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Background: Clear cell odontogenic carcinoma (CCOC) is a rare odontogenic malignant tumor. The standard treatment for CCOC is surgical resection and adjuvant radiotherapy (RT). Radiotherapy is generally considered in inoperable cases. However, there are no reports on definitive RT for CCOC, and the role of RT in patients with inoperable CCOC remains unknown. Therefore, in this report, we present two cases of carbon-ion (C-ion) RT for CCOC., Case Presentation: In case 1, a 73-year-old man with mandibular CCOC presented with recurrence in the inferior temporal fossa after two tumor resections. The tumor was considered inoperable, and C-ion RT (57.6 Gy in 16 fractions) was administered. The tumor remained controlled even after 20 months of C-ion RT; however, the patient died of other causes. In case 2, a 34-year-old man with maxillary CCOC presented with recurrence in the left sinonasal region after two tumor resections. The tumor was considered inoperable, and C-ion RT (64 Gy in 16 fractions) was administered. However, recurrence was observed in the irradiated field 19 months after the treatment. Subsequently, C-ion RT (64 Gy in 16 fractions) was repeated for the recurrent tumors. Seven years and 6 months after the initial irradiation, the tumor remains controlled, and the patient is alive without any unexpected serious adverse events., Conclusion: C-ion RT may be an effective treatment option for patients with inoperable CCOC., (© 2024. The Author(s).)

Background: Although metastatic involvement of bony sites including cranial bones is common in neuroblastoma (NB), mandibular metastases (MM) are uncommon, and specific outcomes have not been reported upon in the modern therapeutic era., Methods: In this retrospective study, medical records on patients with MM from NB were reviewed. Statistical analysis was performed using the Kaplan-Meier method., Results: Of 29 patients, nine (31%) had MM at diagnosis, whereas in 20 (69%) MM were first detected at NB relapse at a median time of 26 (6-89) months from diagnosis. Median maximal diameter of lesions was 3 (range 0.8-4.9) cm. MM were unilateral in 83% of patients, with ascending ramus (55%) and mandibular body (38%) being the two most common sites. All patients received systemic chemotherapy, and 26 (93%) patients received radiotherapy to MM. At a median follow-up of 37.3 (24.2-219.5) months, eight of nine patients with MM at diagnosis did not experience mandibular progressive disease. Eighteen of 20 patients with MM at relapse received therapeutic radiotherapy; objective responses were noted in 78%. Seventy-two percent (5/18) had not experienced relapse within the radiation field at a median of 12 (2-276) months postradiotherapy. Dental findings at follow-up after completion of NB therapy included hypodontia, hypocalcification of enamel, and trismus. Median 3-year overall survival in patients with relapsed MM was 51 ± 12% months from relapse., Conclusion: MM when detected at diagnosis is associated with a prognosis similar to that for other skeletal metastases of NB. Radiotherapy is effective for control of MM detected both at diagnosis and relapse. Significant dental abnormalities posttherapy warrant regular dental evaluations and appropriate intervention., (© 2021 Wiley Periodicals LLC.)

Objective: There is no useful tool to clinically predict the occurrence of osteoradionecrosis (ORN) of the mandible quantitatively. The aim was to investigate the risk factors, including different modalities of radiotherapy, for developing mandibular ORN in patients undergoing marginal mandibulectomy and postoperative radiotherapy., Methods: Between January 2006 and December 2012, 167 subjects who underwent marginal mandibulectomy and postoperative radiotherapy with different modalities were enrolled. The association of ORN with mandibular bone measurements and patient variables was analyzed, and a nomogram was established., Results: Fifteen (8.98%) of the 167 patients developed ORN during the follow-up period, and ORN was significantly associated with diabetes mellitus (DM), body mass index (BMI), remaining bone height, remaining bone height to original bone height ratio, resected bone height to original bone height ratio, and mandibular dose (P: < 0.001, 0.004, 0.042, 0.018, 0.010, 0.020, respectively). Interestingly, the risk of ORN had no significant difference between conformal and intensity modulation radiation therapy (P = 0.407). Multivariate analysis revealed that DM and resected bone height to original bone height ratio ≥ 50% were independent risk factors for postoperative ORN. A nomogram consisting of BMI, DM, resected bone height to original bone height ratio, mandibulotomy, and mandibular dose for predicting the ORN-free probability was established; and the c-index of the nomogram for ORN status was 0.803., Conclusion: A nomogram based on the risk factors was plotted to strengthen the prediction of ORN quantitatively. Surgeons should be more discrete regarding the treatment plan for patients with higher probability of ORN., Level of Evidence: 3b Laryngoscope, 130:101-107, 2020., (© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)

