Maxillary Tumor Research Articles

Intraoperative verification of resection margins of maxillary malignancies by cone-beam computed tomography

Resection of maxillary cancer often results in incomplete excision because of the tumour’s proximity to important structures such as the orbit. To deal with this problem we prospectively investigated the feasibility of intraoperative imaging during maxillectomy to verify the planned resection margins. In total, six patients diagnosed with maxillary cancer listed for maxillectomy were included, irrespective of the histological type of tumour. Before resection, an accurate intended resection volume was delineated on diagnostic images. At the end of the operation we took a cone-beam computed tomographic (CT) scan of the treated maxilla, after which the accuracy of the resection was quantitatively evaluated by comparing the preoperative resection plan and the images acquired intraoperatively, based on the anatomy. Further resection was then done if necessary and quantitatively evaluated with a second cone-beam CT scan. Postoperatively we compared the results of the scan with those of the histological examination. Of the six, two resections were reported pathologically as less than radical, each of which was detected by intraoperative CT and resulted in extensions of the original resections. The mean (SD) distance between the planned and the actual resection was 1.49 (2.78)mm. This suggests that intraoperative cone-beam CT imaging is a promising way to make an adequate intraoperative assessment of planned surgical margins of maxillary tumours. This allows for intraoperative resection margins to be improved, possibly leading to a better prognosis for the patient.

Primary vs secondary zygomatic implant placement in patients with head and neck cancer-A 10-year prospective study.

Zygomatic implants can provide excellent remote anchorage to support the prosthetic rehabilitation of patients treated for maxillary and midfacial tumors. Patients who underwent zygomatic implant placement by the author between 2006 and 2016 as part of their oncology treatment were followed prospectively. Forty-nine consecutively treated patients received 131 zygomatic implants of which 9 failed and were removed from 4 patients; 24 patients (49%) received radiotherapy either before or after implant insertion. The overall 12-month survival estimate was 94% and the 60-month estimate was 92%. The use of zygomatic implants in the management of maxillary and midfacial malignancy is a predictable prosthetic treatment modality to support complex oral and facial prostheses. Their use with or without free tissue transfer can provide effective prosthetic rehabilitation with high implant survival irrespective of the timing of placement or the need for adjuvant radiotherapy. Zygomatic Implants provide an excellent platform for the restoration of the dentition and facial structures affected by maxillary and midfacial malignant disease.

Open and endoscopic medial maxillectomy for maxillary tumors – a review of surgical options

It has been the gold standard approach for maxillary tumors to do an open radical maxillectomy. The introduction of endoscopic surgery has provided an alternative method for tumor removal without creating a cosmetically disfiguring scar. We reviewed the literature to describe the open and endoscopic medial maxillectomy for the management of maxillary tumors. This review is based on a selective literature search of the PubMed database, searching for the terms “medial maxillectomy,” “endoscopic medial maxillectomy,” “partial maxillectomy,” “maxillary tumors,” “sinonasal neoplasms,” and “inverted papilloma.” Some older standard publications, textbooks, and our own clinical experience were also included. No language or year of publication restriction was applied. The indication for medial maxillectomy, either open or endoscopic medial maxillectomy is inverted papilloma, a benign locally invasive sinonasal tumor. The aim is to remove all diseased tumor tissue together with complete margin clearance. At the same time, the wide cavities provide easier monitoring of recurrent tumor on follow-up. Lack of complications of open surgery as well as improved access to medial and posterior sinonasal regions suggests that the endoscopic techniques for selected lesions may be a good alternative to open surgery. The endoscopic medial maxillectomy is the preferred option for the treatment of benign sinonasal neoplasm involving the medial wall of maxilla specifically inverted papilloma. Adjuvant external approach may be performed when needed to allow complete eradication of any residual disease.

Neuroendocrine Carcinoma Arising in a Wound after Endoscopic Sinus Surgery for Maxillary Sinusitis

Sinonasal tumors with neuroendocrine differentiation are a rare group of neoplasms that account for only 5% of all sinonasal malignancies. Paranasal neoplasms very rarely arise postoperatively from the maxillary sinus. We encountered a case of neuroendocrine carcinoma arising in a wound after endoscopic sinus surgery for maxillary sinusitis. At the first medical examination, we tried to discriminate between maxillary tumor and postoperative recurrence of maxillary sinusitis.

