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Objectives Survival for patients with recurrent oral squamous cell carcinoma is usually poor, and the most effective treatment has not yet been clearly defined. The present study evaluates the outcome in radiotherapy-naïve patients after recurrence of oral squamous cell carcinoma with respect to different treatment modalities including surgery, radiation, chemoradiation, and palliative treatment. Patients and methods In this retrospective study, we included all patients with primary oral squamous cell carcinoma who received exclusively surgical therapy between 2010 and 2020 and who suffered from locoregional recurrence in their follow-up. Patients with previous adjuvant therapy were excluded from this protocol. Clinical and pathological parameters were collected and statistically evaluated. Survival analysis was performed according to Kaplan–Meier. The primary endpoints were overall and progression-free survival in dependance of treatment strategy for recurrent tumors. Results Out of a total of 538 patients with surgically treated primary oral squamous cell carcinoma, 76 patients met the inclusion criteria. The mean follow-up was 38 ± 32 months. Patients who received surgically based therapy had a significantly better outcome in terms of disease-free survival (DFS) and overall survival (OS) (DFS p p p Conclusion We recommend primary surgical therapy for radiotherapy-naïve patients with recurrent oral squamous cell carcinoma, supplemented by risk-adapted adjuvant therapy. Clinical relevance Surgical therapy continues to play a central role in the treatment of radiotherapy-naïve patients with recurrent oral squamous cell carcinoma.

Insbesondere nach ausgedehnter Tumorresektion im Kopf-Hals-Bereich stellt der mikrovaskulare Gewebetransfer den Goldstandard in der rekonstruktiven Chirurgie dar. Durch den gestiegenen Anspruch an die postoperative Lebensqualitat kommt es zu einem erhohten Bedarf an funktionell und asthetisch ansprechenden rekonstruktiven Masnahmen. Hierfur steht je nach Ausdehnung und Struktur des Defekts eine Vielzahl unterschiedlicher mikrovaskularer Transplantate zur Verfugung. In der Mund‑, Kiefer- und Gesichtschirurgie spielt v. a. die knocherne Rekonstruktion des Ober- und Unterkiefers eine wichtige Rolle mit dem Ziel, essenzielle Funktionen wie Artikulation, Phonation sowie die Kau- und Schluckfunktion zu erhalten oder wiederherzustellen. Hier hat sich insbesondere durch den Einsatz der virtuellen Planung und deren Ubertragung in den Operationssaal mittels Resektions- oder Osteotomieschablonen und den Einsatz patientenspezifischer Implantate ein hohes Mas an Prazision entwickelt, was die Vorhersagbarkeit des Rekonstruktionsergebnisses entscheidend verbessert hat. Die adaquate kaufunktionelle Rehabilitation nach einer knochernen Rekonstruktion erfordert i. d. R. die Insertion dentaler Implantate zur Verankerung eines Zahnersatzes, was oft mit einem hohen zeitlichen Aufwand bis zur vollstandigen prothetischen Versorgung verbunden ist. Hier bietet der „Jaw-in-a-day-Ansatz“, bei dem die vollstandige dentale Rehabilitation simultan zur Kieferrekonstruktion erfolgt, eine vielversprechende Technik an. Diese setzt jedoch eine sorgfaltige Patientenselektion voraus und muss noch im Langzeitverlauf abschliesend beurteilt werden.

Weichgewebezysten der Kopf-Hals-Region manifestieren sich zumeist als langsam an Grose zunehmende, gut abgrenzbare, schmerzlose Schwellungen, bei denen mit zunehmender Grose Begleitsymptome durch das verdrangende Wachstum oder durch Superinfektion hinzukommen konnen. Nicht selten sind die Zysten mit Weichgewebefisteln assoziiert. Der Diagnostik sollte immer die Erhebung einer ausfuhrlichen Anamnese vorausgehen, da sich einige der Zysten (z. B. laterale/mediane Halszyste) bereits in der fruhen Kindheit manifestieren, wohingegen andere erst seit kurzer Zeit, beispielsweise traumatisch bedingt, bestehen (z. B. submukose Zysten). Die klinische Untersuchung kann durch eine Sonographie erganzt werden. Bei unklaren Fallen oder zur besseren Therapieplanung kann eine Schnittbildgebung mit multiplanarer Darstellung hilfreich sein. Therapie der Wahl ist i. d. R. die vollstandige chirurgische Exstirpation der Zyste; eine histopathologische Aufarbeitung zur Diagnosesicherung ist obligat. Eine Zystostomie oder eine Sklerosierung zystischer Veranderungen sollte aufgrund des erhohten Rezidivrisikos und der unvollstandigen histologischen Untersuchung derzeit nur als Therapiealternative besonderen Falle vorbehalten sein.