Purpose: To assess radiotherapy (RT) outcomes in patients with gingival carcinoma and growth up to or involvement of the lower jaw bone., Methods: This was a retrospective analysis of 51 patients with squamous cell carcinomas of the gingiva. Patients received definitive (group 1, 31.4%) or postoperative (group 2, 66.7%) RT between 2005 and 2017 at the Department of Radiation Oncology, University Hospital Heidelberg. The primary endpoint was overall survival (OS) in both treatment groups. Other endpoints were local-disease-free survival (LDFS), progression-free survival (PFS) and treatment-related toxicity (Common Terminology Criteria for Adverse Events, CTCAE, Version 4.03)., Results: Median age at first diagnosis was 63 years. All patients had a local advanced disease (American Joint Commission on Cancer [AJCC] stage III-IV). After a median follow-up of 22 months (range 3-145 months), 20 patients (39.2%) were still alive. At 5 years, OS rate was 36.6%. No significant differences in OS (p = 0.773), PFS (p = 0.350) and LDFS (p = 0.399) were observed between the two groups. Most common higher-grade acute RT-related complications (≥ grade 3) were dermatitis (78.2%), oral mucositis (61.7%), xerostomia (51.5%), and loss of taste (74.6%). Three cases (5.8%) of osteoradionecrosis (ORN) of the lower jaw were detected after 15-31 months., Conclusions: Definitive and postoperative RT have similar treatment outcomes for patients with lower gingiva carcinomas of the lower jaw. The most common acute complications (grade ≥3) were dermatitis, oral mucositis, xerostomia and loss of taste.

Background: Tracheocutaneous fistula represents one of the most troublesome complications of prolonged tracheostomy. Simple closure of a fistula can be ineffective, particularly in the context of prior surgery and adjuvant radiation. As such, modes of repair have expanded to include locoregional flaps and even free tissue transfers., Objective: This paper describes a case of persistent tracheocutaneous fistula in an irradiated patient who had undergone previous unsuccessful attempts at repair., Method and Results: The use of regional fasciocutaneous supraclavicular flap with prefabricated conchal bowl cartilage resulted in successful closure of the tracheocutaneous fistula., Conclusion: This represents a novel technique for closure of such fistulas in patients for whom previous attempts have failed. This mode of repair should be added to the surgeon's repertoire of reparative techniques.

Although rare, ameloblastic carcinoma (AC) is one of the most common malignant tumors occurring in the odontogenic epithelium. Evidenced-based medical guidelines for AC are not established because AC is a rare type of cancer. However, surgery for AC is the primary initial treatment modality. A few reports suggest that radiotherapy (RTx) is effective for AC; however, the tumor is generally considered to be radioresistant. Furthermore, if RTx is performed for AC, osteonecrosis may occur because most of the ACs arise from the jaw. Here, we report a case of an older patient with maxillary AC who had underlying medical problems and who received conventional RTx with good outcomes. Ten years after the treatment, no major adverse event accompanying irradiation, local recurrence, or metastasis was observed. We discuss the therapeutic effect and usefulness of RTx on AC. As indicated by our findings, RTx for AC may represent a definitive treatment strategy for patients with poor general conditions or those with tumors that cannot be resected completely., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Isolated lingual and lower face Raynaud phenomenon without primary Raynaud of the digits is a very rare condition associated with chemoradiation therapy (RT) in previous reports. The condition, which more commonly presents in patients with a history of Raynaud disease, is often self-limiting, but vasodilating agents and steroids have been suggested as possible treatment options. Spasmodic torticollis is a different, more common entity, also associated with history of RT or previous head and neck surgery. We present a rare case of a patient who developed Raynaud phenomenon of the lower face and tongue in the presence of spasmodic torticollis after mandibulectomy and free fibula reconstruction followed by RT to the oral cavity and neck. Possible causes, pathophysiologic mechanisms and treatment options are discussed. This is the first report of botulinum toxin treatment of isolated secondary Raynaud phenomenon of the lower face and tongue.

The cornerstone modality of treatment of central mucoepidermoid carcinoma (CMEC) of the mandible is surgery, optimally, an en bloc resection with/without segmental or hemimandibulectomy. Notwithstanding the documentation of a survival benefit in few case reports with the addition of postoperative radiotherapy in carefully selected high-risk patients, there does not exist a clearly defined consensus regarding the role of adjuvant radiotherapy. We report the case of a 49-year-old man who presented with right lower jaw swelling which on imaging was found to be a multiloculated lesion causing bony expansion and cortical destruction of the mandible and was diagnosed with CMEC after radiological and histopathological criteria were met. He underwent right hemimandibulectomy and histopathology showed squamous and mucinous cells with positive mucicarmine staining and characteristic immunohistochemistry markers confirming the diagnosis of CMEC. He subsequently underwent adjuvant radiotherapy and is disease free 5 years since treatment completion., Competing Interests: Competing interests: SN is consultant, Medical Affairs in Varian Medical Systems, India. All other authors have no conflicts of interests to declare., (© BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

Rationale: Although an ototoxicity is well-known as adverse event of the radiotherapy, it is not widely known that immunosuppressed patients who underwent radiotherapy in head and neck region have risk of malignant external otitis., Patient Concerns: A 68-year-old man with diabetes, who had been diagnosed as intraosseous squamous cell carcinoma of the right mandible, underwent surgical resection. He received a total of 60 Gy/30Fr postoperative radiation. Four months after the course of radiation, he suffered from right aural fullness, otalgia and otorrhea., Diagnoses: Clinical examination revealed granulation and existence of Pseudomonas aeruginosa in the external auditory canal. Computed tomography showed expansive inflammation and erosion in the temporal bone. The patient is elderly and diabetes. These findings led to the diagnosis of malignant external otitis., Interventions: The ear irrigation and administration of quinolones were started. Afterwards, fistula was formed in the oral cavity, and connected to the right external auditory canal. Therefore, irrigations were performed not only from ear but also from the oral fistula., Outcomes: Eight weeks after starting treatment, the malignant external otitis was completely healed., Lessons: Physicians should raise awareness of malignant external otitis in immunosuppressed patients with oral cancer after radiotherapy.

