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Objectives: Computer assisted head and neck reconstruction has gained popularity over the past few years. In computer assisted surgery (CAS), surgical margins are predetermined in virtual surgery and resection guides are designed to be fitted intra-operatively. However, concerns have been raised regarding the oncological safety of predetermined surgical margins. Therefore, the aim of this study was to compare surgical margins, recurrence and survival outcomes in patients underwent CAS and non-CAS in head and neck reconstruction., Methods: We retrospectively reviewed the patients underwent oral and maxillofacial malignancies surgical excision and free flap reconstruction from October 2014 to December 2019 by the same chief surgeon. Patients were divided into two groups depending on whether CAS and predetermined surgical margins were adopted. The primary outcome was surgical resection margin and the secondary outcomes included recurrence and survival., Results: A total of 66 subjects were recruited with 37 in the CAS group and 29 in the non-CAS group. The follow-up rate was 100%. The average follow-up time was 24.5 months. No significant difference in resection margin was identified between the groups (p = 0.387). Tumor staging, margin status, perineural invasion, lymphovascular invasion and extranodal extension were identified as significant factors influencing survival. Both before and after adjustment for these prognostic factors identified, CAS and non-CAS group showed no significant difference in survival outcome., Conclusion: Predetermined surgical margins do not compromise oncological safety in terms of resection margin, disease recurrence and patient survival., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background and Objectives: The reported risk of nodal metastasis in hard palate and upper gingival squamous cell carcinoma (SCC) has been inconsistent with inadequate consensus regarding the utility of neck dissection in the clinically negative (cN0) neck., Materials and Methods: Using the National Cancer Database, cN0 patients diagnosed with SCC of the head and neck with the subsites of the hard palate and upper gingiva were identified from 2004 to 2014., Results: A total of 1830 patients were identified, and END was performed on 422 patients with cN0 tumors. Pathologically positive nodes occurred in 14% (59/422) of patients in this cohort. Higher tumor stage, academic hospital type, and large hospital volume (>28 cancer-specific cases/year) were associated with a higher likelihood of END both in univariate and multivariate analyses (P < .05). Patients >80 years of age were less likely to receive END on multivariate analysis (OR 0.52, 0.32-0.84). No variables, including advanced T stage, predicted occult metastases. Cox proportional hazards regression analysis showed that patients who underwent END demonstrated improved OS over an 11-year period (hazard ratio 0.75, P = .002). On subgroup analysis, this improvement was significant in patients with both stage T1 and T4 tumors., Conclusions: Tumor stage, hospital type, and hospital volume were associated with higher rates of END for patients with cN0 hard palate SCC and after controlling for clinical factors, END was associated with improved overall survival., (© 2019 Wiley Periodicals, Inc.)

Objectives: Exploring the clinicopathological features of ameloblastic carcinoma (AC) and reviewing the literature to improve the diagnosis and treatment of the disease., Materials and Methods: Clinical data and pathological features of 18 cases of AC were retrospectively analyzed. A systematic review was carried out by searching PubMed and Medline databases using the MeSH terms "ameloblastic" and "carcinoma.", Results: In the systematic analysis, 125 cases of AC from 81 eligible original studies and 18 cases of AC from this research were included. The male-to-female ratio was 2.58:1, and the mandible-to-maxilla ratio was 1.80:1. Mean age of patients was 45.3 years. Thirty-seven cases of recurrence and 27 cases of metastasis were recorded., Conclusion: AC is a rare neoplasm of the odontogenic epithelium. A systematic review indicates that diagnoses at the early phase and a close periodic assessment for recurrence and metastasis are necessary., (© 2019 Wiley Periodicals, Inc.)

Background: The aim of this article was to develop prediction models that calculate postoperative 2- and 5-year mortality probabilities of patients with squamous cell carcinoma of the maxilla (MSCC)., Methods: Data were collected from the medical records of patients who had been operated between 2000 and 2015 for MSCC. Potential clinical and histopathological predictors were identified. Confounding-(un)adjusted multivariate Cox and logistic regression models were computed with stepwise backward selection. Internal validation was performed to assess calibration and discriminatory ability., Results: Ninety-five patients with MSCC were included. Two-year follow-up was complete, and 85 patients had 5-year follow-up. Age, neck treatment, surgical margins, bone invasion, spindle growth, and vasoinvasive growth were associated with mortality. Models were adjusted for confounding with Charlson's comorbidities index. C-indexes were .841 and .770 respectively, and .838 and .749 after bootstrapping., Conclusion: The MSCC-specific mortality probability can be calculated with new prediction models., (© 2019 Wiley Periodicals, Inc.)

Introduction: Neoadjuvant chemotherapy (neo-CT) for osteosarcomas is the standard of care. Management of maxillo-facial osteosarcomas (MFOS) is challenging. In this rare disease, we collected a large cohort of patients with the aim to report the histological and radiological local response rates to neo-CT., Patients and Methods: All consecutive adult patients treated between 2001 and 2016 in two French sarcoma referral centers (Pitié-Salpêtrière Hospital, APHP, RESAP France and Gustave Roussy Institute France), for a histologically proved MFOS were included. Clinical, histological and radiological data were independently reviewed. Tumor response to neo-CT was assessed clinically, radiologically with independent review using RECIST v1.1 criterion and pathologically (percentage of necrosis). Multivariate analysis was done for outcomes, tumor response and disease-free survival (DFS)., Results: A total of 35 high grade MFOS were collected. The clinical tumor response was 4% (1/24 receiving neo-CT), the radiological response was 0% (0/18 with available data) and the pathological response was 5% (1/20 with available data). Three patients (12.5%) initially resectable became unresectable due to clinical and radiological progression during neo-CT. Tumor size and R0 (clear margins) surgical resections were significantly associated with DFS., Conclusion: MFOS is a rare disease. This large retrospective cohort of MFOS indicates the lack of benefit and potentially deleterious effects of neo-CT. We suggest privileging primary surgery in initially localized resectable MFOS. The benefit of adjuvant chemotherapy should be prospectively studied., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Maxillary defects predispose patients to different undesirable effects. The aim of this study was to assess the quality of life (QoL) of patients with maxillary defects (acquired/congenital) wearing obturators., Methods: The study comprised 30 patients aged between 16 and 78 years. Interviews were conducted to collect information pertaining to patients; sociodemographic, self-reported function of obturator using Obturator Functioning Scale (OFS), self-evaluation of general health using Visual Analogue Scale (VAS), radiotherapy treatment, salivary gland removal, reconstructive surgery, neck dissection and length of time obturators were worn. Clinical examination included type of maxillectomy, Aramany classification of the defect, and evaluation of obturator function using the Kapur retention and stability scoring system., Result: Quality of life was affected significantly by marital status (P = 0.026). Married patients had better quality of life 61.3%, followed by divorced patients 38.8%, widowed 37.3% and the least QoL was detected in single patients 36.5%. Significant association between the type of maxillectomy and QoL was detected (P = 0.002). Retention of obturator prosthesis had a highly significant association with QoL (P < 0.001). Type of maxillectomy had a significant relation with obturator retention (P = 0.005). Stability had a significant correlation with QoL (P = 0.022). Obturator wearers who were treated with radiotherapy had lower QoL than those who were not treated with radiotherapy., Conclusion: Rehabilitation of patients with maxillary defects using obturator prosthesis is an appropriate and not invasive treatment modality. Results support that good obturators contribute to a better life quality.

