The study objective is to determine the clinical and radiological characteristics of fibrous dysplasia of the maxillofacial area in children.
Materials and methods. A retrospective analysis of the data of the Department of Maxillofacial Surgery of the Russian Children’s Clinic for 15 years was performed. Clinical manifestations of fibrous dysplasia were compared with the X-ray characteristics in 86 patients.
Results and conclusion. In the study group, boys (in 1.2 times) slightly prevailed. The median age of debut of the disease was 8.4 years, and the time before treatment was 2.2 years. The main complaint was the appearance of a painless slowly progressing deformation. Most often, the maxilla and frontal bone were affected. X-ray fibrous dysplasia was manifested by the presence of a focus with a reduced density, relative to the adjacent bone, the type of “ground glass” with the possible presence of cysts.

The study objective is to describe the available techniques of microscopically controlled surgery for skin cancer with histological control of tumor resection margins (three-dimensional (3D) histology). This approach almost completely eliminates the risk of recurrence and allows preserving healthy tissue. It is a standard treatment for skin cancer in Germany; however, in Russia and other CIS countries, this method is not in use.

Materials and methods. We reviewed German standards for skin cancer treatment and currently available research literature on the treatment methods used for skin cancer.

Results. Automated subcutaneous tumescent local anesthesia (ATLA). Since ATLA contains a highly diluted (up to 100 times) anesthetic, we can inject a 100-fold larger volume, thus, increasing the anesthetized area. The use of naropin or ropivacaine in ATLA ensures long lasting effect (10 h on average), while the incidence of side effects is two times lower due to mixing of anesthetics and reducing their doses. The anesthetic solution is injected slowly; therefore, the patient has neither pain nor oppressive feeling. Moreover, the sodium chloride solution was replaced by ionosteril, which eliminates burning sensation. Microscopically controlled surgery (MCS). Before excision, the tumor is topographically marked (with indicating the 12 o’clock position) in order to determine the tissues that should be additionally excised after finding a tumor infiltrate in the resection margin. The tumor is excised by circumscribing an ellipse of skin; the scalpel blade should be tilted toward the tumor, making an acute angle with skin surface. The defect is closed by wound closure strips; then a compression bandage is placed over the strips. When the complete removal of tumor infiltrates is histologically confirmed, the wound is sutured or closed with a flap (if necessary). MCS ensures complete removal of the tumor and preservation of healthy tissues, which is particularly important for patients with head and neck cancer. Three-dimensional histology. In the case of small tumor specimens (up to 2 cm), the margins and the basis of the specimen are folded to a one plane by incisions (“Muffin” technique). Larger specimens require the “Tubingen cake” technique: a narrow (2–4 mm) lateral strip is cut vertically around the full perimeter of the tumor border (marginal fragment). Then a narrow section is cut from the bottom of the specimen (basal fragment); the remaining tissue is cut by diameter (medial fragment). The marginal and basal fragments are examined to identify tumor infiltrates, whereas the medial fragment is used for the diagnosis. The 3D-histological examination allows revealing twice as many tumor infiltrates as conventional histology in Germany, tumor recurrence is the lowest in the world. 3D-histology does not require additional labor costs. Defect closure using intracutaneous 3D-sutures for high tension. Absorbable butterfly and double butterfly sutures withstand strong skin tension, which allows avoiding reconstructive surgery with local tissues and skin transplantation and allows avoiding expander using. This improves functional and aesthetic results, reduces the duration of surgery, the incidence of postoperative complications, and treatment costs.

Conclusion. MCS, 3D histology, ATLA, and defect closure with intracutaneous 3D-sutures for high tension preserve healthy tissues, reduce the frequency of complications and relapses, improve functional and cosmetic results, and decrease the duration of surgery and treatment costs. This technique has proven its efficacy in Germany; so we recommend its implementation in the Russian Federation and in CIS countries.

The study objective is to assess the results of this approach and identifications of factors that may influence the effectiveness of such an approach.