A case report of maxillary prosthetic treatment for a patient with abnormal denture space after maxillary gingival tumor resection

A case report of maxillary prosthetic treatment for a patient with abnormal denture space after maxillary gingival tumor resection

Clinical study of free anterolateral thigh perforator flap in repairing maxillary complex tissue defects

Objective To explore the effect of free anterolateral thigh (ALT) perforator flap in the repairment of complex maxillary defects. Methods The clinical data of 51 patients undergoing the reconstruction of maxillary defects in ALT perforator flap between January 2013 and October 2016 in the Peking University Hospital of Stomatology were retrospectively analyzed. All the patients received ALT reconstruction during the maxillary tumor resection. Results Four patients had blood vessel crisis after surgery in 51 cases. Two cases were removed due to flap necrosis, and 49 cases survived with a satisfactory appearance and function, and the overall flap survival rate of 49 cases was 96.08% (49/51). Conclusion ALT perforator flap provides an ideal reconstruction for complex maxillary defects with a well-restored function in the surgical ares which could avoid the facial asymmetry and contribute to the following treatment. Key words: Maxillary neoplasms; Reconstructive surgical procedures; Anterolateral thigh flap; Maxillary defects; Reconstruction

Comparison Between Endoscopic Prelacrimal Medial Maxillectomy and Caldwell-Luc Approach for Benign Maxillary Sinus Tumors.

ObjectivesEndoscopic prelacrimal medial maxillectomy (EPMM) was previously reported to treat maxillary inverted papilloma. This study aimed to compare prelacrimal recess approach with the conventional Caldwell-Luc approach (CLA) to remove benign maxillary sinus tumors and to evaluate the usefulness of this approach based on our experience.MethodsTen patients who underwent EPMM at our hospital from January 2013 to December 2017 were reviewed. We also reviewed 30 patients who underwent benign maxillary sinus tumor resection via CLA during the same period. From medical records, postoperative pathological results, complications due to surgery, and recurrence rate were evaluated.ResultsThere were eight inverted papilloma, one ameloblastoma, and one ossifying fibroma in the EPMM group. In the CLA group, all 30 cases were inverted papilloma. There were no cases of failure at gross total removal during surgery, and no recurrences were observed during follow-up in either groups. Mean follow-up period was 13.0 months in CLA group and 10.8 months in EPMM group. Regarding postoperative complications, 11 patients of the CLA group (37%) and three patients of the EPMM group (30%) had numbness around the cheek and upper lip area after surgery (P=0.715). In the CLA group, there were eight patients who had numbness lasting more than 3 months after surgery, and two patients had numbness for more than 1 year. However, facial numbness disappeared within 3 months in all patients in the EPMM group, in which epiphora was not observed.ConclusionEPMM is the effective surgical approach for resecting benign maxillary sinus tumor compared with CLA. Although facial numbness was reported in EPMM, the duration of numbness was shorter than CLA.

Ameloblastoma: a retrospective single institute study of 34 subjects

Objective: This study aims to clarify demographic and clinical aspects of patients with ameloblastoma treated at a single Finnish institute during 1985–2016. Associations between predictor variables (gender and age) and outcome variables (location, tumour type, growth patterns and average tumour size) were sought.Materials and methods: A retrospective cohort study was designed and implemented including 34 patients diagnosed with primary ameloblastoma and treated at the Helsinki University Central Hospital. Patient records were investigated, and tissue samples re-evaluated. The chi-square test was used on all categorized variables and t-test for continuous ones. A p value equal to or under .05 was considered significant.Results: Males were slightly more predominant among the Finnish patients with ameloblastoma. Maxillary tumours were seen exclusively in male patients (p = .034). Additionally, these patients were older than patients with mandibular tumours (p = .007). A mixture in histological growth patterns was more common than originally anticipated. The study revealed a wide range of clinical signs and subjective symptoms, of which pain or other sensations were experienced most often.Conclusions: This study of 34 subjects shows that southern Finnish patients with ameloblastoma do not substantially differ from patients in similar study designs.

Restorative aspects of oral cancer reconstruction.

The oral rehabilitation of head and neck cancer patients is a vital and pivotal part of their care pathway, helping to restore function, aesthetics and improve patient well-being and quality of life. Patient-reported outcome data demonstrates that such patients consider that many of their continued and unmet needs relate to their oral and dental rehabilitation. It is therefore incumbent on all dental team members to be aware of the entire spectrum of restorative management options that can be utilised in both the prevention and rehabilitation of this patient cohort. The literature highlights that maxillary and mid-face tumours are challenging, as patients often suffer both profound functional and aesthetic consequences with significant physiological and psychological impact. Conversely, mandibular and floor of mouth tumours often result in issues primarily affecting oral function. This paper will summarise commonly encountered functional and aesthetic issues facing the restorative dental team and highlight widespread preventive challenges.

