Survival of Patients with Floor of Mouth Squamous Cell Carcinoma Treated with Surgical Resection and Reconstruction

To identify predictors of survival in patients with floor of mouth Squamous Cell Carcinoma (FOMSCC) in order to improve patient selection for resource intensive resection and reconstruction procedures. A retrospective record review of patients who underwent resection and reconstruction for FOMSCC at Charlotte Maxeke Johannesburg Academic Hospital. Patient data were collected and analyzed with respect to age, sex, race, tobacco usage, alcohol usage, tumour stage and post-operative chemo-radiation. One- and five-year recurrence and survival rates were also evaluated. Within the study period, 20 patients were identified that were treated with resection and reconstruction for FOMSCC. The mean age at diagnosis was 56.85 years, with 70 percent of the sample being male and fifty percent being black. Amongst the sample, 90 percent of patients used tobacco and 60 percent were frequent alcohol users. The most common stage at diagnosis was stage IVA which was found in 40 percent of the sample. There were no significant factors associated with recurrence at 1 year. At 5 years, alcohol usage was a significant predictor of recurrence (P=0.044).There were no significant factors associated with death at 1 year however tumour stage at 5 years was a significant predictor (P=0.035). Out of 20 patients, five patients had recurrence. Total person-time was 72.9 person-years, with a mean follow-up time of 3.65 (SD 2.04) years per person. Out of 20 patients, nine patients died within 5 years (45%). Alcohol was the only statistically significant factor associated with increased mortality. Our findings suggest earlier diagnosis, and active treatment of early stage disease may be the best means of improving 5-year survival rates. Efforts to improve quality of care and manage limited resources should concentrate on choosing the appropriate disease stage for surgical management, improve cancer surveillance and strengthen referral system so as to improve early detection of disease and provide, social support and counselling for adjunctive habits such alcohol and tobacco use cessation which will improve patient outcomes.

Gardner-associated fibroma presenting as an unusual floor of mouth mass in a child

Floor of mouth lesions in the paediatric population are uncommon. The spectrum of pathology that afflicts the floor of mouth spans inflammatory conditions, developmental anomalies, vascular malformations and benign tumours or malignancies. We report a rare case of Gardner-associated fibroma (GAF) presenting as a slow-growing floor of mouth mass in a 10-year-old boy. GAF is associated with Gardner’s syndrome (GS) and familial adenomatous polyposis (FAP), both of which are associated with multiple colonic polyps and increased risk of colorectal malignancy. To our knowledge, this case report represents the first case in the literature of a GAF presenting in the floor of mouth of a paediatric patient, and discusses the clinical implications of this rare diagnosis.

The mandible

The mandible is the largest of the facial bones, occupying a prominent position upon and providing the foundation for the lower third of the face. Despite holding the honour of being the strongest bone in the face, its protrusive location makes it vulnerable to injury – particularly in relation to aggressively placed fists, steering wheels and concrete. Anatomically, the mandible consists of a symmetrical, horseshoe shaped body continuous with paired broad rami posteriorly. The former houses the lower teeth within the alveolus whilst the latter provides attachment for the four principle muscles of mastication from the its medial and lateral surfaces and coronoid and condylar processes. In addition to the aforementioned muscles of mastication, the mandible provides origin to the muscles of the tongue, the floor of mouth and some muscles of facial expression.

Parachute Technique for Head and Neck Free-Flap Inset

The treatment outcome of advanced squamous cell carcinoma involving the head and neck is well known to be dire and usually needs multimodality treatment even including optimal reconstruction after ablative surgery. When a significant area of the soft tissue is resected, reconstruction of oral cavity or pharynx needs to minimize morbidities while achieving adequate functional outcomes. For the better functional outcome, invasive approaching procedures such as lip and jaw splitting, or extensive floor of mouth or pharyngeal muscle ablation should be avoided. Without these surgical procedures, reconstructive surgeons may encounter technical difficulties in flap inset due to deep and narrow space after head and neck cancer resection. In a deep and narrow surgical defect, accurate approximation and suture is extremely difficult. Eventually, repeated flap manipulation and stretch might be inevitable, and even pedicle kinking or injury could happen. Herein, we suggested the “parachute” technique, which was generally used in blood vessels or aortic valve suturing in a narrow surgical field and for avoiding mismatched suture. We applied this “parachute” technique for free-flap inset to head and neck defect, and we herein report our successful outcomes.

Fractures of the mandible

The mandible forms the lower face and supports the teeth, the diaphragm of the floor of mouth, and the mobile tongue. It articulates with the skull base via the temporomandibular joints and is controlled by the muscles of mastication. Fractures of the mandible are common and require accurate reduction and stable fixation, particularly in the dentate patient. The anatomy, pathology, and management of mandible fractures are described in this chapter.