North Americans in 2004 were projected to die from oral and pharyngeal cancer at a rate of 1.2 per hour. Oral healthcare providers can be instrumental in reducing the incidence of oral and pharyngeal premalignant and malignant lesions by identifying patients with high-risk behavior, educating their patients about the consequences of their high-risk behavior, and by early detection of premalignant and malignant conditions. The fact only 34% of the cancers of the oral cavity and larynx are localized at the time of diagnosis and evidence that at least one third of the patients diagnosed with an oral or pharyngeal malignancy have undergone oral cancer screening within the past three years suggests the current protocol for the early detection of pre-malignant or malignant changes appears to be deficient. To facilitate early diagnosis, oral healthcare providers must take into consideration the capriciousness of oral cancer and must be familiar with the availability and application of diagnostic modalities beyond conventional visual inspection and palpation of oral soft tissues. This article provides a comprehensive review of the disease for healthcare professionals.

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Squamous cell carcinoma of the oral tissues: A comprehensive review for oral healthcare providers

Major Pulmonary Resection for Suspected but Unconfirmed Malignancy

Bipaddled radial forearm flap for the reconstruction of bilateral buccal defects in oral submucous fibrosis

Background
Oral submucous fibrosis (OSMF) is a potentially malignant disorder of the oral cavity. The surgical management of this condition involves excision of the fibrotic bands and interpositional grafts to retain the increased oral opening. Various procedures and graft material have been utilised with differing success rates.

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Surgical Interventions in Oral Submucous Fibrosis: A Systematic Analysis of the Literature

Various surgical techniques and innovations have been applied to manage complex penile deformities. As an adjunct to penile reconstructive surgery, use of fascia lata, the superficial connective tissue structure of the thigh, may also be considered. Herein, four case reports are described in which fascia lata was applied: penile deformity associated with multiple unsuccessful penile prosthesis surgeries; penile prosthesis migration alter phalloplasty ; partial penile loss after ablative penile cancer surgery: and penile fibromatosis (Peyronie's disease). Fascia lata was autogenously obtained from the lateral thigh in all cases and used for, respectively, corporoplasty, penile prosthesis fixation, penile elongation, and tunica albuginea grafting. Surgeries were successful in every instance, and each patient reported satisfactory neophallic appearance and function postoperatively. The functional anatomy of the fascia lata was investigated further with lower extremity cadaveric dissections. For penile reconstructive surgery, fascia lata offers an autogenous source, it can be expeditiously obtained causing minimal morbidity, and it serves as a viahle graft material with good tensile strength. Its application derives from, and may extend to, other reconstructive surgeries.

Fascia lata in penile reconstructive surgery: a reappraisal of the fascia lata graft.

The progression of submucous fibrosis to oral cancer is well established. This condition in an advanced stage causes progressive trismus. Oral cancers associated with severe submucous fibrosis (interincisor distance [IID] < or = 1.5 cm) require bilateral buccal mucosal reconstruction after tumor excision. After wide excision of the tumor, a regional flap is used to reconstruct the buccal mucosal loss on that side. The opposite buccal mucosa, afflicted by advanced submucous fibrosis, is released at the same time to open the mouth and is resurfaced by an ipsilateral, inferiorly based nasolabial flap. This helps to rehabilitate the oral cavity completely and to prevent the recurrence of trismus. In 18 months, 12 patients underwent total reconstruction of intraoral tumors associated with submucous fibrosis. The average preoperative IID was 0.875 cm. All patients had inferiorly based, two-stage nasolabial flaps for submucous fibrosis reconstruction. The average pain-free postoperative IID was 3.13 cm.

Total oral reconstruction for cancers associated with advanced oral submucous fibrosis.

Reconstructive procedures following chest wall resection pose a special surgical challenge. With modern surgical technique, a wide range of reconstructive options are at the surgeon's disposal and, hence it is imperative that the appropriate procedure be selected in a given patient. A total of 64 patients underwent resection of malignant chest wall tumors at the Tata Memorial Hospital. The technique of preference at our institution for reconstruction of full-thickness chest wall defects uses a combination of autogenous fascia lata and Marlexmesh. We present our experience with chest wall reconstruction following extirpative surgery in these patients. © Wiley-Liss, Inc.

Reconstruction of chest wall defects following extirpative surgery

The definitive diagnosis confirming lung cancer by microscopic examination is indicated before the therapy whenever possible and particularly prior to undertaking thoracotomy in situations when tissue diagnosis is not achieved. In such situations the thoracotomy becomes diagnostic with the therapeutic procedure. In clinically suspected cancer of the lung, histological confirmation is usually available at times, and cytology confirmation must suffice. At Tata Memorial Hospital for cancer and allied diseases in Bombay, India, we analyzed retrospectively 298 cases, which were submitted for different diagnostic procedures in suspected lung cancer. The yield of positive tissue diagnosis of malignancy obtained by each method is described and discussed. We observed that transthoracic needle biopsy gives significant information on inflammatory diseases of the lung. The sputum examination makes the simplest revelation of malignant cells, to an extent of 53% at our institution for three successive samples.

Relative accuracy of diagnostic method in bronchogenic carcinoma.

Surgical resection of a solitary pulmonary metastasis is an established procedure. A medical generation ago when such a shadow appeared on chest roentgenogram of a patient who had known cancer elsewhere in body, it was assumed to be "metastasis" from an extrathoracic site. With increasing advances in knowledge, the occurrence of second primary or new lesion is now no more curiosity in clinical practice. To one's surprise, the lesions that are assumed to be metastatic have often turned out to be "fresh" lesion or even unrelated benign, granulomatous, inflammatory, or parasitic lesion. This paper analyses 66 patients during a period of 20 years who underwent thoracotomy for such solitary pulmonary lesions, and emphasizes the role of diagnostic-cum-therapeutic-thoracotomy in such a clinical situation where in prethoracotomy tissue diagnosis is not forthcoming.

Jeetendra J. Vyas

Papers

Total oral reconstruction for cancers associated with advanced oral submucous fibrosis.

Reconstruction of chest wall defects following extirpative surgery

Relative accuracy of diagnostic method in bronchogenic carcinoma.

Exploratory thoracotomy on a patient with previous malignancy--"metastasis" or "new primary" or "unrelated lesion".