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Review QOL outcomes among patients undergoing segmental mandibulectomy and bony free flap reconstruction for ONJ.PubMed was searched for MeSH terms "Quality of life," "Osteonecrosis," "Osteoradionecrosis," "Bisphosphonate-associated osteonecrosis of the jaw," "Free tissue flaps," and "Mandibular reconstruction."English language studies with QOL outcomes data for patients undergoing free flap reconstruction for advanced ONJ were included. 197 records were initially screened; 18 full texts assessed; 10 full texts included. PRISMA guidelines were followed.Ten studies were included in this systematic review: six retrospective, three retrospective with comparison groups, and one prospective. In studies with comparison groups, ONJ patients have worse self-reported QOL than the general population as well as head and neck cancer patients without ONJ. Nearly all patients with QOL measurements (220/235 patients) had ONJ from prior radiation. Segmental mandibulectomy and bony free flap improved overall QOL in over half of patients, as well as pain associated with ONJ in 70-75 % of patients. Surgery did not improve long-term effects of radiation such as chewing, swallowing, and salivary production. Donor site morbidity rarely affects QOL.Osteonecrosis of the jaw (ONJ) worsens quality-of-life, and advanced disease often requires segmental mandibulectomy and bony free flap reconstruction. Patients and surgeons may expect improvement in some, but not all, domains of patient-reported QOL by the use of segmental mandibulectomy and reconstruction for advanced ONJ.

The mechanisms of perineural invasion (PNI) in oral cavity squamous cell carcinoma are only partially understood, and no studies have specifically investigated the role of perineural fibroblasts in PNI. Here, we identified fibroblasts within the microenvironment of perineural invasion and assessed their expression of matrix metalloproteinase-2 (MMP-2).Tumor specimens from 12 patients with oral cavity squamous cell carcinoma and pathologically-confirmed perineural invasion were stained by immunohistochemistry (IHC) for vimentin (positive control) and MMP-2. Scoring was quantified and compared at nerves involved with PNI and nerves uninvolved with PNI.All 12 patients had perineural fibroblasts around involved and uninvolved nerves as marked by vimentin IHC staining. Perineural fibroblasts had detectable MMP-2 expression at areas of perineural invasion in all 12 patients, but no patients had MMP-2 expression by fibroblasts at nerves without PNI.MMP-2 is expressed by fibroblasts within the microenvironment of perineural invasion, and MMP-2 expression by fibroblasts is a possible mechanism of perineural invasion by oral cavity squamous cell carcinoma. MMP-2 may be an anti-cancer target among oral cavity squamous cell carcinoma patients with PNI.

The clinical utility of sentinel node biopsy for melanoma has led multiple investigators to apply this approach to other cutaneous malignancies as well as to early cancers of the upper aerodigestive tract. Data are most extensive for oral cancer. A multi-institutional pathologic validation trial for selected oral cancers provided negative predictive values of 96%. Subsequent trials should document clinical follow-up. This technique may ultimately play a wider role in the management of mucosal cancers.

The clinical utility of sentinel node biopsy techniques for cutaneous melanoma has led multiple investigators to study the applicability of this approach to other solid tumors, including cancers of the upper aerodigestive tract, and especially the oral cavity. Preliminary data indicate that it may be useful for early oral cancers, with the exception of floor of mouth tumors, where technical challenges related to the proximity of the lymphatic basin remain a problem. A multi-institutional pathologic validation trial, involving sentinel node biopsy followed by completion selective neck dissection, has completed accrual. While central step sectioning and immunohistochemistry remain to be completed and analyzed, routine pathologic techniques provided negative predictive values of 96% for oral cancer excluding floor of mouth lesions. Subsequent trials need to involve clinical follow-up and evaluation for recurrence in the neck. We believe this technique may ultimately play a role in the management of early oral cancer.

Munchausen's syndrome is a factitious illness in which patients fabricate medical problems in order to receive medical attention. Their "symptoms" are typical of actual medical conditions and their history is dramatic yet plausible, but no pathology can be found on imaging and other investigations. We report the case of a young woman whose Munchausen's syndrome manifested as purported bleeding from a tracheotomy site. In actuality, she had drawn the blood from an arm vein and spattered it on her neck.