Maxillary Squamous Cell Carcinoma Research Articles

Challenges in Managing Post-Radiation TMJ Pseudoankylosis.

This study demonstrates the outcomes of post-radiation temporomandibular joint (TMJ) pseudoankylosis management and its challenges. A rare maxillary squamous cell carcinoma was treated with subtotal maxillary resection. Subsequent radiation therapy, failure of free flap reconstruction, and 1 year of jaw hypomobility instigated TMJ pseudoankylosis with a maximal mouth opening (MMO) of less than 5mm. Bilateral coronoidectomy was done simultaneously with maxillary reconstruction, followed up with buccal fibrosis release and extensive jaw exercises. At 16 months of follow-up, the patient's MMO was 20mm. Although bilateral coronoidectomy released the attachment of the atrophic temporalis muscle, it did not correct the other causes of trismus, specifically the progressive fibrosis of masticatory muscles, loss of elasticity of the TMJ ligaments, and other soft tissue abnormalities. Radiotherapy-induced-trismus refractory to physical exercise may require further management to achieve satisfactory MMO.

Survival Outcomes and Patterns of Failure in Maxillary Alveolus Squamous Cell Carcinoma.

Introduction Squamous cell carcinoma (SCC) of the maxillary alveolus is a relatively rare disease. There is lack of data on this subsite as compared with other sites. The factors that affect survival in cases of maxillary alveolar SCC are tumor stage, local and cervical metastases, histological grading, and the margin status. Objectives To evaluate the overall survival (OS), the disease free survival (DFS), and the complex interaction and effects of margin status, histological differentiation, habits (such as smoking and the use of smokeless tobacco products), and cervical and distant metastases based on clinicopathological data. Methods We examined the electronic database at our hospital from 2003 to 2017. We included all cases with a histopathological diagnosis of SCC of the maxillary alveolus. Tumors originating primarily from the maxillary alveolus were included, while those originating from adjacent subsites, like the hard palate, the buccal mucosa or the maxillary sinus were excluded. We also excluded all the patients who were not operated on with a curative intent. Results More than half of the patients had stage-IV tumors at the time of presentation, while only one fourth of them had nodal metastasis. The rate of recurrence increased in cases of primary tumors in advanced stages and the degree of histological differentiation. The 2-year and 5-year OS rates were of 54.5% (18 patients) and 30.3% (10 patients) respectively. Conclusion Primary tumors in advanced stages, histological grade, and presence of nodal metastasis are poor prognostic markers in terms of long-term survival.

Maxillary neoplasms in four dromedary camels.

Four camels (Camelus dromedarius) presented to the Veterinary Teaching Hospital at King Faisal University with maxillary masses. On radiographs, the masses were multicystic and expanded the maxillary bone. The tumors were diagnosed by histopathologic examination as conventional ameloblastoma, two cases as intraosseous squamous cell carcinoma, and central odontogenic fibroma with ossification. To the authors' knowledge, this is the first report of ameloblastoma in a camel, the first detailed description of maxillary squamous cell carcinoma in camels, and the first report of central odontogenic fibroma in any animal species.

Occult metastases of oral maxillary squamous cell carcinoma: Systematic review and meta-analysis.

Squamous cell carcinoma (SCC) is the most common malignant neoplasm of the oral cavity. The performance of END (elective neck dissection) in cases of maxillary SCC is controversial because the literature traditionally classified maxillary tumors as having low metastatic potential. The aim of this systematic review and meta-analysis was to determine the percentage of occult cervical metastases in maxillary SCC to identify in which cases there is the need to perform an END. We searched the PubMed database to select articles dated from 2000 to 2020 that fulfilled our inclusion criteria; finally, we reviewed 27 manuscripts. We show that the overall cervical and occult metastases rate was 35% and 19%, respectively. For T1, the percentage of occult metastasis rate was 11%; for T2, it was 16%; for T3, it was 20%; and for T4, it was 32%. We suggest END (levels I-II-III) as treatment to T3/T4 cN0 patients.

21. Treatment of the cN0 neck in Oral Maxillary Squamous Cell Carcinoma: A retrospective analysis of our experience at a regional centre

Unlike other oral cavity subsites, the management of the cN0 neck in oral maxillary squamous cell carcinoma (MSCC) can vary. Valid options include surveillance, radiotherapy (RT) and elective neck dissection (END) with/without post-operative radiotherapy (PORT). Studies have shown that nodal metastasis in MSCC may behave as predictably as other oral cavity subsites, thus greater consensus is needed. We present our experience of the management of the cN0 neck in patients with cT1-4N0M0 MSCC.