Intraoral defects secondary to resection of mandible leading to mandibular discontinuity are very complicated to treat as the muscles exert forces on the residual portion of the mandible. Primarily this leads to disfigurement of the face. These forces also make mastication difficult due to imbalance. Ultimately it leads to poor quality of life for the patient. Apart from that the clinical outcome and prognosis of prosthetic rehabilitation of such patients is very poor. The composite fibular flap is the preferred donor site for reconstruction of most complex orofacial-mandibular defects. The addition of a skin island allows for absolute tension-free intraoral closure that enhances tongue mobility. After reconstruction with free fibula graft, planning for prosthodontic rehabilitation by various methods can be carried out. Treatment strategy is dependent on the intraoral situation and patient's acceptance. This article reports various treatment considerations for implant retained prosthetic rehabilitation in a patient who had undergone mandibular reconstruction with free fibula flap.

Osteoradionecrosis (ORN) is a well-known and usually late complication of radiation therapy in the treatment of head and neck cancer. Although the therapy can be life extending, it also produces tissue toxicity in ipsilateral and contralateral tissues in an acute and chronic fashion. In the most severe cases of ORN, such as the one presented in this report, bilateral disease results in the need for total mandibulectomy and creates a tremendous reconstructive challenge. The advent of microvascular surgery and free tissue transfer has caused an evolution of the management protocol for severe ORN cases. This report describes a unique case of total mandibulectomy with synchronous reconstruction using a single vascularized fibula osteocutaneous flap with subsequent dental implant reconstruction and prosthetic rehabilitation., (Published by Elsevier Inc.)

We retrospectively review the only three cases in the Irish National Maxillofacial Unit over a 12-year period. Methods involved retrospectively reviewing clinical notes, radiology and histopathology of three cases. Case one was an 80-year-old male presenting with mandibular swelling, who received radiotherapy alone. Case two was a 26-year-old male with swelling and odynophagia. He underwent left hemimandibulectomy and fibular free flap reconstruction. Case three was a 64-year-old female with mental nerve involvement who underwent a right hemimandibulectomy. The cases presented here illustrate a diverse sample regarding patient demographics and management approaches. Surgery usually necessitates en bloc resection, free flap reconstruction and 1-1.5 cm margins. Adjuvant radiotherapy may be required for close margins.

Background: The vascular fibula flap is an ideal choice for function and appearance reconstruction of mandible. Despite the high success rate, "late complications" such as Ti plate exposure and local infection related to osteosynthesis are not uncommon., Patients and Method: A retrospective cohort of patients who received vascular fibula reconstruction for mandible from January 2011 to December 2013 from the Department of Oral and Maxillofacial Oncology in a tertiary hospital were charted: clinical, pathological, and therapeutic factors were analyzed for late complications in univariate and multivariate analyses., Results: One hundred forty-two patients were finally analyzed with median follow-up time of 47 months; 19 of them had "late complications," which occurred at a median of 8 months. Preoperative or postoperative radiotherapy (P = 0.02), type of Ti plate (P = 0.019), and the disease characteristics (P = 0.02) were significant factors on univariate. Cox regression suggested postoperative radiation (P = 0.009) and smoking history (P = 0.037) were independent significant factors for late complications. Secondary reconstruction (P = 0.069) and preoperative radiotherapy (P = 0.086) were borderline significant., Conclusion: Postoperative radiation and smoking history are associated with late complications. Mini Ti plate should be less used. Patients with risk factors need to be observed for at least 6 to 16 months before further management.

Sarcomas are rare diseases of the head and neck region, representing around 1% of all malignancies. Amongst them, ameloblastic fibrosarcoma (AFS) is of even greater rarity, with less than 100 cases reported in the literature. Consequently, no standard treatment or guidelines have been made available. Surgery is often performed as primary therapy, but may be limited due to anatomical or functional reasons. We present a case of AFS successfully treated by postoperative radiation therapy. A detailed case study is provided, followed by a review of the English-language literature focusing on the role of radiation therapy.

Customized intraoral devices help the radiation oncologist minimize the adverse effects of radiation and maximize the tumor control rate by keeping the anatomic structures in a consistent position during each fraction of radiation treatment. This article illustrates the fabrication of a bolus-type positioning device for a combined intraoral/extraoral defect treated with proton radiation therapy., (Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