Background: The purpose of this study was to evaluate active surveillance strategy in the clinically negative neck in maxillary squamous cell carcinoma (SCC)., Methods: One hundred fourteen consecutive patients diagnosed with oral maxillary SCC were analyzed retrospectively from 3 centers in The Netherlands. Analysis parameters included regional disease-free survival of N0 patients stratified for T classification, elective radiotherapy (RT) of the neck; and overall survival of the whole cohort, stratified by N classification; salvage neck surgery rates., Results: Within the N0 cohort, 26.0% of the patients developed neck metastasis in the follow-up visits. Regional recurrence was not related to T classification or postoperative RT of the neck. Regional and locoregional recurrence were associated with diminished overall survival (p < .05). Regional metastasis was operable in 22 of 26 cases (85%). Only 1 patient presented with inoperable neck metastasis without local recurrence., Conclusion: Watchful waiting was feasible in this cohort. If meticulous follow-up is not available, elective neck dissection is recommended. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1794-1798, 2016., (© 2016 Wiley Periodicals, Inc.)

Purpose: Primary intraosseous squamous cell carcinoma (PIOSCC) is a rare malignant odontogenic tumor that originates from odontogenic epithelial remnants. It is often difficult to diagnose PIOSCC definitively; hence, extraction or surgical treatment is performed before the initial diagnosis in most cases. The present study examined new insights into and prognostic factors of patients with PIOSCC admitted to the authors' department., Materials and Methods: An extensive record review was conducted of patients who underwent radical surgery for PIOSCC from January 2001 through December 2014., Results: Of all cases of OSCC, the frequency of PIOSCC was 1.45%. The 2-year relapse-free survival (RFS) and overall survival (OS) rates were 50.0 and 41.6% in all cases, respectively. Three patients underwent surgery or tooth extraction before the initial diagnosis; in fact, intervention before initial diagnosis was found to be an important poor prognostic factor for RFS and OS. In contrast, patients who were not treated before the initial diagnosis was made did not exhibit any locoregional recurrence., Conclusions: The treatment of PIOSCC should be similar to that for oral cancer with at least clinical stage T3N0 in the National Comprehensive Cancer Network clinical practice guidelines. In addition, cases of PIOSCC that are not treated before the initial diagnosis are more likely to obtain a good prognosis., (Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Our aim was to identify the preoperative computed tomographic (CT) characteristics most efficient in predicting overall survival (OS) of patients with maxillary cancer (MC)., Methods: A retrospective review of CT images was performed in 115 patients with histopathologically confirmed primary MC from January 2005 to December 2013, who were classified into 2 subtypes (epithelial and non-epithelial) according to tissue of origin. The prognostic value of CT characteristics for OS was determined firstly through univariate Kaplan-Meier survival estimates with log-rank tests. Significant predictors were further tested with multivariable Cox proportional hazard models., Results: CT characteristics predictive of OS in univariate survival analysis were long and short diameter of the mass, long and short diameter of the largest cervical lymph node and adjacent soft tissue infiltration (P < 0.05). In the multivariable Cox analyses, the significantly independent predictors were long diameter of mass ≥ 4.2 cm (hazard ratio [HR] 1.8; 95 % confidence interval [CI] 1.1-3.0) and short diameter of the largest lymph node ≥ 7 mm (HR 1.9; 95 % CI 1.0-3.6) for all MC patients, as well as for non-epithelial MC patients (HR 3.1; 95 % CI 1.2-8.0; HR 3.3; 95 % CI 1.3-8.7, respectively)., Conclusions: Preoperative CT characteristics of tumor size, lymph node size and adjacent structure infiltration are predictive of the OS time of MC patients. The information brought up in this study could be used in clinical practice to inform about the possible prognosis, and be beneficial to clinical decision making.

Ewing sarcoma (ES) of the jaw bones comprises a small fraction of ES at all sites. Due to their rarity, a specific policy for local treatment is lacking. The aim of this study was to evaluate the local therapy for ES and recommend measures to individualize treatment options. Patients with primary non-metastatic ES of the jaw bones treated between August 2005 and February 2015 were analyzed. All patients received primary induction chemotherapy, following which lesions amenable to resection based on specific radiological criteria were resected; those with unresectable lesions were offered definitive radiotherapy. The maxilla was the primary site in 13 patients and the mandible in eight. The median age of patients was 11.6 years (range 5-17 years). Overall, surgery was performed in 17 patients and definitive radiotherapy was used in four patients. Postoperative radiotherapy was administered to 12 patients and was avoided in five patients with 100% tumour necrosis. The 3-year overall survival, event-free survival, and local control were 68.1%, 63.6%, and 80.2%, respectively. Mandible primary and a histological response to chemotherapy were significant prognostic factors. The stratification of patients based on radiological criteria aids in selecting local therapy. In eligible patients, surgery with contemporary reconstruction results in optimal oncological and functional outcomes. Surgery also has the added advantage of identifying patients who may not need radiotherapy., (Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Pediatric maxillary and mandibular tumors offer considerable challenges to otolaryngologists, oral surgeons, pathologists, and radiologists alike. Because of the close proximity to vital structures, appropriate steps toward a definitive diagnosis and treatment plan are of paramount importance. This article reviews the most common causes of pediatric jaw masses and discusses diagnostic and therapeutic considerations and recommendations.

