCC Patients underwent Chest CT. Relevant information available Discussed on H&N MDT. Exclusion: Recurrent H&N SCC If Chest CT had not been completed No all information available. Results To date, 104 individuals have been analysed, with 6 (5.76%) presenting with suspicious nodes or positive nodes on chest CT. the majority of these being staged as T3/T4. One patient with a T1N1 (level 2a) tumour presented with nodes that were reported as ‘suspicious’. A further 150 patients will be analysed during the course of this study.