We present a rare case of massive tongue necrosis occurring simultaneously with bilateral osteoradionecrosis (ORN) of the jaw in a patient with a history of treatment, including surgery and postoperative radiotherapy, for a retromolar trigone carcinoma 8 years earlier. There is a distinct possibility that the extractions and administration of local anesthesia with a vasoconstrictor contributed to the onset of ORN; together, these events may have influenced the blood supply to the tongue. A glossectomy was performed after hyperbaric oxygen therapy. One month after the surgical procedure, the patient responded satisfactorily to the treatment, showing significant improvement in speech and oral food intake, as well as significant decrease in lingual pain. Although the simultaneous occurrence of these oral complications is rare, the practitioner must be aware of the factors that instigate ORN and compromise vasculature as well as the clinical signs of tongue necrosis. Additionally, the possibility of tongue necrosis secondary to irradiation of the head and neck should be taken into consideration when an irradiated patient undergoes tooth extractions under local anesthesia with agents containing epinephrine., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: Mucoepidermoid carcinoma, compared to other tumors of salivary glands, occurs in 5–10% of cases. Histopathologically, it is divided into a well differentiated tumor that is of low-grade of malignancy, and a medium and poorly differentiated tumor of high grade of malignancy. Central mucoepidermoid carcinoma (CMEC) of the mandible was firstly described by Lepp in 1936, on a 66-year-old female patient. CMEC is characterized by atypical clinical image and radiological manifestation., Case Outline: A 55-year-old female patient was examined at the Clinic of Dentistry in Niš, Serbia, with anamnestic data regarding the presence of painless swelling in the right side of the mandible. Considering the histopathological results and presence of enlarged lymph nodes, right hemimandibulectomy and tumour excision from pterygomandibular space followed by supraomohyoid neck dissection was done. In due course, postoperative radiotherapy was applied (60 Gy), Conclusion: CMEC represents a rare tumor, characterized by local tissue destruction and ability to metastasize. Initial biopsy represented the key in preoperative planing. Radical excision with neck lymph node dissection followed by postoperative radiotherapy in our case represent a successful method of treating CMEC of the mandible.

Purpose: This study aimed to investigate the impact of preradiation tooth loss in patients with head and neck cancer., Materials and Methods: Records of 397 (partially) dentate patients who were referred for preradiation oral screening were included. Number and location of teeth lost and occluding pairs lost were determined for different tumor locations., Results: The majority of patients (54%) were affected by tooth loss. Proportion of teeth lost, their location, and proportion of occluding pairs lost were not evenly distributed across tumor locations. The highest proportions of teeth were removed with oral tumors (maxilla: 25%; mandible: 47%). For preradiation preventive extractions only, ie, not taking into account teeth that were lost due to ablative surgery, tooth loss in the mandible was still not evenly distributed across tumor locations, but tooth loss in the maxilla and occluding pairs lost were., Conclusions: Tumor location affects preradiation tooth loss, though this is primarily a consequence of ablative surgery rather than a consequence of preradiation dental extraction decisions. Since patients with oral cavity tumors are affected most by preradiation tooth loss, treatment planning with regard to functional rehabilitation is desirable for this patient group in particular.

Background: The aim of this retrospective study was to evaluate the survival of dental implants placed after ablative surgery, in patients affected by oral cancer treated with or without radiotherapy., Methods: We collected data for 34 subjects (22 females, 12 males; mean age: 51 ± 19) with malignant oral tumors who had been treated with ablative surgery and received dental implant rehabilitation between 2007 and 2012. Postoperative radiation therapy (less than 50 Gy) was delivered before implant placement in 12 patients. A total of 144 titanium implants were placed, at a minimum interval of 12 months, in irradiated and non-irradiated residual bone., Results: Implant loss was dependent on the position and location of the implants (P = 0.05-0.1). Moreover, implant survival was dependent on whether the patient had received radiotherapy. This result was highly statistically significant (P < 0.01). Whether the implant was loaded is another highly significant (P < 0.01) factor determining survival. We observed significantly better outcomes when the implant was not loaded until at least 6 months after placement., Conclusions: Although the retrospective design of this study could be affected by selection and information biases, we conclude that a delayed loading protocol will give the best chance of implant osseointegration, stability and, ultimately, effective dental rehabilitation.

Unlabelled: Multidisciplinary approach to follicular thyroid carcinoma with giant mandibular and multiple sites metastases. Case report Metastatic tumors generally have poor prognosis, with short survival period and rarely indication to surgical treatment. In case of thyroid-differentiated cancer with distant metastases, prognosis is usually better, because of the possibility of treating metastasis by Radio Ablation by 131Iodine, after surgery. We report the case of a 65 years old woman, presenting with a giant mandibular metastasis from follicular thyroid carcinoma, originating from a cervico-mediastinal nonfunctioning goiter, with lung metastases. After the diagnostic work-up, she underwent left hemi-mandibulectomy, reconstruction by the placement of a precustomized titanium plate with condylar prosthesis and total thyroidectomy. Subsequently the Patient was treated by Radio Ablation by 131 Iodine, in four consecutive sessions. She is alive with no progression of the neoplasm after forty-six months follow-up. Even in advanced differentiated thyroid carcinoma, surgery should be taken into consideration, to treat the patient by complementary therapies and to improve the prognosis in term of survival., Key Words: Advanced differentiated thyroid carcinoma, Metastatic differentiated thyroid carcinoma.

Objective: Metastatic tumors of the mandible are rare and usually present clinically as growths. The prognosis of lung cancer patients with bone metastases is poor., Case Report: This article shows a metastasis from adenocarcinoma of the lung affecting the mandible of a 75-year-old female patient where the metastatic lesion was detected before primary tumor. The patient were treated with radiation therapy with palliative and antalgic intent. But the patient died 8 weeks after the diagnosis., Conclusion: Radiation therapy was effective and well tolerated in the case. Bone metastases particularly mandible metastasis of lung cancer has poor prognosis. Palliative and supportive therapy may be firstly chose because of poor prognosis.

Primary intraosseous squamous cell carcinoma is an extremely rare tumor of the mandible. The diagnosis is based on the evidences showing that the tumor is neither originated from a distant metastasis of another primary tumor nor an invasive oral cancer. In this article, we report a 59-year-old female case with a medical history of ductal carcinoma of the breast, lichen planus, and rheumatoid arthritis who was admitted with complaints of a painful and swollen left lower jaw, and was surgically treated for primary intraosseous carcinoma of the mandible and with postoperative adjuvant radiotherapy.