Background and Objective: The rarity of Ewing sarcoma (ES) of the jaw coupled with the technical challenge of resection and associated functional and cosmetic impairment has resulted in deficient data on surgical management of these tumors. The purpose of this study is to describe the results of surgical excision and reconstruction of primary non-metastatic ES of the mandible and maxilla in children., Methods: Consecutive patients (mandible = 6, maxilla = 5) treated with surgery from August 2005 to January 2013 were selected. All patients received induction chemotherapy and were selected for surgical resection based on the presence of specific criteria for operability., Results: The median age was 11.5 years (range 5-16 years). Free fibular osteocutaneous flap was commonly used for reconstruction. There were no complications related to microvascular anastomosis or flap loss. Five patients had 100% tumor necrosis and did not receive radiotherapy. Teeth alignment, chewing, swallowing, and speech were normal in all and donor site morbidity occurred in one. The 5-year overall, event-free survival, and local control are 87.5%, 72.9%, and 90%, respectively., Conclusion: In eligible patients, surgery with contemporary reconstruction results in optimal oncological and functional outcome. Surgery also has the added advantage of identifying patients who may not need radiotherapy., (© 2014 Wiley Periodicals, Inc.)

Background: The purpose of this study was to investigate the incidence of cervical metastasis in squamous cell carcinoma (SCC) of hard palate and maxillary alveolus and to define its impact factors., Methods: We conducted a retrospective study of patients surgically treated for SCC of hard palate and maxillary alveolus from 2002 to 2011. In situ hybridization was performed to detect high-risk human papillomavirus (HPV) infection., Results: The incidences of cervical metastasis and occult metastasis were 17.2% (11/64) and 9.8% (5/51), respectively. The pT classification and vascular invasion were correlated with cervical metastasis. Occult metastatic risk was significantly higher among patients with pT4. Presence of positive nodes impaired prognosis significantly., Conclusion: SCC of hard palate and maxillary alveolus has nonnegligible incidences of both overall and occult metastasis, which were highly associated with pT classification. We recommend routine, synchronous elective neck dissection for T4 lesions, whereas observation is an alternative for T1 to T3 lesions., (Copyright © 2013 Wiley Periodicals, Inc.)

Objectives/hypothesis: Hard palate and maxillary alveolus are two commonly grouped oral cavity subsites due to their anatomic contiguity and oncologic disease behavior. Few studies have been conducted investigating clinical presentation, staging, prevalence of cervical metastases, and outcomes in this population. The primary objective of this study was to analyze predictors of disease-free survival (DFS) in surgically treated patients, particularly as it relates to the role of neck dissection., Study Design: Cohort study with planned data collection., Methods: This cohort study used planned data collection over 15 years (1994-2008) at a large tertiary care cancer center to study all patients presenting with squamous cell carcinoma of the maxillary alveolus and hard palate treated surgically. Univariate and multivariate Cox regression analyses were used to identify predictors of DFS., Results: Ninety-seven patients met the inclusion criteria (54 male, 56%). The majority of patients (54, 56%) presented with locally advanced disease (cT3, cT4). Occult nodal metastases were noted in 26% (17 of 65) of patients clinically staged as N0. The 3-year DFS was 70% (95% confidence interval = 59%-78%) with a median time to failure of 1.1 years (range = 0.3-9.7 years). Cox regression multivariate model demonstrated that advanced pathologic T stage, hard palate tumor site, and poorly differentiated tumor grade were each independent predictors of DFS., Conclusions: A significant portion of the patients with hard palate and maxillary alveolus tumors harbor occult cervical metastases. Elective neck dissection in the high-risk patients may potentially be beneficial in providing more accurate staging and improving DFS., Level of Evidence: 2b., (Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives/hypothesis: The aim of this study was to describe a technique using the fascia lata (FL) component of the anterolateral thigh (ALT) flap to re-create the orbital floor and lateral nasal wall after total maxillectomy., Study Design: Retrospective analysis of medical records., Methods: A total of 22 patients underwent maxillary reconstruction using a composite ALT-FL flap following cancer resection. All patients underwent total maxillectomies via the Weber-Ferguson approach. The ALT flap was harvested with the deep fascia of the thigh with the aim of using it for lining of the orbital floor and lateral nasal cavity. The FL was sutured to the palatine bone inferiorly, nasal bone and zygomatic bone superiorly, and nasopharyngeal mucosa posteriorly to provide an orbital floor and make a neonasal cavity., Results: There was 100% free flap survival. Speech was normal in eight (36%) patients, near normal in 10 (46%), and intelligible in four (18%). Seventeen (77%) patients gained a good facial appearance, and five (23%) a fair appearance. Sixteen (73%) patients complained of mild nasal crust formation, and the rest (27%) developed moderate crust., Conclusions: Microvascular reconstruction using a composite ALT-FL flap provided a reliable fascial component for orbital floor and nasal surface reconstruction of total maxillectomy defects., (Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.)

The purpose of this study was to determine the survival and prognostic factors of patients with diffuse large B-cell lymphoma (DLBCL) of the oral cavity and maxillofacial region. Retrospectively, the clinical records of patients with a primary diagnosis of DLBCL of the oral cavity and maxillofacial region treated at the A.C. Camargo Hospital for Cancer, São Paulo, Brazil, between January 1980 and December 2005 were evaluated to determine (A) overall survival (OS) at 2 and 5 years and the individual survival percentage for each possible prognostic factor by means of the actuarial technique (also known as mortality tables), and the Kaplan Meier product limit method (which provided the survival value curves for each possible prognostic factor); (B) prognostic factors subject to univariate evaluation with the log-rank test (also known as Mantel-Cox), and multivariate analysis with Cox's regression model (all the variables together). The data were considered significant at p≤0.05. From 1980 to 2005, 3513 new cases of lymphomas were treated, of which 151 (4.3%) occurred in the oral cavity and maxillofacial region. Of these 151 lesions, 48 were diffuse large B-cell lymphoma, with 64% for OS at 2 years and 45% for OS at 5 years. Of the variables studied as possible prognostic factors, multivariate analysis found the following variables have statistically significant values: age (p=0.042), clinical stage (p=0.007) and performance status (p=0.031). These data suggest that patients have a higher risk of mortality if they are older, at a later clinical stage, and have a higher performance status.

Objective: To identify the overall survival and prognostic factors of malignant lymphoma of the oral cavity and the maxillofacial region., Study Design: Clinical records data were obtained in order to determine overall survival at 2 and 5 years, the individual survival percentage of each possible prognostic factor with the actuarial technique, and the survival regarding the possible prognostic factors with the actuarial technique and the Log-rank and Cox's regression tests., Results: Of 151 subjects, an overall survival was 60% at 2 years, and 45% at 5 years. The multivariate analysis demonstrated statistically significant differences for clinical stage (p=0.002), extranodal involvement (p=0.030), presence of human immunodeficiency virus (p=0.032), and presence of Epstein-Barr virus (p=0.010)., Conclusion: The advanced clinical stage and the larger number of involved extranodular sites are related to a lower overall survival, as well as, the presence of previous infections such as the human immunodeficiency and the Epstein-Barr virus.

