Treatment of the carcinoma of the lip through high dose rate brachitherapy.

OBJECTIVES: The objective of the present study is to value the results obtained in the treatment of 28 patients a prospective group, affected of upper lip carcinoma treated through external molds of high dose rate brachytherapy. DESIGN OF THE STUDY: A total of 28 patients affected of lip carcinoma were treated through superficial ready--made molds and high dose rate brachytherapy. The dose of radiation given was 6,000 to 6,500 cGy in 33 to 36 fractions of 180 cGy on tumors up to 4 centimeters of diameter. On the big tumors the dose given was 7,500 to 8,000 cGy in 43 to 46 fractions. The patients were followed every 3 months, evaluating in each visit the local control, regional and at distance of the tumor, the existence of complications or sequels and the aesthetic result obtained. RESULTS: All the patients completed the foreseen treatment. All the cases had complete remission of the tumor. During the period of pursuit local relapses were not detected neither regional or at distance. Patients did not present immediate or late complications during the treatment. In the observations made 6 and 12 months after the treatment 27/28 patients had excellent or good aesthetic results. CONCLUSIONS: Because of the high control of the tumor,good tolerance to therapy, absence of complications and reverts,easy employment of molds, accuracy in positioning the source in the daily repetition of the treatment and the security that offers for radioprotection,we conclude that this therapy will probably be of habitual use the next years.

Dental management of the complications of radio and chemotherapy in oral cancer.

The most common malignancy of the oral cavity is epidermoid or squamous cell carcinoma, which accounts for approximately 5% of all neoplasms. Unfortunately, the great majority of these tumors are diagnosed in stages which require surgery with radio- and chemotherapy. Radiotherapy constitutes an important option in the treatment of oral tumors, and can be applied either alone or in combination with surgery and chemotherapy. The latter has no precisely defined role in the treatment of squamous cell carcinomas, and is usually used as a coadjuvant therapy or for palliative purposes. Since these treatments affect not only the malignant cells but also the healthy tissues of the patient, side effects usually develop during and after treatment, in the form of oral lesions and systemic alterations. Examples include mucositis, xerostomia, immune suppression, and viral and fungal infections, among other problems. The present study offers a management protocol for the oncological patient before, during and after radio- and chemotherapy. In addition, emphasis is placed on the important role of the dental professional in the prevention and treatment of the main oral complications, proposing dental management guidelines which are applicable in the general clinical context.

Tuberous sclerosis and its oral manifestations. A clinical case.

Tuberous sclerosis (TS) is a congenital anomaly in the development of the embryo which is transmitted through the autosomal dominant gene. It has various forms of clinical expression. It is classified as one of what are known as Phacomatoses (phakos stain and oma tumour), which are development anomalies that can originate tumours and/or hamartomas in the nervous system. Lesions in the nervous system are nearly always accompanied by cutaneous anomalies. In this study we introduce the case of a woman patient aged 55, diagnosed several years earlier with Tuberous Sclerosis, who attended for intraoral lesions which were clinically compatible with fibromata. These lesions of fibrous appearance occurred above all on the lower lip and in both cheeks' mucous membranes, little mentioned in the literature as a site for such a manifestation of TS. The pathological anatomy suggested lesions compatible with Angiomyolipoma. In addition, the data referring to TS are reviewed; its implications for the mouth are described; and histopathological results are used to examine the significance of the word Angiomyolipoma.

The quality in the radiology department.

In the last three years, the Spanish juridical ordinance has regulated (mostly the radiologic protection area) the essential quality that every radiodiagnostic and dentistry unit should comply with. This quality, as in every service, rests on the competence of the professional's who perform it. This means that in advanced countries much time and effort is dedicated to forming these people and therefore the academic charge for teaching dentistry radiology in Venezuela results 15 times higher than what is dedicated in our environment. Also, the supply of graduates or specialized radiologists is very poor; for example, it does not exist in Barcelona while in Merida the radiology service staff has 4 licentiates exclusively dedicated to oral radiology assistance and teaching (apart from two other people who work as technicians). This wealth influences positively in the quality of the service. Among other things, it allows the readjustment of the incoming petitions and also to justify them better and makes possible that all the explorations go out with the corresponding judgment. The academic quality in this discipline is also high due to the fact that it is a university teaching service. Our goal, through this work, is to show the situation of the problem comparing 2 different university services of oral radiology and reveal the lacks found with its solutions.