Head and Neck Osteosarcoma—The Ongoing Challenge about Reconstruction and Dental Rehabilitation

Abstract

Head and Neck osteosarcoma is an uncommon disease. Hitherto, the treatment is surgical resection and survival is influenced by the presence of free margins. However, the dimension of the resection may represent a hurdle for an adequate Quality of Life (QOL). Maxillofacial district is a narrow space where the function, esthetics and patient’s relational skills fit together like the gears of a clock. The functional results depend on the type of reconstruction and prosthetic rehabilitation that are both important to guarantee a good aesthetic result and finally increase the patient’s self-esteem. This study aims to report our experience about head and neck (HN) osteosarcoma focusing the attention on reconstructive and dental-rehabilitative problems. It is a retrospective study all patients were surgically treated in our department. Subjects with histological diagnosis of HN osteosarcoma, treated between 2005 and 2017 were included. The demographic characteristics, surgical treatment, eventually secondary reconstruction and prosthetic rehabilitation, performed in the same department, have been collected. The QOL was assessed through the EORTC QLQ-H&N35 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35) questionnaire. Fifteen patients were enrolled, eight received a free flap microsurgical reconstruction. Dental rehabilitation was performed in five cases and a mobile prosthesis was always delivered. Eighteen implants were inserted in fibula bones for three patients; highly porous implants were used.

Dental Management of Maxillofacial Ballistic Trauma

“…The older, three-phased approach (Futran et al) consists of immediate debridement, fracture stabilization, and primary wound closure, thereafter followed by delayed hard and soft tissue reconstruction and subsequently by revision of residual deformities of the oral cavity: for this last phase, flap debulking, dental implant placement, and scar revisions are important components. The newer trend consists in an early and aggressive approach with open surgical reduction and fixation and reconstructive procedures carried out in one step with the soft tissue’s debridement and closure [ 5 , 7 , 15 , 19 , 21 , 22 , 26 , 32 , 33 , 34 , 35 ]. The advantages of an early and aggressive reconstruction are an increased tissue mobilization, a reduced tissue fibrosis, and a reduced period of facial deformity.…”

“…Risk factors for infection included a delayed wound management, lack of an adequate wound management, a wound size between 1–2 cm, and incorrect wound care [ 12 ]. An adequate wound debridement and a correct stabilization of the fracture site are the mainstays of treatment: the fracture site should be considered highly contaminated, and while many fragments will appear viable, the wounds must be washed out, and if necessary, fragments should be excised to minimize the risk of infection [ 33 , 34 , 35 ]. Surgical reconstruction of discontinue defects often involves the use of grafts dictated by the size of the defect and surgeon’s preference.…”

“…Implant-retained prosthesis with acrylic resin teeth and metal substructures have been described: the metal substructure helps to enhance the strength of the acrylic resin, especially when there is a distal cantilever extension in the prosthesis [ 10 ]. In general, several factors should be taken into consideration on the implant survival: surgeon’s experience, bone quality, bone topography, and the technical aspects such as implant length, diameter, and primary stability [ 3 , 33 ]. The correct osseointegration and the survival of dental implants can heavily be influenced by side effects such as xerostomia, persistent hyposalivation, fibrosis of soft tissue, delayed healing, reduced angiogenesis, and, in our opinion, the most important factor in ballistic trauma, the wound contamination.…”

Head and Neck Cancer Treatment during COVID-19 Pandemic: A Central Experience in Rome. Emergency Management, Infection Prevention and Control

“…Every year, an estimated 177,384 people die of oral and lip cancer around the world, 1489 of whom in Italy [ 20 ]. In the case of head and neck tumors, the surgical treatment, consisting of resection and reconstruction, must be timely, to allow for any possible adjuvant treatment [ 21 , 22 , 23 ]. Moreover, therapeutic outcomes and morbidity hinge on the disease’s size and progression.…”

A New Medical Record Proposal to the Prognostic Risk Assessment for MRONJ in Oncologic Patients: “Sapienza Head and Neck Unit” Proposal

“…The baseline dental score is awarded on the first visit, before the patient starts the pharmacological therapy. This score emerges from the assessment of dental caries (number and level), tooth mobility, periodontal disease, the presence of fragments of root caries, periapical disease, missing teeth, and stability and denture congruence or dislocations [ 18 , 19 ].…”