Purpose Strategies for Indolamine-2,3-dioxygenase 1 (IDO1) inhibition in cancer immunotherapy once produced encouraging results, but failed in clinical trials. Recent evidence indicates that immune cells in the tumour microenvironment, especially macrophages, contribute to immune dysregulation and therefore might play a critical role in drug resistance. Methods In this study, we investigated the significance of IDO1 expressing immune cells in primary tumours and corresponding lymph node metastases (LNMs) in oral squamous cell carcinoma (OSCC) by immunohistochemistry. The link between IDO1 and macrophages was investigated by flow cytometry in tumour tissue, healthy adjacent tissue and peripheral blood mononuclear cells (PBMCs). IDO1 activity (measured as Kynurenine/Tryptophan ratio) was assessed by ELISAs. Results High IDO1 expression in tumour-infiltrating immune cells was significantly correlated with advanced stages [Spearman’s rank correlation (SRC), p = 0.027] and reduced progression-free survival (multivariate Cox regression, p = 0.034). IDO1 was significantly higher expressed in PBMCs of patients in advanced stages than in healthy controls (ANOVA, p + macrophages were more abundant in intratumoural areas than peritumoural (t test, p p t test, p Conclusion All in all, IDO1 expressing immune cells, especially macrophages, are more abundant in advanced stages of OSCC and are associated with reduced progression-free survival. Further investigations are needed to explore their role in local and systemic immune response. The IDO1 activity might be a suitable biomarker of metastasis in OSCC patients.

Bacterial osteomyelitis of the jaw is a severe disease potentially requiring extensive surgical treatment. We have evaluated the incidence rates of bacterial osteomyelitis following dental abscessation associated with primary or secondary tooth extraction. A retrospective cohort study was designed and included patients with dental abscesses and surgical treatment including the extraction of focus teeth. Patients were either treated with primary removal during acute infection or secondary delayed extraction within an infection-free interval. The primary outcome variable was the occurrence of bacterial osteomyelitis following the abscess. Secondary outcomes were the influence of general disease, antibiotic therapy, and surgical technique. One hundred nine patients were enrolled in the study; 4 patients (3.7%) developed osteomyelitis. Primary tooth extraction was performed on all these patients (p = 0.017). Significant associations of diabetes (p = 0.001), the use of clindamycin (p = 0.025), and transcutaneous incision (p = 0.017) with the incidence of osteomyelitis were detected. More severe infections may be associated with a higher risk for the development of osteomyelitis following dental abscesses. A history of diabetes and clindamycin therapy might form further predisposing risk factors. Because of the low incidence and the small case number, our data need to be interpreted carefully. Osteomyelitis of the jaw is a rare but severe disease that may require extensive therapy and that impairs the quality of life of affected patients. The evaluation of risk factors to enable further reduction of incidence is therefore urgently required.

Background Despite modern treatment techniques, radiotherapy (RT) in patients with head and neck cancer (HNC) may be associated with high rates of acute and late treatment-related toxicity. The most effective approach to reduce sequelae after RT is to avoid as best as possible healthy tissues and organs at risk from the radiation target volume. Even small geometric changes can lead to a significant dose reduction in normal tissue and better treatment tolerability. The major objective of the current study is to investigate 3D printed, tooth-borne tissue retraction devices (TRDs) compared to conventional dental splints for head and neck RT. Methods In the current two-arm randomized controlled phase II trial, a maximum of 34 patients with HNC will be enrolled. Patients will receive either TRDs or conventional dental splints (randomization ratio 1:1) for the RT. The definition of the target volume, modality, total dose, fractionation, and imaging guidance is not study-specific. The primary endpoint of the study is the rate of acute radiation-induced oral mucositis after RT. The quality of life, local control and overall survival 12 months after RT are the secondary endpoints. Also, patient-reported outcomes and dental status, as well as RT plan comparisons and robustness analyzes, will be assessed as exploratory endpoints. Finally, mesenchymal stem cells, derived from the patients’ gingiva, will be tested in vitro for regenerative and radioprotective properties. Discussion The preliminary clinical application of TRD showed a high potential for reducing acute and late toxicity of RT in patients with HNC. The current randomized study is the first to prospectively investigate the clinical tolerability and efficacy of TRDs for radiation treatment of head and neck tumors. Trial registration: ClinicalTrials.gov; NCT04454697; July 1st 2020; https://clinicaltrials.gov/ct2/show/record/NCT04454697.

