BACKGROUND:Due to its anatomic site, the treatment of head and neck cancer (HNC) significantly affects activities of daily living. Clinical heterogeneity and accelerated aging in older adults make it crucial to identify patient-related, prognostic factors. The objective of the present study was to assess the prognostic value of patient-related factors for 2-year overall survival (OS) in older adults with HNC, after adjustment for tumor-related factors. METHODS:This was a secondary analysis of the EGeSOR randomized, controlled trial conducted in France between 2013 and 2018. Patients with HNC aged 65 or over and who were candidates for either curative or palliative treatment were randomized to receive a geriatric assessment with result-driven interventions and follow-up (the intervention group) or the standard of care (the control group) and followed up for 24 months. The primary outcome was two-year OS. RESULTS:475 patients were included. There was no intergroup difference in the 2-year OS rate (hazard ratio (HR) [95 %CI] = 0.82 [0.60;1.12], p = 0.208). In two multivariable models, female sex was a protective factor against all-cause death (p = 0.008 and p = 0.003). Older age (p < 0.001) and the number of comorbidities were associated with poor 2-year OS. The frailty risk (G8 score) was not associated with 2-year OS. When considering the geriatric assessment variables, low autonomy (an instrumental activities of daily living score <8), poor mobility (a one-leg standing test result <5 s), nutritional status (an abnormal Mini Nutritional Assessment score) and cognitive status (a Mini Mental State Examination score <24) were associated with poor 2-year OS. CONCLUSION:The study's results highlighted several patient-related, prognostic factors. Chronological age and tumor-related variables should not be the only factors taken into account when making treatment decisions.

This systematic review aimed to evaluate the dental prosthetic rehabilitation (DPR) in patients after jaw reconstruction with fibula free flap. Four databases were searched from January 2000 to January 2023. Of the 2507 studies identified, 36 observational studies were included. Cancer was the most common surgical indications for jawbone resection with 58.3 % of cases followed by benign tumours which representing 24 %. The DPR rate was estimated at 51.6 % across the studies (ranging from 38 % to 55 % depending on the benign or malignant nature of the tumors). Implant-supported prostheses represented 58.9 % of cases of which 66.9 % were fixed and 33.1 % were implant-stabilized overdentures. Virtual surgical planning (VSP) was used in 20 % of studies and aimed to improve the position of the grafted fibula, quality, and aesthetics of DPR and to decrease ischemia and the operating time. One in two authors performed DPR 12 months after jaw reconstruction. If implant survival rate reached 93 % in non-irradiated fibula, it fell to 38 %, 55 %, and 77 % if implantation occurred in the 12, 17, and 24 months after radiotherapy, respectively. Various parameters should be better investigated in further studies including the typology of the prostheses (implant-supported vs removable), the use of VSP, and the optimal time for DPR taking into account the characteristics of the tumor, the size of bone defect, and the need for external irradiation therapy.

Due to the location and toxicity of treatments, head and neck cancer (HNC) has a major impact on quality of life (QoL). Objective: to assess the effects of geriatric-assessment (GA)-driven interventions on QoL over 2 years in older adults with HNC.EGeSOR was a randomized study of HNC patients aged ≥65, receiving a pretreatment GA, a geriatric intervention and follow-up (intervention) or standard of care (control). The primary endpoint was QoL score using the European Organisation for Research and Treatment of Cancer's (EORTC QLQ-C30) and HNC (QLQ-HN35) QoL questionnaires over 24 months.In total, 475 patients were included (median age: 75.3; women: 31%; oral cancer: 44%). QoL scores improved over 24 months with various trajectories, without significant differences between the groups. A total of 74% of patients (interventional group) did not receive the complete intervention. Cancer characteristics, functional status, and risk of frailty were associated with change in the Global Health Status QoL score.There is a need to develop an alternative model of implementation such as patient-centered health-care pathways. TRIAL REGISTRATION:NCT02025062.

This systematic review aimed to evaluate the surgical techniques used for orbital floor reconstruction after Brown class III maxillectomy for cancer. Three databases were searched from January 1990 to January 2022. Of the 614 studies identified, 20 were retained after eligibility assessment. The surgical techniques were classified into four groups: free bone flaps (A), alloplastic implants (B), bone grafts (C), and soft-tissue reconstructions (D). Ectropion and diplopia concerned 42.6% and 6.6% of the patients, respectively. Soft tissue reconstruction was more likely to cause ectropion (17/27), followed by the reconstruction techniques of group B (34/79), group C (26/70), and group A (1/7). Postoperative enophthalmos was identified in 18 patients (9.6%), mostly in group D (5/35), followed by groups B (8/68), A (3/33), and C (2/52). Free bone flaps and alloplastic implants represent good reconstructive options in terms of postoperative ocular parameters.