Introduction: After ablative surgery of the mandible, angular stable alloplastic reconstruction plates are commonly employed. The aim of the study was a long-term evaluation of local anatomical, as looking at systemic factors influencing specific complications and the failure rate of such plates., Materials and Methods: In a retrospective study covering an 11-year period, we reviewed the outcomes of angular stable plates of patients who had a segmental resection of the mandible and subsequent alloplastic reconstruction. Complications and failure rates were assessed and local (anatomical size and localization of resection) as well as systemic risk factors (age, sex, radiation therapy, smoking) evaluated., Results: Altogether, 162 plates were reviewed. The overall complication rate was 28% (fractures n = 8, loose screws n = 7, dehiscences n = 31) after an average time of 13 months. Cumulative survival rates of 73% after one, of 67% after 2, of 59% after 3 and of 40% after five years were observed. We found a significant correlation of increasing defect sizes to a rising complication and failure rate. Plate dehiscence occurred more often in defects including the midline (p = 0.005). Though not statistically significant, the occurrence of plate fracture was associated with lateral mandibular defects (7/8, p = 0.113). In smoking patients an earlier failure rate was seen., Conclusion: The results clearly indicate that the success of alloplastic reconstruction plates of the mandible is dependent on various risk factors. They should--if possible--be used temporarily only. If not done primarily, a secondary approach with bone reconstruction is recommended., (Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: To study epidemiological, clinical, pathological anatomy and therapeutic results of localized primary bone lymphoma., Patients and Methods: Between February 1993 and February 2013, four patients were treated for localized primary bone lymphoma in Sfax's hospitals (Tunisia). Treatment was decided regarding to the age of the patient, his performance status, stage of the disease, lactate dehydrogenase (LDH) and socio-economical conditions of the patient. The therapeutic evaluation was done after chemotherapy and after radiotherapy. There was a clinical, biological and radiological follow-up., Results: The mean age was 59.5 years. The sex-ratio was 3. Bone localizations were clavicula, femur, humerus and mandibula. All patients had stage I large cell B lymphoma. In 3 cases, imaging showed osteolytic lesions with cortical destruction and extension to soft tissues. One patient had a fracture of the humerus. The treatment consisted in chemotherapy followed by radiotherapy. Three patients were alive with complete remission after a mean follow-up of 76 months., Conclusion: The treatment of primary bone lymphoma is based on a combination of chemotherapy (with or without anti-CD20) and radiotherapy. The prognosis is excellent when it is localized., (Copyright © 2013 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)

Periosteal ossification of the vascular pedicle of a fibular free flap after reconstruction of mandibular and maxillary continuity defects has been thought to be rare. The purpose of this study was to evaluate its incidence and contributory factors to its development., (Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: To evaluate the complications and factors associated with titanium plates in mandibular reconstruction with different methods., Methods: A retrospective analysis of 660 patients who received primary reconstruction of the mandible was conducted. The characters of the mandibular defect and methods of reconstruction were recorded. The complications and factors associated with the reconstruction were analyzed., Results: The majority of mandibular defect was in a shape of L (n = 324 ). The total complication rate was 14.7% (97/660), which included screw loosening 5.8% (38/660), plate fracture 3.3% (22/660), plate exposure 3.8% (25/660), infection 7.4% (49/660) and malunion or ununion 2.9% (19/660). The mandibular defects reconstructed by reconstructive plates had a higher complication rate than that by bone grafts. The complication rate was 10.8% (63/586) in cases reconstructed by bone grafts with miniplates. The complications were associated with radiation therapy and diabetes. Radiation therapy had a significant effect on plate exposure., Conclusions: Reconstruction with bone grafts can minimize the rate of plate related complication. The complications were associated with radiation therapy and diabetes.

This case report details a 65-year-old male patient who underwent mandibular resection and radiotherapy as treatment for squamous cell carcinoma of the right mandible. The patient was rehabilitated with an implant-supported fixed partial denture and a maxillary occlusal ramp. The patient has been wearing his prosthesis for 2 years with no complaints.

A 50-year-old man had undergone a complicated removal of tooth 48 which initially seemed related to a follicular cyst. Subsequently, it turned out that a squamous cell carcinoma had probably developed from the follicular cyst. The patient underwent excision of the tumour, hemimandibulectomy, a neck dissection, and reconstruction of the mandibula using a metal plate, followed by postoperative local radiotherapy. This type of development of a squamous cell carcinoma presents very rarely. From the literature, it can be concluded that the prognosis is unfavourable and that the tumour tends to grow aggressively. In case of abnormal wound healing after the removal of a tooth (with a follicular cyst), it is recommended to examine representative tissue histologically.

With recent improvements in survival duration after cancer treatment, it is becoming increasingly important to study treatment-related morbidity and mortality. Radiation-induced sarcomas in the irradiated field are well-known potential late sequelae of radiotherapy. These tumors are biologically aggressive. In the case described here, a radiation-induced fibrosarcoma appeared at 20 years after initial surgery, radiotherapy, and chemotherapy for an osteosarcoma of the mandibular condyle. Radiation-induced fibrosarcoma is relatively rare in the head and neck region. The details of this case are presented, and diagnostic and management considerations are described.