Background Intensity-modulated re-radiotherapy (reIMRT) has been established as a standard local treatment option in patients with non-resectable, recurrent head and neck cancer (rHNC). However, the clinical outcome is unfavorable and severe toxicities (≥grade III) occurred in 30–40% of patients. The primary aim of the current trial is to investigate carbon ion reirradiation (reCIRT) compared to reIMRT in patients with rHNC regarding safety/toxicity as well as local control, overall survival (OS), and quality of life (QoL). Methods The present trial will be performed as a single center, two-armed, prospective phase II study. A maximum of 72 patients will be treated with either reIMRT or reCIRT to evaluate severe (≥grade III) treatment-related toxicities (randomization ratio 1:1). The primary target value is to generate less than 35% acute/subacute severe toxicity (≥grade III), according to the Common Terminology Criteria for Adverse Events v5.0, within 6 months after study treatment. The total dose of reirradiation will range between 51 and 60 Gy or Gy (RBE), depending primarily on the radiotherapy interval and the cumulative dose to organs at risk. Individual dose prescription will be at the discretion of the treating radiation oncologist. The local and distant progression-free survival 12 months after reirradiation, the OS, and the QoL are the secondary endpoints of the trial. Explorative trial objectives are the longitudinal investigation of clinical patient-related parameters, tumor parameters on radiological imaging, and blood-based tumor analytics. Discussion Recent retrospective studies suggested that reCIRT could represent a feasible and effective treatment modality for rHNC. This current randomized prospective trial is the first to investigate the toxicity and clinical outcome of reCIRT compared to reIMRT in patients with rHNC. Trial registration ClinicalTrials.gov; NCT04185974; December 4th 2019.

Die Kraniosynostose ist ein vorzeitiger Verschluss einer oder mehrerer Schadelnahte aufgrund einer Storung innerhalb der osteogenen Prozesse, die wahrend der Ossifikation des Schadels ablaufen. Diese bedingen ein fur die jeweils betroffene Schadelnaht typisches klinisches Erscheinungsbild. Die Standarddiagnostik umfasst die klinische Untersuchung mit zephalometrischen Messungen (analog, 3-D-photometrisch) und eine Sonographie der Schadelnahte. Der Einsatz von ionisierender Strahlung innerhalb der Routinediagnostik sollte ebenso wie die MRT-Untersuchung in Sedierung vermieden und nur in Ausnahmefallen in Betracht gezogen werden. Fur die operative Korrektur des Neuro- und Viszerokraniums stehen an das Alter der Patienten angepasste, standardisierte Verfahren mit guten, vorhersagbaren Ergebnissen zur Verfugung.

Hamangiome sind die haufigsten Weichgewebstumoren im Kindesalter, circa 3–10% der unter Einjahrigen sind betroffen. Infantile Hamangiome (IH) zeigen ein charakteristisches Wachstumsverhalten, das in Proliferations-, Ruhe- und Ruckbildungsphase unterschieden wird. Unter Berucksichtigung des klinischen Verhaltens werden Hamangiome nach der International Society for the Study of Vascular Anomalies (ISSVA) zur Gruppe der vaskularen Tumoren gezahlt und so eindeutig von der Gruppe der vaskularen Malformationen abgegrenzt. Die Atiologie der Hamangiome ist bis heute noch nicht abschliesend geklart. Anhand der typischen Entwicklungsphasen und unter Berucksichtigung der klinischen Untersuchung ist i.d.R. eine recht eindeutige Diagnosestellung moglich, eine weitere bildgebende Diagnostik erubrigt sich meist. Aufgrund des gutartigen, selbstlimitierenden Wachstums der IH kann haufig auf ein interventionelles therapeutisches Vorgehen verzichtet werden.

Although metastatic carcinoma is the most common malignant tumor of the bone, less than 1% of all metastatic bone lesions are presented in the maxillofacial area. As the mandibular body is the most frequent localization, metastasis to the mandibular condyle is extremely rare.This report describes a rare case of prostate carcinoma metastatic to the mandibular condyle in a 75-year old man, who was referred because of persistent pain in the temporomandibular joint (TMJ) region and a limitation of opening, initially misdiagnosed and treated as temporomandibular disorder (TMD). Histopathological examination confirmed the suspected metastasis of prostate carcinoma and local radiation therapy was performed.TMD represent a diagnostic challenge and sometimes an interdisciplinary approach is required to prevent a delay of the correct treatment. Metastatic cancer should be included in the differential diagnosis of TMD, especially in patients with a malignant disease.