Malignant growth Maxilla management an analysis

Introduction: Oral squamous cell carcinoma (SCC) is a malignant neoplasm, originating from the oral epithelium. Incidence and mortality rates for oral SCC may vary depending on personal habits, socioeconomic characteristics, environmental factors and quality of health care facilitates available in the geographical location. Case Report: This paper presents a case of 45-year-old female patient diagnosed with moderately differentiated squa-mous cell carcinoma of the maxilla. The treatment provided was right hemi-maxillectomy with split thickness skin grafting , followed by maxillary obturator for obliteration of the surgical defect and dental rehabilitation. Conclusion: The paper highlights comprehensive management of maxillary SCC to provide disease-free life, as well as restore the form and function post-operatively.

Journal of Maxillofacial and Oral Surgery, 2014

Most malignant tumors arise from the primary tissue except when showing extreme dedifferentiation. This can be identified by examination of tumor cells and their products. Occasionally two distinct tissues are recognized within a malignant tumor. In mixed malignant tumors both carcinomatous and sarcomatous elements are present either because of simultaneous malignant change occurring in the epithelium and its nonepithelial stroma or there is a sarcomatous transformation of stroma of a carcinoma. Willey's in 1960 stated that in these circumstances the resulting tumor must be classified as a ''carcino-sarcoma''. These separate tumors arise in nearby structures and may grow to infiltrate in each other resulting in a tumor mass. The present article is a report of a diagnostic dilemma in an extremely rare carcinosarcoma of maxilla in a 24 year old male which was first on biopsy reported as odontogenic myxoma. After resection (right maxillectomy under GA using Weber Fergusons approach with Diffenbach's extension) was diagnosed as Squamous Cell Carcinoma arising from lining of the maxillary antrum associated with Osteogenic Sarcoma (chondroblastic differentiation) of maxilla with negative margins. The tumor was restaged to T2NoMx and further managed as per National Comprehensive Cancer Network Guidelines. Immunohistochemistry later re-diagnosed it to be an Osteogenic Sarcoma maxilla with chondroblastic differentiation. 'T' stage remains the most reliable predictor of survival and locoregional control. Complete surgical resection for all 'T' stages (except T4b, any N) followed by postoperative therapy remains a corner stone of treatment of maxillary sinus tumors.

Journal of Cancer Therapy, 2014

Introduction: Squamous cell carcinoma (SCC) is the predominant neoplastic tumor that occurs in the oral cavity. SCC arising from the maxillary gingiva, hard palate and maxillary alveolus is relatively rare. Since soft tissue barrier is thin, the diagnosis of cancer in these regions is usually ulcerative and invasive to the underlying bone already in the early stages of the disease. The aim of the present study was to retrospectively evaluate our data regarding the management of loco-regional lymph nodes and the efficacy of neck dissection in the clinically negative neck when maxillary squamous cell carcinoma is diagnosed. Furthermore, we wish to establish the role of prophylactic neck dissection and T stage from which it should be implemented. Methods: Archival records of oncological patients that were treated for SCC of the maxillary alveolus, hard palate and gingiva were collected. Overall 20 patients met the inclusion criteria, 11 men and 9 women. Average age of first diagnosis was 68 years. Results: At initial examination, 2 patients (10%) had clinically positive lymph nodes and undergone therapeutic neck dissection. The remaining 18 patients had clinically N0 necks. Five patients (28%) had occult positive lymph nodes following prophylactic neck dissection. One of the patients had a primary resection with no neck treatment. This patient eventually developed metastases in the neck two month post-surgery (occult disease). The overall positive lymph nodes in maxillary squamous cell carcinoma were 40% (8/20) with an occult metastasis rate of 33% (6/18). Disease specific mortality was 45% (9/20). Conclusion: In the present study, the majority of patients that were diagnosed with occult metastatic disease were either large tumors (T4, 60%) or with moderate to poor differentiation (mood-poor 80%). We conclude that patients who are present with a high grade (moderate-poor) large or invasive max-* Corresponding author. Y. Leiser et al. 1066 illary SCC (T2-T4), a prophylactic selective neck dissection (levels I-III) should be performed.