Objective: To describe a surgical technique for total palatomaxillary and orbital reconstruction using a fibula osteocutaneous free flap in a layered fashion., Methods: Case series from a tertiary care facial plastic and reconstructive surgical practice including patients with postextirpative Brown 3a and 3b orbitopalatomaxillary defects undergoing immediate microvascular reconstruction. Application of the layered fibula free flap to composite maxillary defects permits single-stage, optimal reconstruction of contiguous orbitomaxillary defects, reconstitution of midface 3-dimensional contour, and restoration of the anterior alveolar arch with robust bone, thereby providing for potential sequential dental rehabilitation with osseointegrated implants., Results: This technique demonstrates excellent long-term symmetry, support, function, and aesthetic contour. Although patients may need minor, adjunctive procedures, this technique is flexible in design and offers reliable outcomes with a minimum of morbidity., Conclusion: The fibula osteocutaneous free flap, because of its design flexibility and ability to provide structural support, is an excellent reconstructive option for total maxillary defects, including those that involve the orbit.

Purpose: To assess clinical behavior, response to treatment, and factors affecting survival in maxillofacial osteosarcoma treated at a tertiary referral center., Patients and Methods: Ethics-approved retrospective review of clinical and pathological records was undertaken for 15 patients managed by the Royal Melbourne Hospital Head and Neck Oncology Tumor Stream., Results: Treatment was a combination of surgery and chemotherapy. Chemotherapy was given as adjuvant, neoadjuvant, or in combination. The overall 2-, 5-, and 15-year disease-free survival rates in this study were 92%, 74%, and 74%, respectively. Using Kaplan-Meier analysis with log rank tests, increasing T stage (P = .01) and positive margins (P = .003) were found to affect survival significantly. Neoadjuvant chemotherapy was not significantly associated with tumor necrosis or improved survival., Conclusions: Tumor size and adequacy of local control were found to be the most important predictors of outcome., (Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: This retrospective study was performed to present our long-term results in the treatment of maxillary squamous cell carcinoma and evaluate especially the influence of T staging and grading on patients' survival., Patients and Methods: We performed a retrospective analysis of 93 consecutive patients with alveolar, gingival, or palatal maxillary SCC treated at our clinic with surgical resection and/or radiation therapy. Data were obtained from chart review and patients' records and were analyzed statistically using the log-rank test and Kaplan-Meier survival curves. The male:female ratio was 2:1 and the mean age was 63 years (range 35 to 94 yrs). Most patients showed a T4 stage (66%) and the most frequent staging was T4N0M0 (42%). The most common histopathological grading was G2 (57%), followed by G3 (22%) and G1 (21%). The 5-year overall survival rate was 71%, and the recurrence rate was 37%. Advanced T stage (T4) and grading did not significantly influence the cumulative survival rates., Conclusions: T-stage and grading do not have a significant impact on patients' long-term survival. The most crucial factor for recurrence prevention and therefore survival are free resection margins., (Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: This multicenter study was undertaken to characterize the metastatic behavior of oral maxillary squamous carcinoma and to determine the role of selective neck dissection., Methods: A retrospective, multicenter study of patients surgically treated for oral maxillary squamous carcinoma was completed. Data collected included primary tumor location, cervical lymph node status, and neck failure rate., Results: The study included 146 patients. The adjusted regional metastatic rate was 31.4%. Of those N0 (clinically negative) necks treated with or without neck dissection, 14.4% developed cervical metastasis. Within the cohort, 7.5% of patients died with distant disease. The regional salvage rate was 52.9%. None of the patients with locoregional failures were salvaged., Conclusions: Maxillary palatal, alveolar, and gingival squamous carcinomas exhibit aggressive regional metastatic behavior. Surgical salvage rates for neck failure are low; therefore, selective neck dissection (levels I-III) is recommended at the time of resection of T2, T3, and T4 maxillary squamous carcinomas., (Copyright © 2010 Wiley Periodicals, Inc.)

Background: The purpose of this study was to determine the incidence of neck metastasis in hard palate and maxillary alveolus squamous cell carcinoma (SCC) and to identify factors predictive of regional failure., Methods: In 139 patients treated for SCC of the hard palate and maxillary alveolus (from 1985-2006), the incidence rates of regional metastasis at presentation and at recurrence were calculated. Factors predictive of regional recurrence-free survival were identified on Cox multivariable regression analysis., Results: Regional failure occurred in 28.4% of patients and was significantly associated with pathologic T classification, ranging from 18.7% (pT1) to 37.3% (pT4). T classification was an independent predictor of regional recurrence-free survival (RRFS) on multivariable analysis. Most patients (65.6%) with regional recurrence were not able to be salvaged., Conclusion: Patients with T2 to T4 primary tumors of the hard palate and maxillary alveolus exhibited high rates of regional failure. In most cases, successful salvage was not achieved. Elective treatment of the neck with surgery or radiation is therefore recommended., (Copyright © 2010 Wiley Periodicals, Inc.)

Objectives: Tumors originating in the maxillary sinus are relativeLy rare. The aim of this article is to review the indications, diagnosis and treatment of patients with maxillary tumors operated at Tel Aviv Sourasky Medical Center during the period 1999 - 2008., Methods: A total of 174 patients underwent surgery due to neoplasms originating in the maxillary sinus: 118 patients (68%) had malignant and 54 (32%) had benign tumors., Results: The most common malignancy was squamous cell carcinoma (40%), and the most common benign tumor was juvenile nasopharyngeal angiofibroma (36%). A total of 146 patients (84%) underwent partial maxillectomy and 28 (16%) total maxillectomy. In 9 cases, resection was extended to include the eye socket or base of skull, due to tumor invasion. Thirty-five patients had post-operative complications, with local wound infection being the most common complication (n = 12). Among patients with malignant tumors, 75 are alive without disease (67%), 12 (10%) are alive with disease and 31 (23%) died of disease or other causes., Conclusions: The surgical approach to malignancies of the maxilla is safe and effective. A multidisciplinary team approach is essential to deliver appropriate therapeutic means for these patients.

