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[Meaningful possibilities of palliative therapy of incurable mouth and pharyngeal neoplasms and their recurrence].

In incurable cancer of the mouth and oropharynx, reasonable palliative therapy should render the patient's remaining life-span worth living. The following problems impair tumor patient's well-being: 1. pain, 2. ingestive and respiratory difficulties, 3. aspect, 4. odor, 5. psychic trauma resulting from 3 and 4. Pain, either caused by the tumor itself or as a reaction to irradiation or inflammatory response, is of primary importance. Impairment of ingestion, respiration, and speech diminishes the quality of life. Disfigurement of the face or a penetrating odor may sometimes cause additional psychic stress. Besides palliative radio- and chemotherapy, in certain cases palliation can be obtained by surgery, which may reduce the size of a cosmetically disturbing tumor mass or create a clean wound surface easier to care for than a necrotic surface. Furthermore, painful neuralgic nerve branches may be severed. Severe lymphedema of the face and neck may be improved by lumbo-peritoneal shunt operation. Most recently, cryosurgery has won an established place in the management of these problems, although certain restrictions must be observed. Superficial recurrences can be treated without further mutilation of the patient. Painful areas of the tumor can be eradicated. Recurrences in the hypopharynx, which are accessible with difficulty only, can be treated with a cryosonde with little harm to an already impaired patient. Multiple tumor lesions can be iced at the same time. Among the reasonable palliative methods of treatment, synchronized irradiation and chemotherapy as well as implantation of solid radioactive substances must be mentioned.

Analgesia↗

[On the indications for and morbidity of segmental resection of the mandible for squamous cell carcinoma in the lower oral cavity].

BACKGROUND: Segmental resection of the mandibula in oral cancer surgery leads to both functional and aesthetic problems. The decision to preserve or resect the mandible depends on the vicinity of the lesion to the bone. Consequently, based on the rules of safety margins to all planes that are recommended for soft tissues, each lesion that is closer than 10 mm to the mandible needs resection of the bone. PATIENTS AND METHODS: To establish data-based treatment modalities, a retrospective study was initiated and the results from all preoperative staging investigations of 152 patients with intraoral squamous cell carcinoma who underwent continuity or marginal resection of the mandible were evaluated. The histological outcome of the resected bone was compared to the staging results. Functional rehabilitation and long-term follow-up including survival rates were evaluated. The study reports on typical complications following segmental resection such as fracture of the reconstruction plate and demonstrates experiences with secondary microsurgical reconstructive surgery. RESULTS: Mainly in cases of stage T1 and T2 carcinomas which are closer than 10 mm to the bone and clinically do not show any infiltration to the mandible, a marginal resection seems to be adequate. The decision about the extension of mandibular resection can be based on intraoperative cross sectional investigation of the periosteum. The survival rate of patients with intraoral carcinomas close to the mandible who underwent marginal mandibulectomy seems to be the same as in cases of continuity resection. A more conservative management of mandibular resection seems to be adequate and a data-based concept to standardize therapy of mandibular resection is presented.

Aged↗

[The central island tongue flap for the reconstruction of the anterior floor of the mouth].

BACKGROUND: There are several techniques described for the reconstruction of the anterior floor of mouth after tumour surgery. Here, we point out the advantages of the central island tongue flap for this indication. PATIENTS AND METHODS: We report on 20 patients with medium sized defect in the anterior floor of mouth, which was reconstructed with the central island tongue flap. Besides this surgical technique, we discuss the results of oral rehabilitation after a follow-up period of at least 3 months. RESULTS: There was now flap necrosis or loss, and the median time for flap formation was less than 45 min. In the follow-up we found successful oral rehabilitation in speech and swallowing.

Aged↗

Chewing and swallowing after surgical treatment for oral cancer: functional evaluation in 196 selected cases.

One hundred ninety-six patients treated for oral cancer between 1992 and 1999 self-scored their speech, chewing, and swallowing using a new self-questionnaire (Functional Intraoral Glasgow Scale) developed at Canniesburn Hospital, Glasgow, to assess the functional efficiency of patients treated for intraoral cancer. The patients were distributed into 12 homogeneous groups, according to the site and size of surgical resection, carefully mapped out on standard diagrams of the oral cavity. The functional outcome for chewing and swallowing was correlated to the site and size of resected tissue, to the reconstruction modality, and to radiotherapy and compared with the speech quality. The general trend is very similar for both chewing and swallowing; the smaller the resections, the better the functional outcome. Chewing was mostly affected by resections of the floor of the mouth, whereas swallowing was mostly affected by demolition of the base of the tongue and of the retromolar trigone. Speech showed a better postoperative recovery than chewing and swallowing. The reconstruction modality did not influence the eventual outcome for either function. Radiotherapy in combination with surgery is a negative functional prognostic factor. A correlation between site and size of excision and functional outcome is presented using color multiple-view diagrams for immediate appreciation to identify positive and negative prognostic factors.

Adult↗

[Prevention of oral cancer].

Etiology control is the most important primary prevention of oral cancer. The use of tobacco and alcohol increases the risk of a squamous cell carcinoma of the oral mucosa. The dentist can play an important role in the secondary prevention or screening for premalignant lesions, asymptomatic malignancies and second primary tumours of the oral cavity. Because of their age, edentulous patients run a high risk of oral cancer. Therefore, a regular oral check-up of these patients should be recommended.

Age Factors↗