A Textbook of Advanced Oral and Maxillofacial Surgery, 2013

Journal of Craniofacial Surgery, 2012

In the management of our case to develop the reconstructive procedure, initially, the deformities of the patient were evaluated and defined. The mandibular deformity of the patient was not directly associated with the ecthyma gangrenosum. Because the patient was a child, it was thought to be developed secondary to the scar contractures during the development stage with permanent dentition, causing anterior mandibular protrusion. The soft-tissue defect was a centrally located full-thickness defect involving 50% of the lower lip. In the reconstruction step, anterior alveolar protrusion was corrected with anterior subapical mandibular osteotomy, and the soft-tissue defect was reconstructed with the local neuromusculocutaneous advancement flap that was first described by Turgut et al. 12 In this technique, neuromusculocutaneous advancing flaps were used to preserve the integrity and functions of both the oral sphincter (orbicularis oris) and the depressor muscles and to prevent the loss of lower lip sensation. With this technique, we believe that the most functional results were achieved without any additional scars in the upper lip or in the cheek. Lower lip defects, which we frequently examine in elder patients due to lip cancer, may also seldomly be seen due to cutaneous infections accompanying septicemia caused by immunosuppressed states such as ALL. For the reconstruction of the defect, missing tissue components in accordance with the options should be identified according to patient's need. Defects measuring one third and two thirds of the lower lip are the most challenging ones to reconstruct with local flaps and require careful surgical planning. Until now, the techniques that have been described for reconstruction of the defects between one third and two thirds of the lower lip generally use the tissues from the upper lip, the cheeks, or the mentum or a combination of these tissues. These techniques have now improved in providing more comfortable execution of oral functions. Oral competence, muscle function, lip sensation, and oral gape are the 4 main goals to be achieved for the execution of normal oral functions. Reconstruction of the lower lip defects with tissue loss between 35% and 70% and with sufficient lower lip tissue left could also be achieved using Karapandzic, Abbe, Estlander, McGregor, or Gillies fan flaps or Nakajima or Schuchardt flaps. 12 These techniques are usually used in elderly patients for reconstruction of lip defects after tumor excision. The main disadvantages of these techniques are the disturbance of the healthy cheek or upper lip tissues that may result in additional scars in children. In conclusion, ecthyma gangrenosum lesions rarely may result in wide and complex facial defects, in neutropenic states. Plastic surgical approach to this rare complication both in the acute phase of the disease and in the management of the late-term sequela is of great importance. In early stages of the disease, appropriate antimicrobial therapy and local wound care with debridements are adequate. However, when the patient's general health status returns back to the normal state, reconstructive procedures should be planned to improve the quality of life. The reconstructive options vary depending on both the location and size of these lesions and are also related to the functional deficit associated with the lesions. With appropriate surgical planning, appropriate functional restoration and aesthetic results can be achieved.

The complexity of tumors extending to the skull base compartments is technically demanding for maximum visualization, control of the vital structures, adequate tumor resection and/or reconstruction. Management of such widely extending tumors requires a team approach and close cooperation between the neurosurgeon, maxillofacial surgeon, oto-rhino-laryngologist and ophthalmic surgeon. This article emphasizes on the role of maxillofacial surgeon in the surgical planning of such extensively involving tumors via facial translocation.

European Journal of Surgical Oncology (EJSO), 2007

Aims: Immediate maxillary reconstruction after malignant tumor extirpation differs from other types of maxillary reconstruction. Our reconstruction algorithm is described in this article. Methods: One hundred ninety-four patients who had undergone maxillectomy for malignant tumors were reviewed, and maxillectomy defects were classified with the method of Cordeiro and Santamaria. Results: Mean total blood loss was 848 ml, and 71 patients died within 2 years after surgery. For type IIIa defects of the orbital floor, titanium mesh or vascularized bone or cartilage was used for reconstruction, but the rate of postoperative complications did not differ between titanium and autografts. Therefore, to reconstruct orbital floor defects we have recently used only titanium mesh. For type I or II defects, we use autografts for only selected cases. Conclusions: We strive to perform less-invasive reconstructive surgery after resection for maxillary malignancy.

Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2006

Sarcomas are relatively uncommon tumors, accounting for 1% of all malignancies. Sarcomas are commonly classified according to their site of origin: soft tissues or bone. The purpose of the clinic study was to focus the symptoms and the clinic signs. The radio-imaging study is essential in the evaluation of the maxilla tumors. The histopathologic study was done to determine the histological type, the differentiation level, the invasion level as well as the presence or absence of the metastases in drainage ganglia. The correlation of the findings of this study leads to a clear and correct clinic diagnosis, an adequate local or general therapy and a prognostic. The diagnostic role of imaging is essential and often permits the orientation to benignity or, on the contrary, requires biopsy if the image is an aggressive one or of uncertain nature. Advances in diagnostic imaging have contributed substantially to the management of tumors. The strong collaboration among the physician, imaging...

Acta Otorrinolaringologica (English Edition), 2008

Objective: To describe the survival and outcome of maxillary sinus cancer in patients managed with surgery and postoperative radiotherapy during the last 10 years in our hospital. Patients and method: Descriptive, retrospective, nonrandomized study of 23 patients with cancer of the maxillary sinus managed at the Vigo University Hospital Complex, Spain, with radical surgery and post-operative radiotherapy, between 1995 and 2004. Results: The 3-year actuarial survival was 47.8% and the adjusted actuarial survival was 60.8%. Permanent local tumour control was achieved in 60.8% of cases (14/23). Local tumour recurrence was the main cause of treatment failure (33.3%; 4/12). The most significant prognostic factors affecting local tumour control and survival were: clinical stage (P<.031), suprastructural location of the tumour (P<.001), and presence of positive resection margins (P<.001). Conclusions: Local recurrence was found to be very high and generally the main cause of death. New treatment protocols should be assessed.

African Health Sciences, 2014

The maxilla and the mandible are the sites of many cystic and neoplastic conditions which could be either benign or malignant. 1 Swellings in the orofacial region are unique due to the obvious cosmetic defect and functional impairment of the anatomically related aerodigestive tract. Orofacial tumors are known to exhibit geographic variations in prevalence and pattern due to cultural, social, occupational or climatic factors as shown by studies from Nigeria 2,3 , other African countries 4,5 , Asia 6 and Western nations. 7,8 Wakiaga et al. 9 in a report from Kenya found ameloblastoma,Burkitt's lymphoma, ossifying fibroma and osteogenic sarcoma as the most common tumors in that order.