Various techniques have been used to repair maxillary defects. The aim of this study was to evaluate the suitability of pedicled temporal musculoperiosteal flap (PTMF) and free calvarial bone graft for the reconstruction of maxillary defects. In this retrospective series, 34 patients operated on from 1995 to 2006 at Turku University Central Hospital because of defects of maxilla reconstructed using PTMF with or without free calvarial bone graft were evaluated. The diagnosis, the indication for surgery, the location and staging of the tumours, and the type of radiotherapy used were reviewed. The classification of the maxillary defects was performed according to the classification of Brown (Br J Oral Maxillofac Surg 40:183-190, 2002) and the success rates of the reconstructions were evaluated. Of the patients, 32 had been operated on due to a malignant tumour, one due to a benign tumour and one due to posttraumatic palatal defect. Preoperative radiotherapy (n = 14), preoperative chemoradiotherapy (n = 2) or postoperative radiotherapy (n = 11) had been used in the tumour group. As a reconstructive method, PTMF had been used with (n = 21) or without (n = 13) free calvarial bone graft. The use of free calvarial bone graft did not have a significant effect on flap survival. At 1-month follow-up, the flap survival in the 32 patients was 71.9%, whereas 28.1% of the patients suffered from partial flap loss, but there was no total flap loss. At 6-month follow-up, the flap survival in 26 patients was 76.9%, whereas 7.7% of the patients suffered from partial flap loss, and there were four (15.4%) total flap losses. If unilateral alveolar maxillectomy had been performed (Brown classification a), at 1-month follow-up, the flap survival was 82.6%, 17.4% of the patients suffered from partial flap loss, and there was no total flap loss. At 6-month follow-up, the flap survival was 89.5%, while 10.5% of the patients suffered from partial flap loss, and there was no total flap loss. The application of PTMF with or without free calvarial bone graft for reconstruction of limited palatal and maxillary defects appears to be feasible.

The clinical characteristics of lymph node metastasis in maxillary cancer patients were analyzed. Thirty-eight (23%) of the 166 patients who received intial treatment at Kurume University Hospital between 1978 and 2003 had cervical lymph node metastasis at the time of diagnosis. The disease-specific 5-year survival rate was 63% in the lymph node metastasis negative group and 18% in the lymph node metastasis positive group (p<0.01). There was a statistically significant correlation between bone invasion and lymph node metastasis in the case of the group with bone invasion of the posterior wall of the maxillary sinus. Cervical neck lymph node metastasis developed in 38 (28%) of 135 posterior-wall-invasion-positive group and in none (0%) of the 31 patients in the negative group (p<0.01). Because distant metastasis is common in patients with lymph node metastasis, postoperative adjuvant chemotherapy is highly recommended.

Material and Methods: A case of ameloblastic carcinoma of the maxilla arising in a 90-year-old patient is presented along with a review of 65 other cases of the international literature., Results: The median age was 44 years with a predominance of men (42/66). The maxilla was concerned in almost one third of cases (21/66). Twenty patients died of disease after a median time of 60 months. Fifteen patients died with metastatic spread in the lung, brain, or bones; the others were due to a local recurrence. The specific survival rate was 68.7% at 5 years., Conclusion: Ameloblastic carcinoma is a rare entity of odontogenic tumors that exhibits malignant histologic features in the primary site. Specific mortality, estimated at 31.3% at 5 years, was generally due to a metastatic spread.

Background: Carcinoma of the retromolar trigone is relatively uncommon. High rates of local recurrence account for a relatively poor prognosis., Study Design: A population-based historical cohort of 76 cases with biopsy-proven squamous cell carcinoma of the retromolar trigone were studied as a case series. Kaplan-Meier survival curves and log rank test were used for statistical analysis., Results: The mean age was 67.2 years. Fifty-six patients were male, 45% had T1 or T2 tumors, and 61% were staged as N0. Treatment included radiotherapy in 35%, surgery alone in 26%, surgery and radiotherapy in 23%, and 16% received palliative treatment. The absolute and disease-specific survivals at 5 years were 51.4% and 67.7%, respectively. In patients treated with surgery, the resection margin status predicted the overall 5-year survival (P = .027), with 75% of patients with negative margins surviving 5 years versus a survival of 0% of patients with involved margins., Conclusions: Squamous cell carcinoma of the retromolar trigone has a poor survival rate for early-stage disease. Adequate surgical margins can improve survival.

Jaw bone disorders causing oral complaints are common in primary care settings. Most of these conditions are of a chronic and benign nature. However they also may be the symptoms of a primary or secondary malignant process in the bone. The most common malignant bone tumor is metastatic carcinoma, and tumors arising in the breast, prostate, thyroid, lung and kidney have a special propensity to spread to bone. Yet metastases to the bones are rare; less than one per cent of all neoplasms metastases to the maxillofacial area. We describe four cases of metastatic tumours to the jaws. Two cases originated from the thyroid gland while the rest were from the oesophagus and the liver respectively. Three lesions occurred in the mandible and one in the maxilla. Patients presented with oral discomforts disregarding the primary tumor. Physicians who frequently advise patients with oral complaints should keep in mind that whereas these symptoms are mostly of a chronic and benign nature, metastases from a malignant tumor must be included in the differential diagnosis.

We investigated the surgical outcome of radical maxillectomy in advanced maxillary sinus cancers invading through the posterior wall and into the infratemporal fossa. Twenty-eight patients with maxillary sinus squamous cell carcinoma, who visited the Otorhinolaryngology Department at Severance Hospital from March, 1993 to February, 2001 and underwent the surgery, were analyzed retrospectively by reviewing clinical medical records and radiologic test results. The mean follow- up period was 78.8 months.(26-162 months) Local recurrence, sites of local recurrence, and the 2-year disease-free survival rate were analyzed. Of the total 28 cases, 9 cases were T3, and 19 cases were T4. Total maxillectomy was performed in 12 cases (42.9%) and radical maxillectomy in 16 cases (57.1%). Regardless of staging, radical maxillectomy was performed only when cancers invaded through the posterior wall and into the infratemporal fossa. When cancers only maginally or did not invade the posterior wall, total maxillectomy was performed. The 2-year disease-free survival rate was 75% for both total and radical maxillectomy, and the local recurrence rates were 8.3% and 18.7% respectively. All recurrence occurred at the posterior resection margin of the maxillectomy. We strongly recommend the use of radical maxillectomy in the cases of advanced maxillary sinus cancers invading the infratemporal fossa. Radical maxillectomy can provide sufficient safety margins and lower the local recurrence rate.