Materials and methods. Since 2009 through 2016 72 patients with stage III and IV aged between 42 and 77 years underwent upfront surgery.Anatomical sites included 34 (46 %) tonsil, 24 (33 %) base of tongue and 14 (21 %) soft palate cases. Transcervical sparing the mandible,mandibulectomy and transoral approaches were used in 42 (58 %), 11 (15 %) and 7 (10 %) patient, respectively. Total glossectomy was performed in 4 (5.5 %) cases. Tumor extension necessitated extended laryngectomy in 8 patients (11.5 %). Primary closure of the pharyngeal wound was possible in 30 patients (42 %). Reconstruction with distant flaps was performed in the remaining 42 patients. Both free (anterolateral thigh – 19, radial forearm flap – 10) and flaps with axial blood supply (pectoralis major – 9, supraclavicular flap – 4) were used. There were 6 T1, 12 T2, 28 T3 and 20 T4 tumors; 62 patients were N-positive: N1 – 10 cases, N2 – 51, N3 – 1. Positive surgical margins were diagnosed in 13 cases (18 %) including 3 cases of R2 resection. Adjuvant radiation therapy with or without chemotherapy was completed in 45 patients (63.4 %). Survival was calculated according to Kaplan–Mayer method.

Results. There was 1 death in early postoperative period. Mean follow-up for the remaining patients (n = 71) was 27 months (1–94). Median survival was 27 months (95 % CI 11.5–42.5); 3-year overall survival was 44 %; 33 out of 34 still alive patients are capable to take food orally. Only 1 (2.9 %) patient is gastrostomy tube dependent. Univariate analysis revealed that positive margins (p <0.0001) and completeness of combined treatment (p <0.01) are the main factors that have statistically significan impact on prognosis.

Conclusion. Combined approach with upfront surgery is one of the main treatment modalities for advanced oropharyngeal cancer. Modern reconstructive options and strict adherence to a proper surgical technique give a high chance for a valuable rehabilitation for the vast majority of patients. Scrupulous planning of the resection of the primary tumor based on modern imaging techniques and encouraging patients to complete all prescribed treatments are the main physician-related factors that influence survival outcome.

The study objective is to assess effect of the reconstructive stage on the course of the postoperative period in patients with oral cancer.

Materials and methods. A retrospective analysis of medical records of 174 patients (121 men and 53 women) aged 36 to 84 years (average 58.26 ± 8.72 years) with oral cancer undergoing treatment from January 2009 to June 2016 was performed. Depending on the nature of the reconstructive stage, the patients were divided into 3 groups. The group 1 consisted of 59 patients, to eliminate the defects of which flaps were taken on axial blood supply, the group 2 included 83 patients who had a reconstructive phase of the operation included a microsurgical reconstruction; 32 patients who had not used additional plastic material to eliminate the defect made up the control group. The following parameters were taken as evaluation parameters: the duration of the operation and hospitalization, the time spent in the intensive care unit, the frequency of serious and frivolous complications. The criterion for distinguishing serious and unserious complications is the fact that the patient returned to the operating room.

Results. The reconstructive stage increased the operation duration by 72.12 min in the group 1 and by 285.72 min in the group 2, the length of stay in the intensive care unit – by 0.67 and 2.58 days, respectively, the hospital stay – by 33.9 and 40.4 %. The incidence of complications was higher in the groups 1 and 2 than in the control (6.6 %), and the type of reconstruction had almost no effect on it (42.37 % in the group 1 and 38.55 % in group 2). The frequency of serious complications was higher in the group 2, the frequency of partial flap necrosis – in the group 1.

Conclusion. The inclusion of a reconstructive stage into the protocol of surgical treatment for oral cancer is absolutely reasonable, because it gives the patients a chance to return to their normal lives. Microsurgical reconstruction is a costly and labour-consuming procedure; however, it has almost the same number of complication as reconstructive surgery with flaps with an axial blood supply.

