Background: ameloblastoma is a common tumor found in head and neck disorder. The definitive treatment include resection of tumor and reconstruction for filling the large defect which left after tumor resection. The reconstruction option which can be done is flap method. In this case, we used sternocleidomastoid-clavicle myoosseus flap in our patient with post traumatic plate displacement post resection and reconstruction of ameloblastoma. Case: a 22-year-old woman presented with unstability of jaw after hitting her chin to the table since 3 days prior to admission. On 2011, she had history of ameloblastoma which got resected and reconstructed with fibular graft and plate in the same year. While the plate seemed to be broken, she was managed with plate removal and reconstruct with sternocleidomastoid-clavicle myoosseus flap. Post operation, patient managed with gradual diet from liquid to solid. Observation Post Operation Day (POD) 3, flap is vital. Patient is discharged on POD 7 and visit as outpatient every 3-5 days until POD 14. Finally, we remove the suture, operation scar is good, and the flap is vital during one year follow up. Conclusion: sternocleidomastoid-clavicle myoosseus flap is practical and safe procedure, which can be used as alternative option in mandible reconstruction.
Background: Platelet-lymphocyte ratio (PLR) is known associated with the prognosis of distant metastatic breast cancer. Tumor-infiltrating lymphocyte (TIL) in breast cancer also associated with the prognosis of distant metastatic breast cancer. In this study, we will examine the relationship between PLR and TIL, in association with the metastatic incidence in breast cancer.Methods: This research is a retrospective, analytic, cross-sectional study. Data was taken from medical records of breast cancer patients at Sanglah general hospital. Samples were taken by nested sampling by selecting all breast cancer patients from the period of January 1st, 2017, to December 31st, 2018, which had complete medical record data, with total sample 211. The PLR and TIL were calculated and analyzed in relation to metastasis incidence of breast cancer.Results: The sample characteristics were sorted by age, education, occupation, the area of origin, menstrual status, breast cancer staging, breast cancer subtype, TIL levels, lymphovascular invasion (LVI) status, metastatic status, and breast cancer grading. The data were analyzed to know the association of PLR, TIL, confounding factors in relation to metastatic incidences. In the sample group with PLR ≥ 156 10µ /µL, there were 22.9% cases of metastases (p = 0.002). The sample group at low TIL had metastatic event 12.5% with (p=0.442).Conclusions: PLR was associated with higher metastasis in breast cancer patients and low TIL had no association with breast cancer metastasis.
Background: embryonal rhabdomyosarcoma is common of rhabdomyosarcoma, usually in 5 years old child. Approximately 28% of embryonal rhabdomyosarcomas occur in head and neck area, and 0.04% of cases occur as intra-oral tumors. Case: a 13 years old female complained of a firm and painless progressive mass in her right mandibular retromolar 6 months prior to her current medical check-up. There was a reddish 8x5 cm mass on the right posterior mandibular region. Mid face CT scan showed a well-bordered solid mass in her right oral cavity expanding to the right maxilla without bone destruction nor intracranial expansion. Incisional biopsy concluded the morphology as an embryonal rhabdomyosarcoma. Four series of neoadjuvant chemotherapy of vincristine, adriamycin, and cyclophosphamide (VAC) regimen gave partial response clinically and was followed by right marginal mandibulectomy procedure. Histopathological surgical specimen examination showed no active cancer cells. Adjuvant chemotherapy was given afterward. The result is good cosmetically and functionally. Discussion: retromolar embryonal rhabdomyosarcoma is diagnosed by physical examination of progressive and firm retromolar mass, retromolar mass with or without nearby-structures invasion radiologically, and confirmed by histopathology examination. Neoadjuvant chemotherapy showed partial response clinically. Complete tumor resection with adequate surgical margin is the key for a successful therapy. Conclusion: embryonal rhabdomyosarcoma is rare. The treatment plan and outcome are unique in every patient depending on the location of the tumor, the histological type, and the respectability. Pathological examination and CT scan play a significant role in diagnosing and making a good surgical plan. Early diagnosis and complete resection with adequate surgical margin is the key for a successful therapy.
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