Mandibulotomy Approach for Resection of Maxillary Tumours: A Clinical Review.

The objective of this study was to assess the accessibility in the resection of maxillary tumours, resection margin status, and morbidity following maxillectomy through lip split with paramedian mandibulotomy approach. A retrospective review of 20 consecutive patients who underwent maxillectomy with resection of primary tumours through lip split mandibulotomy approach with supraomohyoid neck dissection for maxillary tumours between 2008 and 2016. Patients details including the tumours site, extension and neck node involvement. were recorded. Resection technique, status of surgical resected margins was also discussed. Disease status was obtained from patients follow up records. Morbidity was assessed at mandibulotomy site in terms of infection, osteotomy healing, neural disturbance and mouth opening. The institutional research committee approval was taken for this study. All patients underwent adequate en bloc resection of the tumours, except in two patients in whom superior margins was positive. Osteotomy site healed well in our all patients except in one patient in whom there was infection at the osteotomy site during post radiation therapy. Minimal neural morbidity was encountered in four patients (three patients had lingual nerve hypothesia and two patients had inferior alveolar nerve hypothesia) which recovered in all four patients, over the 6th month post-operative period. Post-operative interincisal distance was satisfactory with a mean of 30.5mm. Mandibulotomy with lip split is considered to be an ideal approach to access tumours of maxilla and its adjacent structures, SOHND with level III clearance. This approach provide excellent accessibility for en bloc resection of operable maxillary tumours with good outcome of resultant scar and minimal morbidity.

Navigation-guided resection of maxillary tumors: Can a new volumetric virtual planning method improve outcomes in terms of control of resection margins?

IntroductionIn the present study, our aim was to confirm the role of navigation-guided surgery in reducing the percentage of positive margins in advanced malignant pathologies of the mid-face, by introducing a new volumetric virtual planning method for resection. Materials and methodsTwenty-eight patients were included in this study. Eighteen patients requiring surgery to treat malignant midface tumors were prospectively selected and stratified into two different study groups. Patients enrolled in the Reference Points Resection group (RPR – 10 patients) underwent resection planning using the anatomical landmarks on CT scan; patients enrolled in the Volume Resection group (VR – 8 patients) underwent resection using the new volumetric virtual planning method. The remaining 10 patients (Control group) were treated without the use of a navigation system. ResultsIn total, 127 margins were pathologically assessed in the RPR group, 75 in the VR group, and 85 in the control group. In the control group, 16% of the margins were positive, while in the RPR group the value was 9%, and in the VR group 1%. ConclusionsThe volumetric tumor resection planning associated to the navigation-guide resection appeared to be an improvement in terms of control of surgical margins in advanced tumors involving the mid-face.

Surgical Treatment of Maxillary Antrum Neoplasms.

Paranasal sinus cancers comprise about 0.3% of all cancers and 80% of these lesions arise in the maxillary sinus. A masquerading primary sinus tumour represents a therapeutic challenge as most patients with maxillary antrum cancer are diagnosed with advanced disease. However, distant metastases rarely occur. We examined the clinical outcome of patients with antrum neoplasms. Medical records were obtained for all patients diagnosed with a sinus malignancy between July 2009 and January 2014. During this period, 41 patients with maxillary tumours were treated, among which 9 patients received a maxillectomy. There were 21 male and 20 female patients. All patients underwent computed tomography or magnetic resonance imaging. The most common complications were postoperative epistaxis and swallowing difficulty. The treatment of maxillary antrum tumours is complicated and needs advancements to improve early presentation, timely diagnosis, and better management outcomes.

Outcomes in Patient Undergoing Maxillectomy for Squamous Cancer Invading Maxilla in a Rural Tertiary Care Institute in Socioeconomic Poor Group of Patients

