الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
It was aimed to evaluate the outcome of supraomohyoid neck dissection in treatment of oral squamous cell carcinoma OSCC stage I and II.
This study included 16 patients (11males and 5 females) with primary oral squamous cell carcinoma stage I, II and negative lymph node N0 with no metstasis M0, ages between 34-70 years with average age 57.5 years. They were selected from the outpatient clinic of Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Suez Canal University and also from outpatient clinic of Gharbia Cancer Society Hospital (Tanta).
The patients were divided into two equal groups according to the methods of treatment.
group I (8 patients):
Eight patients, 6 males and 2 females with age ranged from 34 to 66 years with a mean of 56 years. They were treated by excision of the lesion with at least 1cm safety margin.
group II (8 patients):
Eight patients 5 male and 3 female with age ranged from 40 to 70 years with a mean of 59 years were treated by excision of the lesion with at least 1cm safety margin and supraomohyoid lymph nodes dissection.
Medical and dental histories were recorded for each patient. All selected patients were complained of persistent ulcer with size larger than 1 centimeter in diameter which did not respond to conservative line of treatment for two weeks.
Summary and Conclusion
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Preoperative preparation:
All the selected patients with squamous cell carcinoma of the oral cavity (diagnosed by clinical & histopathological examinations) were subjected to dental protocol and preserve good oral hygiene. Preoperative radiographic examinations were performed by CT & MRI for each patient. 5 cm of blood was aspirated from each patient for serum CD44 level analysis by ELISA test. Postoperative clinical examination for pain, wound dehiscence, recurrence, edema and infection was done every 3 days for the 1st month then at 3, 6 and 9 months. CT MRI and serum CD44 level analysis were done for each patient at 3, 6 and 9 months postoperatively. The most common finding on clinical examination were an ulcer on the lateral surface of the anterior two thirds of the tongue (31.3%), floor of the mouth (25.0%), exophytic mass or ulcer on the retromolar region (18.8%), a mass or ulcer on the alveolus margin (12.5%), and an ulcer on the cheek (12.5%).
Different pathological entities were seen, however poorly differentiated squamous cell carcinoma was the most prominent variety accounting for 43.8% of the study group, well differentiated squamous cell carcinoma represented 31.2%, while moderately differentiated squamous cell carcinoma accounted for 25.0% of the studied group.MRI &CT findings were negative preoperatively and throughout the study follow up periods. Serum levels of CD44 were high in all patients with OSCC preoperatively. Serum levels of CD44 were decreased significantly (after surgical removal of the OSCC with supraomohyoid neck dissection) throughout the study follow up periods in group II. While in group I CD44 readings showed slight decrease (after surgical removal of the OSCC only), after 3month then return to increase gradually to be higher after 9 months postoperatively compared to preoperative readings. Recurrence was recorded in 4 cases of group I (50 %) and only one case (12.5%) in group II. Expression of CD44 level was increased in poorly differentiated squamous cell carcinoma than
Summary and Conclusion
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moderately or well differentiated squamous cell carcinoma respectively. Also increase the size of tumor is associated with increase CD44 level.
from the findings of this study we can conclude the followings:
- Wait and see strategy may be preferable in the management of early squamous cell carcinoma stage I of the oral cavity that not located at the tongue or floor of the mouth to reduce the mortality and morbidity (after excision of the squamous cell carcinoma of the oral cavity)
- Tumor site, size and grade may play direct role in increase the incidence of metastasis of squamous cell carcinoma of the oral cavity.
- Supraomohyoid neck dissection is an effective procedure in the management of early squamous cell carcinoma with N0 of the oral cavity.
- Correlation among CD44 readings, tumor size and grade revealed the sensitivity of CD44 as a marker in detecting the progress of the OSCC and metastasis.