Posttransplant lymphoproliferative disorder (PTLD) is a well-recognized complication of long-term immunosuppression following hematopoietic or solid organ transplantation and is associated with significant morbidity and mortality. We present a unique case of PTLD that manifested with a nonhealing dental extraction socket 17 years after renal transplantation. We summarize the existing literature and present a review of an additional 25 cases. These highlight the variable clinical presentations of PTLD within the oral cavity and clear potential for delayed presentation at this anatomical subsite., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Patient underwent mandibular resection due to surgical therapy of oropharingeal malignoma. Facial asymmetry and cosmetic distortion are frequent consequences of such interventions, which may also include deviation and intrusion of the mandible, motor and sensory disorders, abnormal intermaxillary relations and malocclusion. Implant-supported prosthesis could be an optimal solution to prosthodontic treatment of such patients. However, there is a problem in determination of stable (interocclusal) intermaxillary relations. This article describes the choice of therapy and procedures undertaken in prosthetic rehabilitation of a patient who underwent mandibular resection and radiotherapy with supported prosthesis retained with four implants.

Objective: The free fibula flap is the choice flap for mandibular reconstruction following extensive tumor resections. While large defects are managed with a second flap [free or pedicle] in advanced centres, a free fibula flap with a large skin paddle that can be de-epithelised to provide outer skin and inner lining is the best alternative in resource- constrained centres., Materials and Methods: From January 2005 to December 2009 a total of 386 free fibula flaps were used of which 307 flaps had de-epithelised double skin paddle in reconstructing complex oral and mandibular defects after tumor ablative surgeries., Results: Complete flap survival was seen in 282/307 patients. Complete flap loss was seen in 9/307 patients. Partial flap loss was seen in 16 patients. Re - exploration was done in 30 patients and the flap was salvaged in 21 patients., Conclusion: The vascular supply of the free fibula osteo myocutaneous flap is reliable and a flap with a large skin paddle can be used to provide both inner lining and outer cover in resource-constrained centres.

Objectives/hypothesis: To describe a new surgical procedure in the reconstruction of composite oral cavity resections., Study Design: Retrospective chart review for all patients who received mylohyoid pull through muscle flap for reconstruction of oral composite resection with marginal mandibulectomy by the senior author between 1999 and 2008., Methods: Data gathered from the chart review included demographics, pathologic diagnosis, tumor margins, use of reconstruction plate, exposure to radiotherapy, need for gastrostomy tube, flap viability, and flap complications., Results: Twenty-nine patients received composite resection, marginal mandibulectomy, and reconstruction with the mylohyoid muscle flap between 1999 and 2008. Twenty-four of the 29 patients (82.7%) had a partial glossectomy as part of the resection. Flap success was 100%. Complications included partial skin graft loss (2 of 29) and partial flap dehiscence (2 of 29). Total complication rate was 13.8%. Twenty-five patients (86%) were exposed to external-beam radiotherapy. Two patients required supplemental alimentation with a gastrostomy tube. There were no cases of osteoradionecrosis., Conclusions: The mylohyoid flap is a valuable addition to the armamentarium of anterior oral cavity closures. The procedure is intuitive, and surgical time is miniscule. This procedure can often be used in cases previously requiring free flap closure. It allows a quick return to oral alimentation and has minimal donor site morbidity., (Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.)

Several extensive surgical interventions of a cystic lesion in the left mandible were followed by recurrences. The lesion extended from the primary mandibular region into the area of pterygopalatine fossa finally infiltrating the orbital region and the skull base. Histological results could never demonstrate a malignancy with certainty. Due to the patient's poor general condition, the refusal for further surgical inventions and due to the malignoma-like growth pattern radiation treatment was performed. However, this had no effect on tumor progression.

Trismus is a common postoperative complication for patients operated on for cancer of the masticator space, infratemporal fossa, or pterygomaxillary fossa, particularly those who need radiotherapy. When other techniques have failed, free tissue transfer should be considered as an option in young patients who have previously been treated for oral cancer. We report our experience with the free anterolateral thigh musculocutaneous flap in two children., (Copyright © 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: The aim of this study was to evaluate the success rate of chemically modified and conventional sandblasted acid-etched surface (SLA) titanium implants in irradiated oral squamous cell carcinoma patients., Material and Methods: Twenty patients with a mean age of 61.1 years were treated with dental implants after ablative surgery and radio-chemotherapy of oral cancer. All patients were non-smokers. The placement of SLA and modSLA implants was performed bilaterally according to a split-mouth design. All 102 implants (50 SLA, 52 modSLA) placed showed an unloaded healing time of 6 weeks in the mandible and 10 weeks in the maxilla. Mean crestal bone changes using standardized orthopantomographies and clinical parameters like pocket depths, mPII and mBI were evaluated., Results: Of 102 implants, 55 implants (27 SLA implants, 28 modSLA) were located in the maxilla and 47 implants (23 SLA, 24 modSLA) in the mandible. The average observation period was 14.4 months. The amount of bone loss at the implant shoulder of SLA implants was 0.4 mm mesial and 0.4 mm distal. The modSLA implants displayed a bone loss of mesial 0.3 mm and distal 0.3 mm. Two SLA implants were lost resulting in a success rate of 96%. The success rate of modSLA implants was 100%., Conclusion: Regarding the data found in this investigation, we can conclude that implants with chemically modified and conventional SLA titanium surface show high success rates in irradiated patients. SLA implants with or without a chemically modified surface regardless of the location can be restored with a high predictability of success at least in the short time range observed., (© 2010 John Wiley & Sons A/S.)