Background: Oral cancer accounts for more than 250,000 new cases of cancer in India. Oral cancer combining all sites of cancer in oral cavity is the single commonest cancer in males in India. Oral cancer involving upper alveolus and primary maxillary sinus tumors are a surgical challenge due to the complex surgery and rehabilitation. Aim: Optimal treatment strategy for treatment of squamous cancer invading maxillary sinus. Methods: This is a retrospective study of clinicopathological features, treatment, rehabilitation and outcome of all patients who underwent surgical treatment of tumor invading maxillary sinus over a period of 30 months in a rural cancer hospital. Results: Out of a total of 47 patients, 26 (55.3%) were males and 21 (44.7%) were females. Median age was 56 year with youngest patient of 23 year and oldest 88 year old. Primary maxillary sinus cancers were 19.1%, palatal tumors were 10.6% and 70.3% were buccal mucosa and upper alveolus cancers. Early cancers were 51% and locally advanced were 49%. Total maxillectomy was performed in 59.6%, partial maxillectomy in 34.1% and extended maxillectomy in 6.3% of the patients. Histology was squamous carcinoma in all patients and 85.1% were grade 2. Peripheral neural invasion was present in 14.9%, lympho-vascular emboli in 23.4%, and surgical margins were positive in 10% of the patients. Eighty percent patients underwent reconstruction by free microvascular flap. Fifty-one percent patients received postoperative chemoradiotherapy while 25.5% received only radiotherapy and 19.1% received no adjuvant treatment. At a mean follow-up of 11 months 74.5% patients are alive. Good speech was achieved in 70% and intelligible speech in 17% of the patients, while 12.8% were not able to speak. Solid food swallowing was achieved in 36.2%, semisolid in 27.6%, liquid in 19.1% of the patients and 12.8% remained on nasogastric tube feeds. Conclusion: Surgical resection with reconstruction by microvascular flap and postsurgical chemoradiotherapy in locally advanced cancers is key for improved survival and successful rehabilitation in cancer invading maxilla.

Radiographic assessment of keratocyst odontogenic tumor in maxilla using cbct: a case report

Keratocyst odontogenic tumor (KCOT) is a developmental odontogenic cyst of epithelial origin. This lesion shows features of a cyst and a benign neoplasm, because of its behavior, autonomous growth, and potential for recurrence. The KCOT occurs more significant in the posterior mandible than in maxilla. Occasionally, pain, swelling, and drainage indicate a secondary infection of the cyst. Asymptomatic KCOT usually detected in routine radiograph. The radiographic examination is important to determine KCOT diagnose and treatment planning to prevent recurrence. The aim of this case report is to describe radiographic characteristic of keratocyst odontogenic tumor in maxilla using CBCT. A 20 year-old women patient was referred to the oral maxillofacial radiology department of Padjadjaran University with the chief complaint of swelling, painless in the anterior of the upper jaw. In this presented case, we used cone beam computed tomography to find out the margin of the cortical extension, and diameter of the lesion. The CBCT examination shows radiolucent, well-defined lesion in 12-14 region with displacement of 12. The size of the lesion is about 20x15x19mm extended posterior-superiorly near to nasal cavity and it shows less degree of bone expansion. Based on radiographic and clinical examination, the diagnosis was keratocyst odontogenic tumor. KCOT has some radiographic characteristic distinguishable with another odontogenic lesion. Therefore; cbct examination is recommended for the diagnosis of odontogenic keratocysts and proper surgical planning.

Extrafollicular Cystic Adenomatoid Odontogenic Tumor of the Maxilla: a Rare Challenging Case Report with Review of the Literature

Adenomatoid odontogenic tumor is a non-aggressive slow growing epithelial odontogenic tumor with varied clinical and microscopic features. This neoplasm rarely appears as a completely cystic lesion histopathologically; therefore, oral pathologists should be aware of the various histopathologic types of this lesion. The main objective of this case report is to present a rare challenging case of maxillary extrafollicular cystic adenomatoid odontogenic tumor affecting a 28-year-old male.

Complete Cavernous Sinus Resection: An Analysis of Complications

Complete cavernous sinus resection has been described for patients with malignant or recurrent cavernous sinus tumors without other therapeutic options but has been associated with high morbidity and mortality rates. We reviewed the complications associated with complete cavernous sinus resection to gain insights for future complication avoidance. A retrospective analysis of a prospective, single-institution database was performed to identify patients who had undergone complete cavernous sinus resection from July 2014 to October 2017. Patient- and disease-specific data, surgical complications, and clinical outcomes were recorded. Two male patients underwent complete cavernous sinus resection (aged 60 and 47 years) for recurrent maxillary tumors with secondary cavernous sinus extension. Revascularization was performed based on balloon test occlusion (BTO) results, with extracranial-to-intracranial bypass performed in 1 patient with a concerning hemispheric flow pattern found during BTO. Vascularized free flaps were used in both patients to assist with closure of the resulting skull base defect. Three complications related to surgery occurred in 1 patient (thigh hematoma, recurrent cerebrospinal fluid leak, and meningitis). One patient died of pneumonia approximately 2 weeks postoperatively, and the other experienced an acceptable neurologic and oncologic outcome. Despite the high peri- and postoperative risks, complete cavernous sinus resection can be considered for select patients with tumors involving the cavernous sinus without other treatment options. Familiarity with cerebral bypass and free flap reconstruction of skull base defects is critical for complication avoidance and management.

