Acute side effect of postoperative radiotherapy in malignant head and neck neoplasm]

From August 1989 to May 1991,160 patients with malignancies of the head and neck region were treated by surgery and postoperative radiotherapy.Seventy seven patiens underwent resection of the primary lesion combined with neck dissection and 83 patients had resecton of the primary lesion only before radiotherapy.After irradiation 33.8% (54/160) patients developed edema in face and neck,13.1%(21/160) patients developed headache.The style of neck dissection (unilateral,bilateral or no neck dessection) did significantly influence the rates of the acute side effect(P<0.01).The interval between surgery and radiotherapy and radiation dose were not important influential factors(P>0.05).The clinical manifestations,possible mechanism and prevention of the acuter side effect is presented.     

Low-grade myofibroblastic sarcoma of the piriform fossa: a case report with a literature review of a tumour with a predilection for the head and neck

A low-grade myofibroblastic sarcoma was removed from the pyriform fossa of a 44-year-old man. It recurred 4 years later and was removed radically through an incision in the neck. There has been no further recurrence after 11 years.     

Dental extractions and radiotherapy in head and neck oncology: review of the literature

Management of irradiated patients with cancer in the head and neck region represents a challenge for multidisciplinary teams. Radiotherapy promotes cellular and vascular decrease that results in a low response rate in the healing. Consequently, surgical procedures in irradiated tissues present high rates of complication. Osteoradionecrosis (ORN) is the most severe sequelae caused by radiotherapy. It is associated with previous extractions especially those carried out post-irradiation. The management of this side effect is difficult and can result in bone or soft tissue loss, affecting the quality of life. The literature regarding dental extractions performed before and after head and neck radiotherapy was evaluated, focusing on indications, criteria, surgical techniques and adjunctive therapies such as antibiotics and hyperbaric oxygen. Osteoradionecrosis can be minimized by oral evaluation and care prior to irradiation and healing time which allows tissue repair until the commencement of radiotherapy. In dental extractions realized after irradiation, minimal trauma, alveolectomy, primary alveolar closure and adjunctive therapies are recommended. Patients must be evaluated before radiation therapy and at that time all unrestorable teeth and/or teeth with periodontal problems must be extracted to reduce the post-radiotherapy exodontias that contribute to ORN. Once dental extractions become unavoidable after irradiation, additional care is needed.     

Metastatic renal cell carcinoma presenting as a clear cell tumour in the head and neck region

Renal cell carcinoma (RCC) is the most frequent urological malignancy in adults and has a male preponderance. It accounts for approximately 3% of adult malignancies and 90–95% of neoplasms arising from the kidney. RCC usually metastasizes to lungs, bone and regional lymph nodes but very rarely to the head and neck region. The following report is based on a female patient with a previously undiagnosed RCC, which metastasized and presented as a clear cell tumour in the head and neck region. A histopathological differential diagnosis for clear cell tumours together with the contributing factors that led to the diagnosis of metastatic RCC will be discussed.     

Osteoradionecrosis of the mandible: a review

Background

Osteoradionecrosis is a serious complication of radiotherapy that often leads to severe facial deformity, pain, pathological fracture, sequestration of devitalized bone, and orocutaneous fistulas. Preventive measures for osteoradionecrosis are the best treatment plan to avoid osteoradionecrosis. Radical surgery is indicated when conservative methods fail or when severe bone and soft-tissue necrosis prevails.

Case report

The purpose of this paper is to explore the recent theories about the definition, classification, incidence, and pathophysiology of osteoradionecrosis (ORN) of the jaws. The predisposing and risk factors for the development of osteoradionecrosis based on the literature review along with case report are also discussed.

Discussion

A better understanding on the risk factors responsible for causing ORN and the underlying pathophysiology may improve our ability to prevent this complication and help to improve the prognosis for those being treated for osteoradionecrosis.     