A 34-year-old man presented with an expansile, erosive tumor involving the left side of the mandible, with secondary invasion into the maxilla, measuring 13 Χ 7 cm. Microscopic analysis revealed a malignant small round cell neoplasm with focal cartilaginous differentiation. Immunohistochemical analysis revealed positivity for vimentin, NSE and CD99 with primitive small round cells, and S100 positivity with neoplastic chondrocytes. To the best of our knowledge, this is perhaps the largest reported case of mesenchymal chondrosarcoma of the maxillofacial region. Diagnosed as inoperable, he was treated with radiation and chemotherapy only to die within a few months.

Hepatocellular carcinoma (HCC) is one of the most frequently encountered malignancies. Distant metastasis is a common sequela, occurring in approximately 50% of cases. Metastasis to the oral cavity is very rare. Careful immunohistochemical evaluation is critical in differentiating HCC from other metastatic malignancies. An understanding of the possibility that HCC may initially present as a mandibular metastasis is crucial to guide management. We describe the case of a 76-year-old man with a 3- to 4-month history of a painless, slowly enlarging, left-sided jaw mass. Biopsy findings were consistent with HCC. While the patient was a known hepatitis C carrier, the presence of HCC had been previously unknown. Additional workup revealed a large hepatic lesion. In view of his poor health, the patient elected to forgo chemotherapy, and he entered a hospice facility. This case provides an illustration that an isolated mandibular mass may represent the initial presentation of HCC. Subsequent identification of the primary tumor via radiographic and pathologic evaluations is important for the guidance of further management.

Diffuse large B-cell lymphoma is the most common type of non-Hodgkin lymphoma and is characterized by the appearance of rapidly developing tumor lesions in the lymph nodes, spleen, liver, bone marrow or other organs. Primary extranodal presentations of this entity in bone are rare (5% of all extranodal lymphomas) and their initial manifestation is usually in the form of a single bone lesion. This paper addresses a case of a 62-year-old male diagnosed with diffuse large B-cell lymphoma in the mandible. The patient had left mandibular swelling with intermittent paresthesia of the left lower lip and chin, without apparent neck adenopathies. No other locations were identified in the several exams performed, and the final diagnosis was an asymptomatic diffuse extranodal large B-cell lymphoma (IE-A) in the body of the left mandible. Four cycles of chemotherapy were given according to the R-CHOP protocol (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) plus external radiotherapy targeted to the involved site, resulting in complete remission of the tumor. Such lesions are fairly uncommon in daily clinical practice. However, considering their severity and the importance of an early diagnosis, such conditions should be included in the differential diagnosis of bone lesions in the orofacial region.

Objective: This prospective study assessed treatment outcome and patient satisfaction of oral cancer patients with a mandibular overdenture on implants up to 5 years after treatment., Materials and Methods: At baseline, 50 consecutive edentulous oral cancer patients, in whom prosthetic problems were expected after oncological treatment, were evaluated by standardized questionnaires and clinical assessments. All implants were installed during ablative tumour surgery in native bone in the interforaminal area. About two-thirds of the patients (n=31) had radiotherapy post-surgery (dose >40 Gy in the interforaminal area)., Results: At the 5-year evaluation, 26 patients had passed away and four patients had to be excluded from the analyses, because superstructures were not present, due to persistent local irritation (n=2), loss of three implants (n=1) and the impossibility of making an overdenture related to tumour and oncological surgery-driven anatomical limitations (n=1). In the remaining 20 patients, the prosthesis was still in function (76 implants). During the 5-year follow-up, total 14 implants were lost, 13 in irradiated bone (survival rate 89.4%, dose >40 Gy) and one in non-irradiated bone (survival rate 98.6%). Peri-implant tissues had a healthy appearance and remained healthy over time. Patients were satisfied with their dentures., Conclusions: It was concluded that oral cancer patients can benefit from implants installed during ablative surgery, with a high survival rate of the implants, a high percentage of rehabilitated patients and a high denture satisfaction up to 5 years after treatment.

This retrospective non-randomized 10-year follow-up study compared 147 patients with squamous cell carcinoma (SCC) of the oral cavity requiring hemimandibulectomy, treated by surgical resection, therapeutic neck dissection and radiotherapy. The 5-year survival rates were compared related to localization, size of the tumour, infiltration of locoregional lymph nodes, distant metastases, histopathological grading, radicality of surgery, and invasion of tumour into the mandible. Occurrence of tumour relapse and its localization was studied. The mean 5-year survival rate was 26%. Patients with SCC of the mandibular alveolar process had higher rates; the lowest rates occurred in SCC of the buccal mucosa. Survival rate was significantly lower with insufficient resection of the tumour (85% relapse). An important number of patients with radical resection died within 3 months of surgery. In almost 55% of the mandibles tumour was not present. In 5% of infiltrated mandibles, dissemination into inferior alveolar nerve was proven. Decreasing survival rate was seen with increasing size of tumour and higher histological grade. Therapeutic neck dissection significantly reduces survival rate and increases the percentage of lymph node relapse. Elective neck dissection should be performed in SCC requiring hemimandibulectomy. Primary reconstruction should reverse the high percentage of postoperative complication arising from increased radicality.