This study assesses the efficacy of Geriatric Assessment (GA)-driven interventions and follow-up on six-month mortality, functional, and nutritional status in older patients with head and neck cancer (HNC). HNC patients aged 65 years or over were included between November 2013 and September 2018 by 15 Ear, Nose, and Throat (ENT) and maxillofacial surgery departments at 13 centers in France. The study was of an open-label, multicenter, randomized, controlled, and parallel-group design, with independent outcome assessments. The patients were randomized 1:1 to benefit from GA-driven interventions and follow-up versus standard of care. The interventions consisted in a pre-therapeutic GA, a standardized geriatric intervention, and follow-up, tailored to the cancer-treatment plan for 24 months. The primary outcome was a composite criterion including six-month mortality, functional impairment (fall in the Activities of Daily Living (ADL) score ≥2), and weight loss ≥10%. Among the patients included (n = 499), 475 were randomized to the experimental (n = 238) or control arm (n = 237). The median age was 75.3 years [70.4–81.9]; 69.5% were men, and the principal tumor site was oral cavity (43.9%). There were no statistically significant differences regarding the primary endpoint (n = 98 events; 41.0% in the experimental arm versus 90 (38.0%); p = 0.53), or for each criterion (i.e., death (31 (13%) versus 27 (11.4%); p = 0.48), weight loss of ≥10% (69 (29%) versus 65 (27.4%); p = 0.73) and fall in ADL score ≥2 (9 (3.8%) versus 13 (5.5%); p = 0.35)). In older patients with HNC, GA-driven interventions and follow-up failed to improve six-month overall survival, functional, and nutritional status.

Metastasis of the oral cavity is a rare condition and should be investigated for a primary tumor in the lungs, breast, kidney and prostate. Involvement of the mandibular condyle frequently mimics TMJ dysfunction with pain, swelling and limitation of mouth opening. We report the case of atypic TMJ dislocation as an inaugural sign of condyle metastasis. We also discuss the diagnostic approach by a brief review of the literature.

The sublingual gland flap: surgical technique and indications for the reconstruction of small oral defects Mathilde Malinge, Benoit Piot, Julie Longis, Thanh Thuy Nham, Marine Anquetil, Hélios Bertin 1 Service de chirurgie Maxillo-faciale et stomatologie, CHU de Nantes, 1 place Alexis Ricordeau, 44093 Nantes Cedex 1, France 2 Laboratoire des sarcomes osseux et remodelage des tissus calcifiés (PhyOs, UMR 1238), faculté de médecine, 1 rue Gaston Veil, 44035 Nantes cedex, France

Osteosarcoma (OS) is the most common cancer of bone. Jaw osteosarcoma (JOS) is rare and it differs from other OS in terms of the time of occurrence (two decades later) and better survival. The aim of our work was to develop and characterize specific mouse models of JOS.

Introduction: Central giant cell granuloma (CGCG) is a rare and benign intraosseous lesion that usually occurs in the mandible and the maxilla. It might be aggressive. Nowadays, several treatments exist. Observation: This case report, with a three years follow-up, was about an aggressive and recurring form of CGCG exclusively managed by surgical approach. Comments: Several pharmacologic approaches are possible (intralesional injections of glucocorticoids, administration of calcitonin, alpha-2a interferon, denosumab) and could be an interesting alternative or complement to the surgical management when CGCG is aggressive, recurring, or non resectable. Conclusion: Surgical approach is the gold standard for the treatment of CGCG but sometimes, pharmacologic approaches could be proposed. According to the scientific literature, denosumab appears as a reliable and effective treatment but more prospective studies are needed.

ObjectivesThe aim of this study was to identify the factors responsible for free flap failure, the surgical complications, and the non-oral feeding period in patients treated for an oral squamous cell carcinoma.Materials and methodsThis multicentric study included 215 patients treated by tumour resection with immediate free flap reconstruction for an OSCC between 2010 and 2016. All of the patient medical files were reviewed and the data regarding the patient medical history, the tumour-related features, the surgical procedure, and the postoperative recovery were compiled. A statistical analysis with univariate and multivariate logistic regression was carried out.ResultsThe free flap success rate was 94.4% in our series. A postoperative complication occurred in 101 patients (41%). Minor surgical complications were shown to increase the free flap failure rate (OR 3.32; p=0.04). A major surgical complication was encountered in 48 patients (22.3%), and these were linked to minor surgical complications (OR 2.89; p=0.004) and the use of a tracheostomy (OR 5.76, p=0.002). Conversely, a medical history of high blood pressure had a protective effect (p=0.04). The non-oral feeding rate at the end of the hospital stay was 28.4%, and it correlated with the tracheostomy (p=0.002), as well as the major and the minor surgical complications (p=0.04).Conclusion-clinical relevanceFree flap reconstruction is a safe and reliable technique with head and neck cancer reconstruction. Postoperative care favouring early and safe oral-feeding, and avoiding a tracheostomy can reduce the incidence of surgical complications after OSCC reconstruction.