Rehabilitation of Aramany Classification I Defect on a Completely Edentulous Patient: A Clinical Case Report.

Abstract: This clinical case report describes a prosthetic rehabilitation for a patient who had partial maxillectomy surgery following the diagnosis of maxillary squamous cell carcinoma in 1991. She was also previously diagnosed with parotid gland pathology on the right and required complete removal of gland along with facial nerve. Her previous prosthesis is 18 years old and claims it not as retentive as before. Intraorally there was a large oval shaped defect on the right side of the maxilla sparing the left alveolus. Defect extends more than 2/3rd of the palatal area with communication to the nasal floor. Presence of buccal frenal pull on the right side on the upper and lower jaws due to the wound contracture on that side of the face. The extraoral facial asymmetry and weakness of facial muscles in this patient may lead to improper denture border seal of the prosthesis. Patient was provided with maxillary acrylic obturator and mandibular acrylic complete denture as a definitive treatment with careful denture extension planning. She was reviewed multiple times till prosthesis stability intraorally was achieved. This improved the prognosis for this patient. The only option for retaining prosthesis in this case, without implants, is optimum engagement of the available soft-tissue undercuts found within the defect space and the non-affected side. Keywords: Completely Edentulous, Obturator, Facial Nerve, Prognosis, Case Report.

Clinico-Epidemiological Study of Maxillary Squamous Cell Carcinoma Cases with Infiltration of The Base of The Skull and/or The Orbit

Clinico-Epidemiological Study of Maxillary Squamous Cell Carcinoma Cases with Infiltration of The Base of The Skull and/or The Orbit

Value of cone beam computed tomography for detecting bone invasion in squamous cell carcinoma of the maxilla

To determine the diagnostic value of cone beam computed tomography (CBCT) in detecting bone invasion in maxillary squamous cell carcinoma (MSCC). In this retrospective cohort study, preoperative CBCT scans were independently assessed by a single surgeon in imaging assessment 1 (IA 1) and by 1 surgeon with 2 dentists in consensus (IA 2) for the presence of bone invasion in MSCC. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, area under the receiver operating characteristic curve (AUC), and Cohen's κ were calculated. Histopathologic results of resection specimens served as the reference standard. Of 27 patients, 19 (70%) had proven bone invasion. IA 1 yielded 68.4% sensitivity, 75.0% specificity, 86.7% PPV, 50.0% NPV, 70.4% accuracy, and 0.717 AUC. All results of IA 2 were true-positive and true-negative, resulting in 100% sensitivity, specificity, PPV, NPV, accuracy, and AUC. The assessments differed in 6 cases. Interobserver κ was fair (0.38, 95% CI 0.04-0.72, P=.038). There was a significant association between CBCT detection of bone invasion and extent of surgical treatment (P=.006) CONCLUSIONS: The diagnostic accuracy of CBCT was high but observer-dependent. CBCT examination may be useful in surgical treatment planning.

A retrospective study of oral maxillary squamous cell carcinomas treated from 2008-2018

<b>Introduction:</b> Controversy exists regarding the management of the clinically node negative neck (cN0) in maxillary or gingival squamous cell carcinoma (MGSCC). This study reviews cN0 MGSCC patients over a 10-year period to record the method of neck management and outcome. <b>Methods:</b> Theatre and pathology records were searched for patients diagnosed and treated for site specific cN0 MGSCC from 2008-2018. The Fisher's exact test was used for comparative analysis and survival statistics calculated using the Kaplan–Meier method and log-rank test. <b>Results:</b> 15/36 of patients had an END and 21/36 underwent observation following primary surgery. Included in these 21 patients, 5 underwent vessel access for flap anastomosis with node sampling. 13/36 of patients received PORT. The total recurrence rate was 15/36; 5/15 local, 8/15 regional and 2/15 with locoregional. Regional recurrence was similar in observed patients 5/21 compared to those who had an END 3/15. 8/15 of patients with recurrence underwent salvage surgery. Salvage rates were 3/7 in patients who received PORT and 5/8 without, with success in 2/3 and 4/5 respectively. <b>Conclusions:</b> END 5- year disease specific survival (DSS) (67%) was similar to observed patients (65%) although those with vessel access had a 80% DSS (p=0.87). pT4a END patients had a higher 5- year DSS versus observation only patients (56% vs 44%) (p=0.53). Bone invasion was significant to RL (p= 0.05). There was no advantage to having an END for the N0 neck in MGSCC and control was also achieved with a ‘watch and wait' policy followed by salvage if required.

