Dental Health Solutions, Inc., USA
Background: The purpose of this study was to assess the effect of free-flap reconstruction of patients with advanced stage IV oral squamous cell carcinoma following ablative tumor resection.The purpose of this study is to elucidate the reconstructive indications of the use of simultaneous double free flaps in head and neck oncological surgery.
Method: The study was based on a restrospective cohort of 76 patients with pathological stage IV OSCC patients (without distant metastasis) treated by tumor ablation with free flap reconstruction.Of the 76 patients, 49 (Group 1, Test) underwent surgical reconstruction with microvascular tissue transfer and in 27 (Group 2, Control) only local or regional flaps were used. Fibula osteo-cutaneous free flap was used in association with forearm free flap in 18 cases, fibula osseous-forearm in 7 cases, fibula osseo-usrectus abdominis in 1 case, iliac crest-forearm in 1 case. Forearm free flap was used for intra-oral reconstruction in all cases. We compared patient survival and cancer recurrence rates between these two groups.
Result: Despite the unfavorably expected prognosis in group 1, both positive margin rate (12.2% in Group 1 versus 21.5% in Group 2, P = 0.112) and cancer recurrence rate (26.6% in Group 1 versus 28.3% in Group 2; P = 0.671) were not significantly different between the two groups. At the end of the follow-up period, 23 (47%) and 33 (67.3%) patients had died of oral squamous cell carcinoma in the microvascular reconstructive and control group, respectively. In the free-flap group, the mean and median survival time was 54 months. In the locoregional flap group, the mean and median survival time was 51 months respectively. No difference was seen in the survival time between the free-flap and local flap groups (P = .2). Univariate Kaplan-Meier analysis revealed that positive surgical margins were significantly associated with shortened survival in the free-flap group and that recurrence was significant in both reconstructive groups. On multivariate Cox regression analysis, the status of the resection margin (P = .05) and tumor recurrence (P < .0004) showed a significant relationship with survival.
Conclusion: Patients with free-flap reconstruction of surgically created defects after oral cancer resection showed a trend toward better 5-year survival.Simultaneous free flap reconstruction, in massive oro-mandibular defects, represents in some selected patients, a good choice to achieve satisfactory aesthetic and functional results.
Dr. Jimmy Kayastha, is a Consultant in Oral and Maxillofacial Medicine and Surgery at Dental Health Solutions Inc., San Francisco, California. He served as the Director for Advanced Education in General Dentistry Residency program at the Marshfield Clinic, Wisconsin. He was appointed Adjunct Clinical Faculty at Case Western Reserve University and Miami Valley Hospital, Ohio. He earned his doctorate from Nova Southeastern University, Florida. He completed his General Practice Residency at Miami Valley Hospital and Oral Medicine Residency at Carolinas Medical Center. He then completed a Fellowship from the Cleveland Clinic and Orofacial Pain Fellowship at Walter Reed National Military Medical Center, Maryland and Glasgow Dental Hospital, United Kingdom. He is an internationally recognized speaker has captivated medical and dental professionals worldwide to motivate real change. He has had scientific publications in the Journal American Medical Informatics Association, Journal American Dental Association and Journal of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology.
Oxford Dental Associates, Inc., USA
Description: Advances in regenerative therapy utilizing bone replacement grafts, guided tissue regenerative tissue techniques and guided bone regeneration has revolutionized the preparation of sites for future dental implant placement. This program will provide a brief evidence-based update of regenerative materials that can be used on a daily basis to predictably regenerate sites for implant installation. It will provide the attendee with information that will be invaluable for decision making and treatment planning of patients with advanced disease or significant morphologic defects.
After attending this program the attendee should be able to:
1) Recognize the indications for advanced regenerative procedures
2) Appreciate the variety of modalities available to address severe osseous problems around teeth or edentulis ridges
3) Understand some different grafting options and materials
4) Recognize the benefit of regenerative procedures for enhancement of restorative outcomes
Dr. Gregory E. Oxford is a board certified dental surgeon who has a clinical as well as research background and has authored and delivered numerous reports on both clinical and scientific aspects of dentistry. A recognized expert and lecturer in the field of periodontology of national and international acclaim, he was the 1998 recipient of the prestigious American Association for Dental Research (AADR) Periodontal Research Award, the Bill Clark Research Fellowship, as well as a recipient of the American Academy of Periodontology (AAP) Partners in Practice Periodontal Research Award. He is also a past President of the Florida Association of Periodontists, Trustee to the American Academy of Periodontists and a recipient of a Navy Clinical Excellence Award. Dr. Oxford acts a consultant for several companies as well as the University of Florida and State of Florida Board of Dentistry. Dr. Oxford maintains a private practice limited to periodontics, implant and surgical dentistry in St. Augustine, FL where he resides.