Objective: To determine factors that influence survival in patients with osteogenic sarcoma of the jaws., Study Design: Multicentre retrospective clinical pathologic study of 35 patients with osteogenic sarcoma of the jaws by the Canadian Society of Otolaryngology-Head and Neck Surgery Oncology Study Group., Methods: Clinical charts and pathology results were reviewed on 35 patients treated between 1980 and 2000 for osteogenic sarcoma of the maxilla or mandible. Records were acquired from several major Canadian cancer registries. The following variables were examined for the effect on survival: age, gender, tumour site, grade and subtype, margins, and method of treatment., Results: The average age of patients was 40 years (range 14-76 years). The sex distribution was similar, with 18 males and 17 females. The primary site was the mandible in 20 patients and the maxilla in 15 patients. The overall survival was 79 +/- 7% at 2 years and 57 +/- 9% at 5 years. Local recurrence (41%) was more common than distant metastases (17%). Positive margins were the factor most strongly associated with poor prognosis on multivariate analysis (hazard ratio = 3.5, p < .04). Disease-free survival dropped to zero by 3 years for those with positive margins (n = 7). For those who were resected with clear margins (n = 25), 5-year disease-free survival remained greater than 50% and the overall survival rate was almost 80%. Tumour site, grade, and subtype did not correlate with prognosis. There was a trend toward better prognosis in those who received chemotherapy in addition to surgery., Conclusion: Osteogenic sarcoma of the jaws is an aggressive disease with a high mortality rate despite a relatively low risk of distant metastases. Negative margins are paramount for optimizing survival rate. Chemotherapy, although contentious, should be considered given the data from long bone studies and the trend toward better survival in several studies, including ours.

Purpose: The purpose of this research was to assess the frequency and clinical significance of antigen processing machinery component and HLA class I antigen down-regulation in primary maxillary sinus squamous cell carcinoma (SCC) lesions., Experimental Design: Formalin-fixed, paraffin-embedded tumor biopsy specimens at pretreatment status from 70 Japanese patients with maxillary sinus SCC were examined for HLA class I antigen and endoplasmic reticulum chaperone molecule expression using an immunohistochemical method. Furthermore, the results of immunohistochemical staining of the lesions were correlated with their histopathological characteristics and with the clinical course of the disease., Results: Calnexin, ERp57, calreticulin, tapasin, and HLA class I antigens were down-regulated in 13, 13, 24, 69, and 78% of the 70 lesions tested, respectively. Both tapasin and HLA class I antigen expression were significantly correlated with the number of infiltrating CD3(+) T cells into tumor lesions (P < 0.01); furthermore, tapasin expression was significantly correlated with tumor differentiation (P = 0.024). Tapasin expression was correlated with that of HLA class I antigens (P < 0.01). Furthermore, tapasin and HLA class I antigen down-regulation in SCC lesions was significantly associated with reduced survival of patients (P = 0.01 and P = 0.002, respectively). Multivariate Cox proportional hazards model analysis identified HLA class I antigen down-regulation as an independent prognostic marker., Conclusions: Tapasin expression appears to be associated with HLA class I antigen expression in primary maxillary sinus SCC lesions. Furthermore, defects in tapasin and HLA class I antigen expression in primary maxillary sinus SCC lesions may play a role in the clinical course of the disease, because these defects were associated with poor prognosis.

Maxillofacial osteosarcoma is a rare tumour. Curative treatment strategies have evolved to include chemotherapy in addition to definitive surgical resection. To review and report our experience in eight patients with maxillofacial osteosarcomas, we retrospectively reviewed eight patients with high-grade maxillofacial osteosarcoma seen over the last decade at our institution. Our results suggest that a combined surgical and chemotherapy approach provides excellent local disease control and high cure rates., (Copyright 2003 Elsevier Science Ltd.)

Background: Maxillofacial sarcomas are rare tumors, varying according to their type, grade, site of occurrence, response to treatment and prognosis. Approximately 10% of all cases of osteosarcoma, a subtype with a particularly poor prognosis, occur in the head and neck., Patients and Methods: During the 35 years from 1963 until 1997, the 25 patients treated for sarcomas at our center were identified and evaluated according to a variety of parameters., Results: Overall 2- and 5-year survival rates were 72% and 60%, respectively. Sarcomas were found most commonly in the mandible, maxilla and tongue. Survival was not significantly correlated with gender, ethnic origin or histopathological staging, but significant correlation was found between type of sarcoma and survival whilst younger patients had better survival rates., Conclusion: Advanced facial reconstruction methods may enable the performance of more radical ablative surgery, thereby improving survival outcome for head and neck osteosarcoma patients. Osteosarcoma appears to be as lethal in the maxillofacial region as in the extremities.

The prognosis for maxillary malignancies with posterior extension to the pterygo-maxillary and infratemporal fossae is worse than for those with anterior-inferior extrinsication. Maxillectomy using only an anterior approach does not enable enblock, radical resection of such tumors. Many different approaches to the infratemporal fossae have been described in the literature. The authors use a double infratemporal and transfacial approach. Between 1990 and 1998 this approach was used on 65 patients with malignant maxillary tumors. There was one post-operative death due to myocardial infarction. There were only 9 cases of temporal infection, and all were resolved. There were no cases of necrosis of either the temporal muscle or the revascularized flaps. The cases included the following tumors: spinocellular and anaplastic carcinoma (21 cases); adenoid-cystic carcinoma (16); adenocarcinoma (4); sarcoma (18); other malignant tumors (6). There were 29 primary tumors while the remaining 36 were recurrences from prior treatment. Using the UICC-AICC 1987-92 staging system there were 22 cases of T3 and 43 T4. Using the 1997 system there were 35 T3s and 30 T4s. Resection was radical in 54 cases while in the remaining 11 there were micro or macroscopic limitations at the rhinopharyngeal level and/or at the orbit apex. The NED survival percentages were: T3 59.2%; T4 28% (using the 1987-92 system) while they were T3 45.7% and T4 26.7% (using the 1997 system). In the 41 patients with carcinoma (spinocellular, anaplastic, adeno and adenoid-cystic) the NED survival percentages were: T3 54.5%; T4 23.4% (using the 1987-92 system) while they were T3 45% and T4 19% (using the 1997 system). The NED survival percentage was 41.4% for primary tumors and 36.1% for recurrences. These results lead one to conclude that this surgical technique permits good results with T3-T4 maxillary malignancies. The prognosis for recurrences is worse than for primary tumors and the prognosis for sarcoma is better than for carcinoma. The UICC-AICC staging systems are valid for prognostic purposes. The current analyses indicate that the 1987-92 system is slightly more suitable than the 1997 system. In fact, there were 13 patients which the 1987-92 system had classified as T4 and which the 1997 system had reclassified as T3. In all these cases the prognosis was more similar to that of T4 than T3.