Summary: Desmoplastic small round-cell tumor (DSRCT) is a rare and aggressive tumor that usually affects young males. Abdominal or pelvic disease is generally present in patients with DSRCT. Despite multimodality treatment, it still remains highly aggressive and has poor prognosis. We report a 16-year-old male with DSRCT in the mandible, an unusual site of the disease, treated with chemo-radiotherapy but recurred in an unexpected site 5 months after the completion of treatment.

Objective: The objective of this study was to investigate radiation-induced late changes in cutaneous gene expression using a microarray platform and quantitative, real-time, reverse-transcriptase polymerase chain reaction (RT-PCR) validation., Study Design: Paired irradiated and nonirradiated skin biopsies were obtained from 19 patients with a history of oral squamous cell carcinoma (OSCC) treated by surgery and adjuvant radiotherapy at the time of secondary corrective surgery. Topic-defined PIQOR (Parallel Identification and Quantification of RNAs) skin microarrays were used to compare gene expression profiles between control and irradiated skin sample in 8 patients. The data were validated for matrixmetalloproteinase (MMP)-1 and tissue-inhibitor of matrixmetalloproteinase (TIMP)-1 by RT-PCR for all patients., Results: Irradiation markedly enhanced the expression of molecules associated with the transforming growth factor (TGF)-beta(1) signaling pathway, blood vessel development, as well as extracellular matrix constitution and turn-over., Conclusions: Our data suggest that radiation-induced late changes in cutaneous gene expression mainly affect molecules related to extracellular matrix (ECM)-constitution and-remodeling., (Copyright (c) 2010 Mosby, Inc. All rights reserved.)

Purpose: The success of osseointegrated implants in the radiated fibula flap used for mandibular reconstruction is variable, and there are few long-term data available in the literature. The purpose of this study is to evaluate implant success in radiated fibula flaps and the native mandible after ablative tumor surgery., Materials and Methods: The medical records of 44 patients who underwent resection and reconstruction of the mandible from 1994 to 2006 were reviewed retrospectively. A total of 206 implants were placed; 144 were placed in a fibula flap, and 92 were placed in the native mandible. Before implant placement, 22 patients (50%) received adjuvant tumoricidal doses of radiation therapy (>6,000 cGy). All patients who received radiation received a standard regimen of 20 preoperative and 10 postoperative hyperbaric oxygen treatments. The follow-up period ranged from 4 to 108 months (mean, 41.1 months). Comparisons were made between groups regarding long-term implant success based on several variables., Results: Implants were considered to be successful if there was no radiographic evidence of peri-implant bone loss and if they were clinically osseointegrated. Of 206 implants, 31 failed, with an overall success rate of 85%. The success rate of implants placed in fibula flaps was 82.4%, and the success rate in native mandibles was 88%. Most of the failures in the fibula (90%) occurred within the first 6 months after implant placement, whereas most of the failures in the mandible occurred after 6 months. The cumulative survival rate was 91.9%, and there was no difference in survival between implants placed in the fibula versus the native mandible or depending on whether the patient received radiation therapy., Conclusion: Acceptable long-term implant success rates may be achieved in the radiated mandible with vascularized fibula flap reconstruction., (Copyright (c) 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: Reconstructing irradiated mandibles with biomaterials is still a challenge but little investigated. We collected data that could help us understand studies in the field of regeneration with biomaterials and irradiated bone., Study Design: Systematic review of the literature., Results: Delay and duration of radiation delivery and total equivalent dose are the most variable parameters in the various studies, resulting in confusion when interpreting the literature. Most reproducible experiments show that radiation reduces osteogenic cell numbers, alters cytokine capacity, and delays and damages bone remodeling. Interindividual variations and how such changes become irreversible lesions are still uncertain. In the case of regeneration using biomaterials, most studies have addressed the question of reconstruction in previously irradiated bone. The results show that osseointegration is often possible, although the failure rate is higher. The sooner the implantation takes place after the end of the radiation, the higher the likelihood of failure. Few studies have focused on primary reconstruction followed by early irradiation, and most of the currently available engineering models would be altered by radiation. Good outcomes have been obtained with bone morphogenetic protein and with total bone marrow transplanation., Conclusion: This review points out the difficulties in achieving reproducible experiments and interpreting literature in this underinvestigated field., (Copyright (c) 2010 Mosby, Inc. All rights reserved.)

Reconstruction of the mandible has evolved significantly over the last 40years. Early attempts were often disfiguring and wrought with complications but with the introduction of free tissue transfer of well vascularized bone in the 1970's there was a significant improvement in outcomes. In recent years the harvest, inset, and microvascular anatomosis have been refined to the point that success rates are reported as high as 99% throughout the literature. Focus has now shifted to optimizing functional and aesthetic outcomes after mandible reconstruction. This paper will be a review defect classification, goals of reconstruction, the various donor sites, dental rehabilitation, new advances, and persistent problems. Reconstruction of segmental mandibular defects after ablative surgery is best accomplished using free tissue transfer to restore mandibular continuity and function. Reestablishing occlusion and optimizing tongue mobility are important to post-operative oral function. Persistent problems in oro-mandibular reconstruction relate to the effects of radiation treatment on the native tissue and include xerostomia, dysgeusia, osteoradionecrosis and trismus. These problems continue to plague the oral cancer patient despite the significant advances that allow a far more complete functional restoration than could be accomplished a mere two decades ago.