Management of sinonasal cancers: Survey of UK practice and literature overview

IntroductionSinonasal malignancy is a rare and heterogenous disease, with limited evidence to guide management. This report summarises the findings of a UK survey and expert workshop discussion which took place to inform design of a proposed UK trial to assess proton beam therapy versus intensity-modulated radiation therapy. MethodA multidisciplinary working group constructed an online survey to assess current approaches within the UK to surgical and non-surgical practice. Head and neck clinical oncologists, ear nose and throat (ENT) and oral-maxillofacial (OMF) surgeons were invited to participate in the 42-question survey in September 2020. The Royal College of Radiologists Consensus model was adopted in establishing categories to indicate strength of response. An expert panel conducted a virtual workshop in November 2020 to discuss areas of disagreement. ResultsA survey was sent to 140 UK-based clinicians with 63 responses (45% response rate) from 30 centres, representing a broad geographical spread. Participants comprised 35 clinical oncologists (56%) and 29 surgeons (44%; 20 ENT and 9 OMF surgeons). There were variations in preferred sequence and combination of treatment modalities for locally advanced maxillary squamous cell carcinoma and sinonasal undifferentiated carcinoma. There was discordant surgical management of the orbit, dura, and neck. There was lack of consensus for radiotherapy in post-operative dose fractionation, target volume delineation, use of multiple dose levels and treatment planning approach to organs-at-risk. ConclusionThere was wide variation across UK centres in the management of sinonasal carcinomas. There is need to standardise UK practice and develop an evidence base for treatment.

Assessment of the Transoral Maxillectomy

Abstract Background: Head and neck cancer accounts for 17% of all cancer cases and could affect functions such as swallowing, phonation, breathing, aesthetics and the individual's quality of life. Aim of Study: To assess the transoral approach for maxil-lectomy in selected cases of cancer maxilla. Patients and Methods: The study included patients who were diagnosed to have maxillary carcinoma after the endo-scopic biopsy. The transoral approach was used for maxillec-tomy in all cases. Then, the patients were followed-up for 5 years. Results: Within the included eleven patients with maxillary squamous cell carcinoma, transoral maxillectomy could be performed without the need for any skin incision. No uncon-trollable epistaxis, orbital injury, septal perforation, postop-erative fistula, skin necrosis, vestibular stenosis or granulation was observed. Recurrence of the tumor was detected in one case only (9.1%) throughout the follow-up. Conclusion: The transoal approach for maxillectomy can be considered as a reliable and safe approach for selected cases of cancer maxilla. So, it should be incorporated into the oncological and maxillofacial surgeon's surgical armamentar-ium to avoid external incisions.

Systematic review and meta-analysis of cervical metastases in oral maxillary squamous cell carcinoma.

BackgroundManagement of the node‐negative neck in oral maxillary squamous cell carcinoma (SCC), encompassing the hard palate and upper alveolar subsites of the oral cavity, is controversial, with no clear international consensus or recommendation regarding elective neck dissection in the absence of cervical metastases.AimTo assess the occult metastatic rate in patients with clinically node negative oral maxillary SCC; both as an overall metastatic rate, and a comparison of patients managed with an elective neck dissection at index surgery, compared to excision of the primary with clinical observation of the neck.Methods and resultsA systematic review was performed by two independent investigators for studies relating to oral maxillary SCC and analysed according to PRISMA criteria. Data were extracted from Pubmed, Ovid MEDLINE, EMBASE, and SCOPUS via relevant MeSH terms. Grey literature was searched through Google Scholar and OpenGrey. Five hundred and fifty‐three articles were identified on the initial search, 483 unique articles underwent screening against eligibility criteria, and 29 studies were identified for final data extraction. Incidence of occult metastases in patients with clinically node negative oral maxillary SCC was identified either on primary elective neck dissection or on routine follow up. Meta‐analyses were performed. Of 553 relevant articles identified on initial search, 29 were included for analysis. The pooled overall rate of occult metastases in patients initially presenting with clinically node‐negative disease was 22.2%. There is a statistically significant effect of END on decreasing regional recurrence demonstrated in this study (RR 0.36, 95% CI 0.24, 0.59).ConclusionThe results of this systematic review and meta‐analysis suggest elective neck dissection for patients presenting with hard palate or upper alveolar SCC, even in a clinically node negative neck.

Squamou Cell Carcinoma Maxillary Sinus: A Case Report

Carcinoma maxilla is generally an aggressive tumor, most commonly seen in elderly population. The disease has a high correlation with alcohol and tobacco consumption. Here we present a case of 55 years female with swelling in right cheek and right side nasal obstruction for last 8 month. Biopsy of the specimen confirms the diagnosis of squamous cell carcinoma of maxilla. Symptoms of maxillary sinus carcinoma can be nonspecific and may delay the diagnosis of same. This clearly draw the attention of careful history and detail physical examinations of suspicious cases for the timely management of the same.