Introduction: Ameloblastic fibrosarcoma is a rare malignant odontogenic tumor. Over 50% reported cases have histological evidence of ameloblastic fibroma at the same site. The mortality rate of the tumor is 19% and its recurrence rate is 37%, which mandates a total resection along with long-term follow-up. Observation: We present the case of a 14-year-old male diagnosed with ameloblastic fibrosarcoma, who underwent multiple stages of treatments and was followed up over 8 years. The initial management consisted of a total tumor resection with chemoradiotherapy. Then, for bone, soft, mucosal, and dental restoration after resection, mandibular reconstruction with a fibula free flap, onlay iliac graft, iliac graft fixation, facial lipofilling treatments (two), vestibular deepening procedures (two), and implant-supported dental prosthesis were performed. Comments and conclusion: This is the first case reported in the literature for the global management of mandibular ameloblastic fibrosarcoma, from oncological treatment to functional and aesthetic long-term rehabilitation.

OBJECTIVES:The effect of amino-bisphosphonates on osteoblastic lineage and its potential contribution to the pathogenesis of bisphosphonate-associated osteonecrosis of the jaw (BONJ) remain controversial. We assessed the effects of zoledronic acid (ZOL) on bone and vascular cells of the alveolar socket using a mouse model of BONJ.MATERIAL AND METHODS:Thirty-two mice were treated twice a week with either 100 μg/kg of ZOL or saline for 12 weeks. The first left maxillary molar was extracted at the third week. Alveolar sockets were assessed at both 3 weeks (intermediate) and 9 weeks (long-term) after molar extraction by semi-quantitative histomorphometry for empty lacunae, preosteoblasts (Osterix), osteoclasts (TRAP), and pericyte-like cells (CD146). Also, the bone microarchitecture was assessed by micro-CT.RESULTS:Osteonecrotic-like lesions were observed in 21% of mice. Moreover, a decreased number of preosteoblasts contrasted with the increased number of osteoclasts at both time points. In addition, osteoclasts display multinucleation and detachment from the endosteal surface. Furthermore, the number of pericyte-like cells increased at the intermediate time point. The alveolar bone mass increased exclusively with long-term ZOL treatment.CONCLUSION:The severe imbalance between bone-forming cells and bone-resorbing cells shown in this study could contribute to the pathogenesis of BONJ.

PURPOSE: To evaluate the efficiency and toxicity of postoperative brachytherapy (POBT) in the treatment of resectable mobile tongue squamous cell carcinoma.PATIENTS AND METHODS: This was a retrospective single-center study of patients with SSC of the mobile tongue who were treated between August 1992 and June 2013 by glossectomy and neck dissection followed by Ir-192 interstitial brachytherapy of the tumor bed. Endpoints were local control, cancer-specific survival (CSS), overall survival (OS), and morbidity. Independent prognostic factors were analyzed in a Cox regression model.RESULTS: A total of 112 patients were identified (median age, 55 years [range, 15-84]; 76% male). Patient and tumor characteristics were: T1T2N0 (85%), pN+ (13%), positive surgical margins (14%), negative margins <5 mm (29%), dysplasic margins (14%), lymphatic vessel invasion (5%), and perineural spread (5%). Median followup was 6.7 years (1.5 months to 17.7 years). Local control, CSS, and OS rates at 2 years were 79%, 81%, and 72%, respectively. The corresponding 5-year rates were 76%, 67%, and 56%, respectively. After POBT, 22% of patients presented grade >= 2 necrosis and 8% experienced chronic pain. Independent prognostic factors were positive surgical margins for poor local control and tumor recurrence and lymphatic vessel invasion for poor OS.CONCLUSION: POBT provided good local control and better CSS and OS than reported for surgery alone. Morbidity was higher than that reported for brachytherapy alone but may be considered acceptable in a well-selected patient population at high risk of local recurrence. (C) 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Infiltrating squamous cell carcinoma (SCC) of the lower lip is a highly curable cancer. We retrospectively analyzed oncologic, functional, and cosmetic outcomes after interstitial low‐dose rate brachytherapy at 58 Gy (50–62) of lower lip SCC treated in our institution.

BACKGROUND:The aim of this study was to identify factors predicting poor prognosis at the time of early oral tongue carcinoma diagnosis. METHODS:A retrospective cohort study was carried out on 70 patients with T1 or T2 squamous cell carcinoma of the mobile tongue treated with primary surgical treatment. RESULTS:In all, 47% of patients received adjuvant treatment. Local recurrence was observed in 29% and regional recurrence in 26%. With a median follow-up of 7.3 years for living patients, 5-year actuarial overall, disease-specific, and disease-free survival rates were 48%, 61%, and 42%, respectively. The presence of poor histological differentiation increased the overall risk of death. Tumor thickness and posterior lingual location independently increased overall and disease-specific risk of death. Concurrent or previous diagnosis of oral lichen significantly increased the risk of disease-specific death and disease recurrence. CONCLUSIONS:This study corroborates several known prognostic factors and indicates that diagnosis of oral lichen planus may be a risk factor for disease recurrence.

An 11-year-old boy was referred to our department for persistent and severe pain in his first right mandibular premolar. There were no local or general signs of infection or parodontopathy. The mother described recurrent episodes of gum swelling and moderate bleeding in the right mandibular molar region for the preceding 5 months. The general practitioner had noticed gum edema, without obvious correlation with the intensity of pain described by the child. An orthopantomogram showed no apical lesions. The maxillary canines were missing, and the mandibular canines were peg-shaped and hypoplasic (Fig 1).