Necrotizing fasciitis of the head and neck: review of the literature and report of a case

Necrotizing fasciitis is a rapidly spreading, life-threatening, bacterial disease. Mortality rates have been estimated to vary between 8.7% and 74%. Mortality depends on many factors, one of which Is early recognition. Necrotizing fasciitis of dental origin has a low prevalence and as such presents diagnostic challenges for the dentist. The literature is reviewed, and a case history Is presented .     

头颈部血管外皮瘤:1例报道及文献复习

报告1例29岁女性左侧咽旁间隙血管外皮瘤病例,并复习头颈部血管外皮瘤的相关文献。头颈部血管外皮瘤发病率低,缺乏特征性临床表现。病理学检查可见紧密排列的肿瘤细胞围绕丰富的不同口径的薄壁血管腔,同时缺乏特异性的免疫标识。广泛切除是治疗血管外皮瘤的有效方法。预后因肿瘤性质不同而有所不同,并存在一定复发率。恶性血管外皮瘤可发生远处转移。婴幼儿(先天性)血管外皮瘤生物学行为良好,局部切除可治愈。     

Interstitial radiotherapy with Ir-192 as a palliative treatment modality in head and neck cancer

In selected patients with advanced head and neck cancer interstitial radiotherapy with Ir-192 can be used as a palliative treatment. Using two cases as examples, we report on our experiences with 19 patients.     

Hypothyroidism after radiotherapy of head and neck cancer

AimHypothyroidism is not commonly considered as a complication of radiotherapy to the head and neck region. The purpose of this retrospective study was to determine the frequency of thyroid dysfunction in patients after radiotherapy, to compare thyroid hormone levels in irradiated patients with Control group and to predict development of thyroid hypofunction in time.Material and methodThyroid function was measured by means of thyroid stimulating hormone (TSH), free thyroxine (FT4) and free triiodthyronine (FT3) in 43 patients who had nonthyroid head–neck carcinomas treated by radiotherapy or radiotherapy in combination with other modalities. These data were compared with hormone levels of 40 Control group patients treated solely by surgery.ResultsHypothyroidism was found in 35% of irradiated patients. In comparison with Control group there were significant differences between TSH and FT4 levels, difference between FT3 levels was insignificant. A correlation between hormone levels and follow-up was detected.ConclusionOur results indicate that hypothyroidism is a frequent late side effect of radiotherapy to head and neck. Lifelong monitoring of thyroid function appears to be justified when radiotherapy is a part of treatment protocol.     

Bisphosphonate-induced osteonecrosis of the jaws: a case report and literature review

Bisphosphonates are nonmetabolized analogues of pyrophosphate that are used for treating skeletal complications secondary to bone metastases. These drugs are capable of localizing to bone and inhibiting osteoclastic activity; however, their exact mechanisms of action remain unclear. Recently, it has been documented that administration of bisphosphonates has been associated with osteonecrosis of the jaws. This article details the case of a woman who received intravenous administration of bisphosphonate for metastatic breast cancer and subsequently developed osteonecrosis in both the maxillary and mandibular jaws.     

Advances in head and neck radiotherapy to the mandible

Management of radiation-exposed bone in the mandible is a dilemma many oral and maxillofacial surgeons must confront and manage. Current advances in radiotherapy techniques using pin-point computerized accuracy in combination with other advances, such as morphed imaging, fractionalization protocols, minimization of scatter, and pretreatment dental examinations, have greatly decreased the late effects of radiation and osteoradionecrosis. The intent of this article is to provide a brief overview of the following topics: radiotherapy physics and radiobiology, effects of radiotherapy on normal tissues, including the pathogenesis of osteoradionecrosis, and advances in contemporary radiotherapy treatment.     

Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment

During the past 80 years a number of theories about the pathogenesis of osteoradionecrosis (ORN) have been proposed, with consequent implications for its treatment. Until recently tissue hypoxia and its consequences were accepted as the primary cause, and this led to the use of hyperbaric oxygen (HBO) for both treatment and prevention of complications of radiotherapy in the head and neck. The benefit of HBO has not been validated. A new theory for the pathogenesis of ORN has proposed that damage to bone is caused by radiation-induced fibrosis. Cells in bone are damaged as a result of acute inflammation, free radicals, and the chronic activation of fibroblasts by a series of growth factors. New treatments have therefore been devised that include pentoxifylline, a vasodilator that also inhibits fibrosis, and tocopherol (vitamin E) to reduce damage caused by free radicals. Impressive results in terms of reversing the process of ONR have been reported using these agents. It has been suggested that this theory and these agents could be the basis of future treatment and prevention of ORN.     

