THESIS SYNOPSIS

DR. APPASAB SANADI

DEPARTMENT OF ORAL AND MAXILLOFACIAL

SURGERY

A.B. SHETTY MEMORIAL INSTITUTE OF DENTAL SCIENCES, DERALAKATTE, MANGALORE – 575 018

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

4th BLOCK, JAYANAGAR,BANGALORE,KARNATKA

ANNEXURE-11

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / DR .APPASAB SANADI
POST GRADUATE STUDENT,
DEPT OF ORAL AND MAXILLOFACIAL
SURGERY,
A.B.SHETTY MEMORIAL INSTITUTE OF DENTAL SCIENCES.
DERALAKATTE- MANGALORE – 575 018
2. /

NAME OF THE INSTITUTION

/ A.B.SHETTY MEMORIAL INSTITUTE OF DENTAL SCIENCES.
DERALAKATTE – MANGALORE – 575 018
3. / COURSE OF THE STUDY AND SUBJECT / MASTER OF DENTAL SURGERY
DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY.
4. / DATE OF ADMISSION TO COURSE / MAY – 2008
5. / TITLE OF TOPIC
“INTRAOPERATIVE CYTOLGIC ASSESSMENT OF MANDIBULAR MARROW SCRAPINGS TO PREDICT RESECTION MARGIN STATUS IN PATIENTS WITH SQUAMOUS CELL CARCINOMA’’
6. / BRIEF RESUME OF THE INTENDED STUDY:
6.1) NEED FOR THE STUDY:
Neoplastic invasion of the mandible is a factor promoting the recurrence of oral carcinomas. Determining the presence and extent of bony involvement is therefore critical in the management of these patients. Where there is difficulty in defining the edges of the tumor at operation is of value1. However, for invasive bone tumors microscopic assessment of bony resection margins remains a problem because of the technical difficulty of sectioning undecalcified bone. Radiologic and clinical examination does not precisely identify the extent of bone involvement2. Combined use of MRI and CT may improve accuracy, but cannot be done intraoperatively.
Hence, a need remains for intraoperative microscopic confirmation of tumor clearance in the bone. This study will be done to assess the feasibility of intraoperative microscopic assessment of mandibular bone resection margins using cytologic examination of smear preparations of bone marrow scrapings.
6.2 REVIEW OF LITERATURE
A study showed that intraoperative cytologic analysis of marrow scrapings from the mandibular margins correctly predicts the presence of tumor and the method is feasible, accurate in the setting of mandibular resection3.
In a study done to assess the frozen sections of curetted cancellous bone at the resection margins (leaving behind the dense cortical bone, which cannot be sectioned). They found the method to correctly predict adequacy of resection in 97% of the margins studied4.
6.3 OBJECTIVES OF THE STUDY
1.  To predict the status of the resected mandibular margins intraoperatively by cytologic examination with patients undergoing segmental resection of mandible for treatment of squamous cell carcinoma.
2.  To assess the feasibility, accuracy and whether intraoperative application of the technique can give valuable guidance for adequate excision of bone invasive tumors.
7 / MATERIALS AND METHODS
7.1 SOURCE OF THE DATA
The study is set up in A B Shetty Memorial Institute Of Dental Sciences, Mangalore. The study group consists of 10 patients, irrespective of age and sex, suffering from oral squamous cell carcinoma requiring segmental resection of mandible.
7.2 METHOD OF COLLECTION OF DATA
Intraoperatively bone marrow and cancellous bone were sampled using a new sterile No. 15 scalpel blade for each site. Five scrapings will be obtained from each patient. Two scrapings will be obtained from the two residual ridges, and another 2 scrapings will be obtained from bony margins of the resected specimen. The fifth sample will be obtained as follows: The resected mandible will be sectioned at a point directly under the tumor where invasion of the mandible is expected. A scraping will be obtained from the marrow and cancellous bone at this site to act as a positive control.
Resultant 5 scrapings will be rolled and smeared along with any associated blood, onto dry microscope slides which will be coded and sent for immediate cytologic preparation and examination. The pathologist will be blind to the surgeon’s labeling code. These will be immediately fixed in alcohol, stained with modified Papanicolau method, mounted before light microscopic examination. Samples will be assigned to the fallowing 2 categories: 1) Negative (-ve) for the absence of malignant marrow cells. 2) Positive (+) for the presence of malignant marrow cells.
Resection specimens will be processed in the standard manner and they will be assessed histologically and categorized as either negative or positive.
INCLUSION CRITERIA
1. The patients diagnosed as oral squamous cell carcinoma involving mandible and requiring segmental resection.
EXCLUSION CRITERIA
1. Patients with oral squamous cell carcinoma with no evidence of mandibular involvement, who does not require segmental mandibular resection.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED IN PATIENTS OR OTHER HUMANS
Yes, the bone marrow and cancellous bone samples from the resected bone margins will be needed from the study group, after obtaining written informed consent.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION :
Yes, ethical clearance letter is enclosed.
8. / List of references
1.  Ord RA, Aisner S: Accuracy of frozen sections in assessing margins in oral cancer resection. J Oral Maxillofac Surg 55:663, 1997
2.  Totsuka Y, Usui Y, Tei K, et al: Mandibular involvement by squamous cell carcinoma of the lower alveolus: Analysis and comparative study of histologic and radiographic features. Head and Neck surg 13:40, 1991
3.  Shaukat Mahmood, David Conway, Keith C R B Ramesar: Use of intraoperative cytologic assessment of mandibular marrow scrapings to predict resection margin status in patients with squamous cell carcinoma. J Oral Maxillofac Surg 59:1138-1141, 2001
4.  Forrest LA, Sculler DE, Karanfilov B, et al: Update on intraoperative analysis of mandibular margins. Am J Otolaryngol 18:396, 1997
9. / SIGNATURE OF CANDIDATE
10. / REMARKS OF THE GUIDE:
11. / NAME AND DESIGNATION( IN BLOCK LETTERS) OF
11.1 GUIDE / DR. NIDARSH.D. HEGDE
PROFESSOR,
DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY,
A.B.SHETTY MEMORIAL INSTITUTE OF DENTAL SCIENCES, DERALAKATTE, MANGALORE- 575018.
SIGNATURE
11.2 CO-GUIDE ( if any )
/ DR. PUSHPARAJA SHETTY
PROFESSOR AND HEAD,
DEPARTMENT OF ORAL PATHOLOGY
A.B.SHETTY MEMORIAL INSTITUTE OF DENTAL SCIENCES, DERALAKATTE, MANGALORE- 575018.
SIGNATURE
11.3 HEAD OF THE DEPARTMENT / DR. S.M.SHARMA
PROFESSOR AND HEAD,
DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY,
A.B.SHETTY MEMORIAL INSTITUTE OF DENTAL SCIENCES, DERALAKATTE, MANGALORE- 575018.
11.4 SIGNATURE
11.5 REMARKS OF THE CHAIRMAN & PRINCIPAL
11.6 SIGNATURE
11.7 PRINCIPAL OF THE INSTITUTTION / DR. B. RAJENDRAPRASAD
PRINCIPAL AND DEAN,
A.B.SHETTY MEMORIAL INSTITUTE OF DENTAL SCIENCES, DERALAKATTE, MANGALORE- 575018.