Does the Brown classification of maxillectomy defects have prognostic prediction for patients with oral cavity squamous cell carcinoma involving the maxilla?

The aim of this study was to investigate the correlation between the maxillectomy defect, T stage, and prognosis of patients with maxillary squamous cell carcinoma (SCC). The Brown classification system was used to appraise the maxillectomy defects due to maxillary SCC. The clinical data of 137 patients with maxillary SCC during the period 2000–2010 were reviewed; 105 patients were followed up. Preoperative T stage and postoperative maxillectomy class were recorded. The relationship between the maxillectomy defect class and T stage of maxillary SCC was analysed. Correlations between the maxillectomy defect class, local recurrence rate, and survival rate were assessed using IBM SPSS Statistics v19.0. The most common maxillectomy defect class was IIb (54.7%, 75/137). The maxillectomy defect class was significantly associated with the T stage (P < 0.001). Both T stage and the maxillectomy defect class were significantly associated with the survival rate of patients with maxillary SCC (both P< 0.001). In conclusion, the class of the maxillectomy defect was found to be associated with the T stage. Both of these were prognostic factors for patients with maxillary SCC. The class of the maxillectomy defect is suitable for clinical application in predicting the prognosis compared with T stage.

ANALYSIS OF EXPRESSION OF P63 AND CASPASE-3 AND THEIR PREDICTIVE VALUE IN PATIENTS WITH SQUAMOUS CELL CARCINOMA OF MAXILLARY SINUS

Introduction: Maxillary sinus cancer is a malignant neoplasm with a prevalence of 3 to 5% of tumors in the head and neck and less than 1% of all malignant neoplasms. The role of p63 and caspase-3 and their predictive value in squamous cell carcinoma of maxillary sinus (SCCMS) remains an underdeveloped and controversial issue that determined the relevance of the study. The aim: To analyze the relationship between the level of expression of p63 and caspase-3 and clinical and morphological characteristics of squamous cell carcinoma of maxillary sinus and to determine their prognostic significance as immunohistochemical markers of tumor progression (relapse and metastases). Materials and methods: A comprehensive investigation with immunohistochemical study of squamous cell carcinoma of maxillary sinus of 103 patients with maxillary sinus cancer II - IV stage (T2-4 N0-3 M0) of the second clinical group was conducted. Results: The moderate and high expression rate of caspase-3 in the overall sample was 50.49% and 16.50% respectively, and one third of cases (33.01%) was characterized by a weak reaction. In the group without metastases (p <0.001), moderate expression of the marker (56.25%) prevailed; in the SCCMS group with metastases it was (60.87%). The mean level of expression of p63 in the examined patients with squamous cell carcinoma of maxillary sinus was 46.0%. The number of p63-positive specimens was statistically significantly (p = 0.034) higher in the SCCMS group with metastases. In patients with the development of squamous cell carcinoma of maxilla on the background of papilloma, a significantly higher (p <0.001) mean level of p63 expression was only moderate (90.91%) and high (9.09%). Conclusions: There was observed a relatively strong associate of the increase in the expression of caspase-3 with SCCMS metastases (p <0.001) and no correlation of immunohistochemical reaction of this marker with relapses. There was determined that the probability of metastases at high expression level of p63 is higher than in tumors with low and moderate level of the oncoprotein (p = 0.003). Based on the level of expression of p63, it is possible to predict the likelihood of development of SCCMS with papillomas (p <0.001); and the development of relapses of squamous cell carcinoma of maxillary sinus (p <0.001).

Application of a Lateral Pedicled Cranial Bone Flap for the Treatment of Secondary Zygomaticomaxillary Defects.

This study aimed to evaluate the effect of laterally-based pedicled cranial bone flap (LBPCBF) for the repair of secondary zygomaticomaxillary defects. Between December 2014 and December 2016, 6 patients with unilateral zygomaticomaxillary defects were selected; of these, 5 had trauma, and 1 was exposed to titanium mesh in the infraorbital area due to radiotherapy following total maxillectomy for right maxillary squamous cell carcinoma. Preoperatively, 3 patients suffered from an intraoral vestibular groove fistula, 2 suffered from an extraoral fistula, and 1 from local exposure of titanium mesh. Surgical treatment was implemented in all 6 patients, of which, the 5 trauma patients underwent debridement, reduction, and fixation of periorbital fracture, followed by repair of the defects in the infraorbital margin, anterior wall of maxillary sinus, and zygomatic body with LBPCBF, and then, reconstruction of the orbital floor with titanium mesh. The other patient with exposed titanium mesh underwent repair of defects in the infraorbital margin and anterior wall of the maxillary sinus with LBPCBF after titanium mesh trimming. Postoperative review at 6 months revealed disappearance of intraoral fistula, wound healing, and improvement of facial deformity in all 6 patients, of which 2 patients demonstrated postoperative ectropion. The application of LBPCBF can simultaneously repair bone defects in the infraorbital margin, anterior wall of maxillary sinus, and zygomatic body, as well as, supplement the soft tissue, thereby indicating a satisfactory treatment effect.