Mucosal malignant melanomas in head and neck surgery: a retrospective study of six patients and review of the literature

Introduction

Of all malignant processes of the oral mucosa, 0.5% are malignant melanomas. Because of late diagnosis, pattern of growth, close proximity to the bone (particularly in palatinal localizations), and the correlated infiltration, malignant melanomas have a bad prognosis.

Patients and methods

In this retrospective study, six cases of patients with oral mucosal malignant melanoma are evaluated, and a critical review of the literature is presented. The female to male proportion was 1:1 with an average age of 60.2 years; all patients were treated between January 1999 and July 2007. A neck dissection was performed on two patients because of clinically positive lymph nodes; one patient received interleukin 2 therapy, and three patients received postoperative radiotherapy. Two male patients died.

Conclusions

We recommend biopsy on every growing lesion, pigmented or nonpigmented, for the required diagnosis and, in cases of malignant melanoma, wide excision as a second step. Neck dissections should be performed in patients with clinically positive lymph nodes. Concerning interleukin 2 therapy, further studies should be performed in order to evaluate a routine application.     

Conformational radiotherapy in cancer of the head and neck: a future perspective

The discovery of X-rays in 1895 by Wilhelm Conrad R?ntgen paved the way to a new scientific epoch in the management of cancer. Today, with the XXI century in sight, radiotherapy has matured and has become one of the mainstays in the management of cancer. Although long-term success with the use of ionizing radiation in cancer treatment can be achieved in about half of our patients, significant improvements in tumor control rates and/or reduction in side effects (i.e. quality of life) are needed. As a future perspective, the authors highlight the gains that can be anticipated from research in the field of 3-D conformal radiotherapy, in particular with regard to sparing critical structures (e.g. parotid glands) in cancers of the head & neck.     

Brown tumor of the jaws as a manifestation of tertiary hyperparathyroidism: A literature review and case report

Brown tumor of the jaws is a manifestation of hyperparathyroidism consisting of osteolytic lesions that show proliferation of multinucleated giant cells in the maxilla and/or mandible. Differential diagnosis of these lesions from local central giant‐cell granuloma is mandatory for the correct treatment of the patient. Radiographic and histopathological exams of the jaw lesion are not sufficient to determine the diagnosis, which requires laboratory tests including serum levels of calcium, alkaline phosphatase, parathyroid hormone (PTH) and phosphate, and radiographic examination of other bones as well, such as hand‐wrist, pelvis, and femur. We present here a brief literature review focusing on the clinical and radiographic features, diagnostic criteria and treatment of brown tumor and also report a case of the disease affecting the jaw.     

Osteoradionecrosis of the jaws: definition,epidemiology, staging and clinical and radiological findings. A concise review

Osteoradionecrosis (ORN) of the jaws is a pernicious complication of radiation therapy for head and neck tumours. This article aims to provide an update on data related to the definition, epidemiology, staging, and clinical and radiological findings of ORN of the jaws. Using certain keywords, an electronic search was conducted spanning the period from January 1922 to April 2014 to identify the available related investigations. Pooled data were then analysed. ORN is described as exposed irradiated bone that fails to heal over a period of 3 months without evidence of persisting or recurrent tumour. The prevalence of ORN varies in the literature. Several staging or scoring systems of ORN have been proposed. Clinical findings include ulceration or necrosis of the mucosa with exposure of necrotic bone. Radiological findings are not evident in the early stages of ORN. Furthermore ORN may not be apparent in imaging even when the disease is advanced. Taking into account the severity of ORN and the difficulties in diagnosing it early and accurately, the clinician should be aware of this complex entity in order to prevent its appearance or the development of more severe complications.