At the Cranio-Maxillo-Facial Surgery Unit of the Istituto Nazionale per lo Studio e la Cura dei Tumori in Milan, Italy between 1987 and 1999 200 anterior cranio-facial resections were performed on malignant ethmoid tumors involving the anterior cranial base and extending to the nasal fossae and, at times to the orbit and maxillary and sphenoid sinuses. In the second portion of this case study the authors simplified their surgical technique. The frontal craniotomy was made rectangular and low, performed with an oscillating saw and scalpel, without drilling holes. The osteotomy of the cranial base was modulated according to tumor extension. Typically a paralateronasal facial incision was performed without opening the upper lip. Whenever the maxillary sinus and/or orbit were involved, the skin incision and osteotomy was consequently modified. Repair of the cranial base was performed with a pedicled pericranial flap. In this case study there were 6 post-operative deaths in the first 30 patients and only 2 in the remaining 170. The male/female ratio was 145/55, mean age 55 years (12-80) and average follow-up 38 months (2-117). There were 120 primary tumors while the remaining 80 patients presented recurrences from prior treatments. There were 96 adenocarcinomas, 42 spinocellular carcinomas, 21 esthesioneuroblastoma 15 adenoid-cystic carcinomas, 9 melanomas and 17 rare tumors. Our classification identified the following stages: 69 T2, 54 T3 and 77 T4 while the UICC-AJCC staging system indicated: 25 T1, 16 T2, 68 T3 and 91 T4. The NED survival according to tumor stage (INT classification) was: T262.3%, T3 44.4% and T4 29.9%. The NED survival for patients who had not previously undergone treatment was: T2 71.7%, T3 58.8% and T4 42.5%. On the other hand the NED survival for the cases of recurrence was: T2 43.5%, T3 20% and T4 16.2%. These results lead to the conclusion that the surgical technique currently used is valid and that the anterior cranio-facial resection should always be performed in patients with ethmoid tumors coming into contact with, or eroding, the cribriform plate. For all staging classes, the prognosis for those patients undergoing surgery for recurrence from prior, inadequate treatment was significantly worse than that for the primary tumors.

Objective: To investigate the clinical significance of craniofacial resection for advanced malignant tumors of OMS region., Methods: Forty-six patients underwent craniofacial resection for malignancies involving the anterior and middle cranial fossa over a 20-year period between June 1978 and December 1997 in our department were evaluated. The extents of cranial resections were anterior cranial fossa in 20 cases, middle crania fossa in 16 cases and anterior and middle skull base in 10 cases. There were 18 patients undergoing orbital exenteration simultaneously. 14 cases had limitted dura resected because of dural involvement., Results: The survival rate at 3 and 5 years was 48.8% (20/41) and 35.1% (13/37), respectively. The survival rate at 10 years was 20.0% (4/20)., Conclusion: Our results revealed a considerably fine prospect of craniofacial resection for patients with advanced malignancies in oral and maxillofacial region.

Objective: To review our experience with osteogenic sarcoma of the jaw., Data Source: The pathology and clinical files of the Mount Sinai Medical Center, New York, NY, were examined., Study Selection: For the past 6 years, 12 pathologically documented cases were identified., Data Extraction: Surgical resection margins, histological tumor grade and subtype, and treatment modality were reexamined with regard to effect on outcome., Data Synthesis: The mean age of occurrence was 32.6 years, ranging from 12 to 60 years. Male predominance was noted in both mandibular and maxillary tumors. Local recurrence occurred in 6 of 12 patients after 3 months to 5 years; 4 of these patients have either persistent disease or died of disease. In this recurrence group, only 2 patients remain disease free 7 and 12 years after initial diagnosis and 6.5 and 8 years after recurrence., Conclusions: This study is too small to draw statistically significant conclusions. However, the longest survivor in the group (disease free at 12 years) had a histologically low-grade mandibular tumor. We reiterate the findings in the literature, which agree that osteogenic sarcoma of the jaw is an aggressive disease. Patient prognosis may depend on the tumor grade and size on presentation, as well as the completeness of initial surgery as monitored by resection margins.

Purpose: To evaluate the possible value of chemotherapy in the treatment of craniofacial osteosarcoma (CFOS)., Design: In a systematic review, data of 201 patients (age, 36.6 +/- 19.0 years [mean +/- SD]) from 20 uncontrolled series on CFOS indexed in Medline and Excerpta Medica between 1974 and 1994 were pooled; 180 patients had undergone surgery. Various chemotherapy regimens had been given to 71 patients. Radiotherapy was used in 69 patients. All patients had data for overall survival, and 182 had data for disease-free survival analysis. Cumulative survival distributions were estimated by the product-limit method, and a multiple regression analysis was performed., Results: Patients' overall and disease-free survival rates were significantly improved by treatment with chemotherapy. This was confirmed for patients with complete surgical removal, as well as for those with incomplete removal of tumor. In a proportional hazards model, complete surgical removal and chemotherapy were independent significant factors for overall and disease-free survival. The effect of radiotherapy was insignificant. No prognostic factors could be identified among age groups, sex, and subsites., Conclusion: Evidence exists that chemotherapy improves survival in CFOS. We advocate the adoption of the chemotherapy protocols used for OS of the long bones for CFOS.

Between 1987 and 1994 we performed 103 anterior cranio-facial resections in patients affected by tumors involving the ethmoid, the nasal cavities and, sometimes, the orbit, the maxillary and sphenoid sinuses. The cibriform plate was always involved. The tumor invaded the frontal dura in 20 patients without intradural neoplastic vegetations. These were present in 6 cases. Ninety-one of these patients had a malignant tumor; from the histologic point of view we had 50 adenocarcinomas, 16 epidermoid carcinomas, 8 estesioneuroblastomas, 6 adenoid cystic carcinomas, 5 melanomas and 6 infrequent types. The surgical technique became simplier in the second half of our patients. Now we perform a coronal skin incision and prepare a pericranial flap without the galea and use it to reconstruct the cranial base defect without bone or alloplastic material. The frontal craniotomy is rectangular, low and made by an oscillating saw without trephine holes. The posterior section of the skull base for a typical ethmoid tumor is always on the sphenoid roof and the lateral ones on the medial third of the orbital roof, al least in the more interested side. The anterior section is on the frontal sinus floor. The osteotomies may be enlarged according to tumor extension. Our facial incision is paranasal without splitting of the upper lip, but sometimes we used wider skin incisions and osteotomies for tumors involving the maxillary sinus and palate. We had many important complications in the first half of out patients with 7 postoperative deaths but none in the second half. Fifty-five percent of the adenocarcinomas, 7% of the epidermoid carcinomas, 75% of the estesioneuroblastomas, 100% of the adenoid cystic carcinomas and 0% of the melanomas are alive and well. Forty-six patients were previously treated elsewhere and 45 were untreated. The cure rate of these two groups of patients is very different: 38.1% of the first versus 61.9% of the second ones are alive and free of disease. Our experience proves that every transfacial or transnasal resection of an ethmoidal tumor involving the cribriform plate must be avoided.

