What's new in Oral & Maxillofacial Surgery

Oral Cancer

Tumour supressor genes:

Loss of heterozygosity on chromosomes that contain putative supressor genes has been evaluated by Field et al. at the University of Liverpool. They have found that the fractional allele loss of tumour supressor genes appears to correlate with lymph node metastasis, thus giving genetic markers for those patients with oral SCCa likely to develop nodal metastases.

Partridge et al at King's School of Medicine & Dentistry have shown that loss of sequences at the short arm of chromosome 3p are a marker of poor prognosis and identifying these patients by molecular genetics will suggest more aggressive surgery in terms of resection margins and prophylactic treatment of the neck.

Reconstructive Surgery:

Although little advances have been made in the cure rate of oral squamous carcinoma, great advances have been made in the rehabilitation of these patients. Access to tumours using principles gleaned from orthognathic surgery has allowed the mandible and maxilla to be divided and swung laterally to gain access to tumours at the back of the oral cavity.

Advance in the practice of microvascular surgery have improved the functional outcome of cancer reconstruction. The commonest free flaps used today are the radial forearm fasciocutaneous flap for oral lining and the fibula, scapular and DCIA vascularised hip graft flaps to bring vascularised bone into areas of mandibular resection, thus allowing early reconstruction with osseointegrated implants.

Osseointegrated implants:

Extra-oral implants are now commonly used to retain ocular, nasal and ear prostheses, with a better cosmetic result than most plastic reconstructive techniques. Implants are also being placed in free vascularised bone for early rehabilitation of patients undergoing bone resections.

Photodynamic Therapy:

Porphyrin derivatives given by mouth are taken up by cancer cells and using tunable light sources, energy can be directed at these tumours to produce a tumourocidal effect

Distraction Osteogenesis:

The principles used in the Ilizarov technique where an external fixator applied to a limb is adjusted to allow bone deposition across an osteotomy site has been applied to the mandible to treat hemifacial microsomia. An external fixator is applied to the mandible and the ramus osteotomy site is distracted to produce elongation of the mandibular ramus.

Functional Cleft Surgery:

The importance of muscular function in cleft lip repair as promoted in the Delaire functional repair has gained many followers who are unhappy with the long term results of many British treated clefts when compared with Scandinavian results. The functional repair aims to re-establish the nasolabial and soft palate musculature followed by restoration of continuity between maxillary fragments by gingivoperioplasty

Oral Medicine:

Thalidomide is back in the news. Its immunomodulating properties have been used for treating severe oral ulceration associated with AIDS.

Botulinum toxin has found new uses in the medical management of masseteric hypertrophy and the production of a 'protective' ptosis following parotid gland surgery.

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