Maxillofacial brown tumours: Series of 5 cases

ObjectivesBrown tumours are benign bone tumours secondary to hyperparathyroidism. The authors describe the various clinical features, diagnostic methods and treatment modalities for maxillofacial brown tumours. Material and methodsThis multicentre retrospective study comprised 5 patients (four women and one man, between the ages of 29 and 70 years) with one or several maxillofacial brown tumours observed over a 16-year period from January 2000 to December 2016. ResultsFour patients presented secondary hyperparathyroidism in a context of chronic renal failure, one patient presented primary hyperparathyroidism due to parathyroid adenoma. Three patients presented a mandibular brown tumour, and two patients presented a maxillary brown tumour. The diagnosis was based on histological examination and laboratory tests. Brown tumours were treated either surgically or conservatively. A favourable outcome was observed in all cases. ConclusionBrown tumours are rare lesions. This diagnosis must be considered in a context of giant cell tumour associated with hyperparathyroidism. Brown tumours should be treated conservatively.

A lesion categorized between ghost cell odontogenic carcinoma and dentinogenic ghost cell tumor with CTNNB1 mutation.

Ghost cell odontogenic carcinoma (GCOC) is a rare malignant neoplasm characterized by the presence of ghost cells. It is considered to arise either de novo or from a preexisting benign precursor, calcifying odontogenic cyst (COC), or dentinogenic ghost cell tumor (DGCT). We report a case of a 44-year-old Japanese male with a left maxillary tumor. The patient received treatment to resect the left maxillary cyst 25 years prior; however, the details were uncertain. The tumor was resected with clear margins. Taken together with the results of histological and immunohistochemical examinations, the tumor was categorized between GCOC and DGCT, and we diagnosed the tumor as GCOC suggesting similarity to DGCT. Further, we focused on CTNNB1, which encodes β-catenin and is frequently mutated in COCs. In this tumor, we identified CTNNB1 Ser33Cys, one of the mutations typically found in COCs. This finding suggests that CTNNB1 is a common target for the pathogenesis of tumors accompanied by ghost cells.

The risks of delayed oral cancer detection in primary care

Oral malignancy necessitates early detection for a better prognosis. Clinical presentation may vary, from a small mucosal lesion with benign clinical features to a large ulcerated mass with considerable local destruction. The case of a 46-year-old patient presenting to a dental access centre with upper quadrant jaw pain, parasthaesia and unexplained tooth mobility is discussed. Delay in recognizing key features suggestive of sinister pathology led to a seven-week delay in referral of an aggressive, rare, odontogenic malignancy; ameloblastic carcinoma. The patient underwent extensive surgery with adjunctive radiotherapy. CPD/Clinical Relevance: Odontogenic malignancy can cause rapid and extensive local invasion with a high potential for local or regional spread. Maxillary tumours often present with late, non-specific symptoms, thus must be detected early.

The landscape of genetic alterations in ameloblastomas relates to clinical features

Ameloblastoma is a mostly benign, but locally invasive odontogenic tumor eliciting frequent relapses and significant morbidity. Recently, mutually exclusive mutations in BRAF and SMO were identified causing constitutive activation of MAPK and hedgehog signaling pathways. To explore further such clinically relevant genotype-phenotype correlations, we here comprehensively analyzed a large series of ameloblastomas (98 paraffin block of 76 patients) with respect to genomic alterations, clinical presentation, and histological features collected from the archives of three different pathology centers in France, Germany, and Turkey. In good agreement with previously published data, we observed BRAF mutations almost exclusively in mandibular tumors, SMO mutations predominantly in maxillary tumors, and single mutations in EGFR, KRAS, and NRAS. KRAS, NRAS, PIK3CA, PTEN, CDKN2A, FGFR, and CTNNB1 mutations co-occurred in the background of either BRAF or SMO mutations. Strikingly, multiple mutations were exclusively observed in European patients, in solid ameloblastomas and were associated with a very high risk for recurrence. In contrast, tumors with a single BRAF mutation revealed a lower risk for relapse. We here establish a comprehensive landscape of mutations in the MAPK and hedgehog signaling pathways relating to clinical features of ameloblastoma. Our data suggest that ameloblastomas harboring single BRAF mutations are excellent candidates for neo-adjuvant therapies with combined BRAF/MEK inhibitors and that the risk of recurrence maybe stratified based on the mutational spectrum.