In the years 1980-1995 60 patients with adenoid cystic carcinoma in the head and neck of different localization were treated at the Department of Otolaryngology. Majority of the tumors originated of the major salivary glands was parotid gland (24 cases). The most common location among the tumor of the minor salivary glands was the palate (5 cases). The tumors arising from others mucous glands, most frequently has located in the maxillo-etmoideal complex (12 cases). The authors stress diagnostic difficulties, the necessity of a proper selection of the surgical method and postoperative radiotherapy, describing the treatment results in the patients. Radical surgical procedure of the adenoid cystic carcinoma yields optimal local control and survival rates.

We identified 51 patients from pathology and operative records who were treated in the Royal Victoria Eye and Ear Hospital with malignant sinonasal tumours between January 1980 and December 1991. Complete follow up was available in 43 patients. There were 30 males, mean age 50 years, range (10-80) and 13 females, mean age 59 years, range (34-75). Commonest presentations were nasal obstruction, nasal discharge and facial swelling. Patients presented late because of initial non specific symptoms. The maxilla was the site of origin in 18 patients, the ethmoids in 13 patients and the nasal cavity in 12 patients. There was a wide range of histological types with squamous cell carcinoma occurring in 19 patients (44%). All patients were treated with surgery, radiotherapy or a combination of both. Chemotherapy was used as an adjunctive therapy in three patients. Local recurrence occurred in 21 (50%) of the patients. Overall three year survival was 58% and five year survival was 45%. These figures compare favourably with larger series in the literature. A high index of suspicion, early recognition and referral of these patients is required to improve survival.

14 patients with an osteosarcoma of the craniofacial bones were evaluated retrospectively. 10 patients were males and 4 were females, ages varied from 10 to 74 years with a mean of 37 years. Ten tumours were located in the maxilla and four in the mandible. All patients underwent surgical resection of the tumour. One patient was irradiated postoperatively with 67.5 Gy and another patient received adjuvant chemotherapy with melphelan. Follow-up ranged from 6 months to 10 years with a mean of 4 years 2 months. Of 14 patients, 5 have died of local disease of whom 1 also had distant metastasis. Disease-free survival was 82.5% after 2 years and 68.8% after 5 years. Overall survival was 79.1% after 5 years. Univariate statistical analysis was carried out, revealing age < 35 years (P = 0.033) and radical surgery (P = 0.007) as statistically significant factors in disease-free survival. It is concluded that radical surgery in young patients with a craniofacial osteosarcoma gives long-term disease-free survival.

A high incidence of a T cell phenotype of sinonasal lymphomas in other Asian countries has been associated with a high incidence of Epstein Barr virus (EBV) infection. We analyzed 13 sinonasal and 18 Waldeyer's ring lymphomas for the prevalence of EBV encoded RNA (EBER) using a sensitive and specific in situ hybridization. In addition, we examined the relationship of histologic findings and immunophenotype as well as the location of the lymphomas to the presence of EBV. The EBER was detected in each of 12 sinonasal lymphomas with a T cell immunophenotype. One B cell sinonasal lymphoma was EBER negative. Four of 18 Waldeyer's ring lymphomas were positive for EBER, including two T cell lymphomas. Two of 16 B cell Waldeyer's ring lymphomas were EBER positive. Morphologically, 11 of 20 diffuse large cell lymphomas, 2 diffuse mixed small and large cell lymphomas, 2 of 4 immunoblastic lymphomas and 1 lymphoplasmacytic lymphoma were EBER positive. Four follicular large cell lymphomas were EBER negative. A characteristic angiocentric or angiodestructive pattern was found in most T cell lymphomas and EBER positive cases. These findings indicate that EBV infection is more strongly associated with the T cell immunophenotype, angiocentric pattern and sinonasal location of the lymphoma.

Clinical examination was performed on 20 cases of malignant melanoma in the oral region encountered at the First Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokyo Medical and Dental University, during the 22-year period from 1970 to 1991. In addition, we reviewed 140 cases reported in the Japanese literature since the last major review in 1974. The results of our study revealed that the clinical course of malignant melanoma in the oral region is worse than oral squamous cell carcinoma and that treatment by radiotherapy is effective in prolonging the life of these patients. Clinically, the tumors were classified into five types: (1) pigmented nodular type; (2) nonpigmented nodular type; (3) pigmented macular type; (4) pigmented mixed type; and (5) nonpigmented mixed type. We suggest that oral malignant melanoma might be different from cutaneous malignant melanoma and that new criteria for diagnosis and therapy for oral disease should be considered.

Teamwork between neurosurgeons and head and neck surgeons has increased the possibility of managing tumours involving the skull base. The authors distinguish the anterior half of the skull base into a median and two lateral portions and describe the surgical approaches utilized to expose it. The authors present their clinical experience in 27 patients with extensive lesions of the anterior half of the skull base and their results.

Proliferating cell nuclear antigen (PCNA) is a nuclear protein, synthesized in the late G1 and S phases of the cell cycle. Therefore, it is considered to be closely related to cell proliferation. The contribution of PCNA to prognostic evaluation of the disease was investigated in 42 squamous cell carcinomas of the maxillary sinuses, retrospectively. Histological sections were prepared by formalin-fixation, paraffin-embedding and staining with monoclonal antibody to PCNA (DAKO, PC10) using the Avidin-biotin peroxidase complex method. The percentage of tumor cells with positive staining for PCNA ranged from 26.3 to 92.3% (average; 61.7%). In order to evaluate PCNA in terms of prognosis, five-year survival rates in the following two groups were compared. One included cases with a PCNA positive rate above the mean level and the other, those below the mean level. Five year survival rate was 30.4% in the group with a higher positive rate, but 42.1% in the group with the lower rate. However, the difference in survival rate between the two groups was not statistically significant. In addition, no correlations either between the rate of PCNA positivity and T-classification of tumors or between the degree of tumor cell differentiation and metastasis to neck lymph nodes were obtained. Further study is necessary to evaluate PCNA as a prognostic marker in human malignancy.

We performed microvascular free-tissue reconstruction of extensive defects in the sino-orbital region in 11 patients. Reconstructions were immediate in 10 patients and delayed in one patient. There was loss of orbit in eight patients, maxilla in eight patients, cranial base in two patients, and skin and soft tissue of the face in six patients. Nine rectus abdominis flaps, one radial forearm flap, and one lateral arm flap were used. Palatal reconstruction with autologous tissue was successful in all patients. Cranial base repairs healed without sequelae or evidence of meningitis. Cosmetically, soft-tissue repair of facial skin was only satisfactory. For large defects, it was difficult to reconstruct the palate and facial soft tissue and to maintain nasal airway patency with a single microvascular procedure. Free-tissue transfers remain the safest and most versatile reconstructive procedure for massive sino-orbital defects after ablation of a tumor.