Should an elective neck dissection be performed for maxillary sinus squamous cell carcinoma?

Should an elective neck dissection be performed for maxillary sinus squamous cell carcinoma?

Increased p16CDKN2A, but not p53, immunostaining is predictive of longer survival time in cats with oral squamous cell carcinomas

Although oral squamous cell carcinomas (SCCs) are common in cats there are currently few prognostic markers for these cancers. This study used 52 feline oral SCCs to determine if prognosis can be predicted by the age or sex of the cat, the presence of bone within the diagnostic sample, or the anatomic location of the SCC. Additionally, as p16CDKN2A protein (p16) and p53 are prognostic for human oral SCCs, p16 and p53 immunostaining was evaluated.Only SCC location and p16 immunostaining were prognostic. Cats with oropharyngeal SCCs had an estimated median survival time (MST) of 151 days which was significantly longer than cats with maxillary (51 days P = 0.017), sublingual (33 days P = 0.011) and mandibular (34 days P = 0.029) SCCs. Overall, 19% of oral SCCs were p16-positive with intense nuclear and cytoplasmic immunostaining within most neoplastic cells, 69% had cytoplasmic immunostaining that was confined to the periphery of nests of neoplastic cells, and 12% had no p16 immunostaining. Cats with p16-positive SCCs had a MST of 87 days, which was significantly longer than cats with p16-peripheral SCCs (MST 37 days, P = 0.03), but not longer than cats with p16-negative SCCs (MST 51 days, P = 0.72). No papillomaviral DNA was amplified from the p16-positive SCCs. Twenty (39%) SCCs contained immunostaining for p53, but this was not prognostic (P = 0.31). These results suggest that feline oral SCCs develop by cellular mechanisms that result in one of three patterns of p16 immunostaining. Cancers which develop due to these mechanisms appear to have different clinical behaviors and p16 immunostaining predicts the behavior of these common feline cancers.

Sinonasal adenocarcinoma with aggressive ocular symptom

Abstract BACKGROUND. The malignant sinonasal tumour is very rare. Sinonasal adenocarcinoma comprises only 10-20% of all primary malignant sinonasal tumours. The commonest type is the maxillary squamous cell carcinoma. It commonly presents with nasal blockage, nasal discharge and epistaxis during the early stage. Headache and blurry vision may occur at an advanced stage when it has invaded the brain, the eye or the optic nerve. CASE REPORT. We present a 63-year-old patient with acute progressive worsening unilateral blurry vision and headache for 1 month. Epistaxis with anosmia developed only later. The patient had a neuroimaging by both Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) scan which showed a skull base tumour, but early biopsy was inconclusive. He underwent combined transcranial and transsphenoidal tumor debulking in view of clinical impression of olfactory neuroblastoma. The histopathological examination showed adenocarcinoma. He was sent for postoperative radiotherapy. CONCLUSION. We highlighted that a patient with sinonasal adenocarcinoma may present initially with the symptom of invasion to neighbouring structures prior to the local symptom.

Prognostic factors and treatment outcomes of advanced maxillary gingival squamous cell carcinoma treated by intra-arterial infusion chemotherapy concurrent with radiotherapy.

The aim of this study was to evaluate the prognostic factors and treatment outcomes of advanced maxillary gingival squamous cell carcinoma (SCC) treated with intra-arterial infusion chemotherapy concurrent with radiotherapy. A total of 46 patients were reviewed retrospectively in this study. The treatment schedule comprised intra-arterial chemotherapy (total, 60 mg/m2 docetaxel and 150 mg/m2 cisplatin) and three-dimensional computed tomography based, daily conventional radiotherapy (total, 60 Gy/30 fr) for 6 weeks. The median follow-up period was 40 months (range, 3-110 months). The 3-year overall survival and locoregional control rates for all patients were 64.3% and 84.3%, respectively. The OS rate of the patients with N0-1 was significantly higher than that of the patients with N ≥ 2 (P < .05). No grade 5 toxicities were observed. Intra-arterial infusion chemotherapy concurrent with radiotherapy was effective for advanced maxillary gingival SCC.