We present an updated analysis of lenvatinib in radioiodine-refractory differentiated thyroid cancer (RR-DTC) with new duration of response (DOR) data unavailable for the primary analysis. In this randomized, double-blind, multicenter, placebo-controlled phase 3 study, patients ≥18 years old with measurable, pathologically confirmed RR-DTC with independent radiologic confirmation of disease progression within the previous 13 months were randomized 2:1 to oral lenvatinib 24 mg/day or placebo. The main outcome measures for this analysis are DOR and progression-free survival (PFS). The median DOR for all lenvatinib responders (patients with complete or partial responses; objective response rate: 60.2 %; 95 % confidence interval (CI) 54.2–66.1) was 30.0 months (95 % CI 18.4–36.7) and was generally similar across subgroups. DOR was shorter in patients with greater disease burden and with brain and liver metastases. Updated median PFS was longer in the overall lenvatinib group vs placebo (19.4 vs 3.7 months; hazard ratio (HR) 0.24; 99 % CI 0.17–0.35; nominal P <0.0001). In lenvatinib responders, median PFS was 33.1 months (95 % CI 27.8–44.6) vs 7.9 months (95 % CI 5.8–10.7) in nonresponders. The median DOR of 30.0 months seen with patients who achieved complete or partial responses with lenvatinib (60.2 %) demonstrates that lenvatinib responders can have prolonged, durable and clinically meaningful responses. Prolonged PFS (33.1 months) was also observed in these lenvatinib responders.

The study objective is to evaluate the utilisation and effectiveness of intensive care unit (ICU) in the postoperative period as to its potential benefits to the head and neck reconstruction services.

Materials and methods. This is a retrospective study on 143 consecutive patients who underwent 144 major head and neck microvascular reconstructive procedures performed by a single surgeon, that focused on perioperative management and on the relation between admission to ICU and complications/outcomes.

Results. Thirty-four (23.6 %) patients were admitted to ICU during the early postoperative period. Admission to ICU was not associated with lower incidence of complications compared to direct admission to the Head and Neck ward: 29.4 % vs 27.3 % (p = 0.807709).

Conclusion. Routinely early postoperative admission to ICU seems not to improve outcomes and/or reduce complications, and, as a consequence, ICU admission should be restricted to selected patients only.

The study objective is to evaluate modern-era radiotherapy (external beam radiotherapy, EBRT) and target therapy (TT) outcomes for advanced medullary thyroid cancer (MTC).

Materials and methods. Seventy eight consecutive patients with stage IV MTC were evaluated. All of them with relapsing locally advanced or metastatic MTC, 16 had clinically relevant mediastinal involvement, and 59 had distant metastasis; 26 patients received conformal EBRT or intensity-modulated radiotherapy in monomode, 16 patients – conformal EBRT with simultaneous TT with vandenanib, 36 patients – TT in monomode. Median EBRT dose was 60 Gy.

Results. Kaplan–Meier estimates of the median overall survival rate was 14 months for radiotherapy in monomode, 48 months – for conformal EBRT + simultaneous TT with vandenanib, 50 months – for TT in monomode. EBRT and TT allows for significantly shorter periods (median 3.8 weeks), to relieve the symptoms of compression-mediated organs and structures of the neck and mediastinum than in the TT (median 10.2 weeks) (p <0.001).

Conclusion. EBRT and TT provided durable locoregional disease control with limited morbidity.

Oropharyngeal squamous cell carcinoma has been traditionally associated with tobacco and alcohol consumption. Nevertheless, latter 30 years have shown squamous cell carcinoma (OPSCC) incidence stagnation and increasing, despite the decrease in smoking prevalence. The incidence was recognized among white men of middle age, often non-smokers or former smokers in the investigations with smoking cessation data. It differs from traditional patient with OPSCC, older men, heavy smoker or alcohol drinker. The incidence of OPSCC is increased due human papilloma virus (HPV) infection. The infection transition is associated with sex and oro-genital contact may lead to HPV-infection of oropharynx and oral cavity. There are multiple types of HPV, but the majority of OPSCC is associated with HPV 16 type. Epidemiology of HPV-associated OPSCC, HPV-infection of oral cavity and/or oropharynx and HPV detection are discussed in the review.

The article is devoted to the diagnosis and treatment of an extremely rare tumor – a sarcoma from follicular dendritic cells with extranodal lesion in the region of the head and neck. These tumors are characterized by a high potential for metastasis and recurrence. Difficulties in choosing the optimal treatment tactics are associated with a small number of observations. Surgical, radiotherapeutics and chemotherapy methods are used. The literature data and the description of 2 own clinical observations of the sarcoma from follicular dendritic cells (with the involvement of the maxillary sinus and the nasal cavity) are presented. Treatment (surgery followed by radiotherapy) was successful. The appointment of adjuvant therapy improves the results of treatment in comparison with the surgical method alone.