RESUMO
Patients with oral cancer have poor nutritional status before treatment. However, there have been no reports of the detailed evaluation of preoperative oral function in patients with oral squamous cell carcinoma (OSCC). Therefore, this study aimed to evaluate the preoperative oral function of patients with OSCC and examine the relationship with nutritional status. Oral function measurements (microorganisms, oral dryness, occlusal force, tongue pressure, masticatory function, Eating Assessment Tool, and Postoperative Oral Dysfunction Scale) and Mini Nutritional Assessment-Short Form (MNA-SF) data were collected from 51 patients with OSCC (men: 37, women: 14, mean age: 72.1 years) who visited the Shimane University Hospital, Department of Oral and Maxillofacial Surgery, from September 2019 to September 2021. The tongue was the most prevalent primary gingiva site [22 patients (43.1%)], and 36 patients (70.6%) had advanced cancer. Comparisons between nutritional status and each related factor revealed significant differences in the number of individuals in the household, cancer stage, presence of pulmonary disease, number of teeth, microorganisms (grade), and masticatory function (mg/dL) (p < 0.05). Multiple regression analysis using the total MNA-SF score as the dependent variable with adjustment for confounding factors showed significant association between oral dryness and tongue pressure (p < 0.05). No significant association was found for the Eating Assessment Tool or Postoperative Oral Dysfunction scale. Patients with OSCC may have decreased oral function because of the tumor at the time of diagnosis, which causes a decline in nutritional status. Preoperative interventions are necessary to improve nutrition based on the state of oral function.
Assuntos
Carcinoma de Células Escamosas , Desnutrição , Neoplasias Bucais , Masculino , Humanos , Feminino , Idoso , Estudos Transversais , Língua/fisiologia , Neoplasias Bucais/complicações , Neoplasias Bucais/cirurgia , Pressão , Estado Nutricional , Avaliação NutricionalRESUMO
Radical tumor resection for oral cancer can cause morphological and esthetic disorders and oral and maxillofacial dysfunction and maintaining a social life could become challenging, especially in the adolescents and young adults(AYA)generation. Conversely, chemoradiotherapy for young patients may cause adverse reactions such as impaired fertility and late side effects of radiation. Therefore, treatment should be performed cautiously. We report a case of AYA generation patient who underwent salvage surgery and maxillofacial reconstruction for recurrent tongue cancer after super-selective intra-arterial chemoradiotherapy. The patient was a 30-year-old woman who was 20 weeks pregnant. She was diagnosed with Stage â ¢ squamous cell carcinoma of the right tongue, cT3N0M0. After abortion, the patient underwent super-selective intra-arterial chemoradiotherapy and achieved a complete response. However, 13 years later, a recurrence of Stage â £A tongue cancer, r- cT4aN2bM0, was reported. Additionally, the patient had osteoradionecrosis. We performed radical tumor resection(bilateral neck dissection plus subtotal glossectomy plus segmental mandibulectomy)and maxillofacial reconstruction with a fibula flap. Subsequently, we performed occlusal reconstruction treatment using dental implants. Three years postoperatively, no tumor recurrence was observed, and the patient was satisfied with the restored morpho-aesthetic and maxillo-oral functions.
Assuntos
Neoplasias Bucais , Neoplasias da Língua , Adulto , Feminino , Humanos , Quimiorradioterapia , Retalhos Cirúrgicos/patologia , Língua/patologia , Neoplasias da Língua/cirurgia , Neoplasias da Língua/patologia , GravidezRESUMO
The treatment of advanced lower gingival carcinoma requires postoperative chemoradiotherapy; therefore, simultaneous hard-tissue reconstruction may not be indicated. In these cases, mandibular reconstruction is performed using a temporal reconstruction plate and various skin flaps. Herein, we reported 2 cases of advanced lower gingival carcinoma treated with a novel computer-assisted patient-specific, fully custom-made mandibular reconstruction plate system(Cosmofix®)in combination with a pedicle/free flap. In case 1, an 80-year-old female patient was diagnosed with right lower gingival carcinoma( cT4aN3bM0, Stage â £B). Under general anesthesia, she underwent tracheostomy, bilateral neck dissection, segmental mandibulectomy, and mandibular reconstruction using Cosmofix® in combination with an ulnar forearm free flap. In case 2, an 81-year-old male patient was diagnosed with right lower gingival carcinoma(cT4aN2bM0, Stage â £A). The patient underwent maintenance dialysis and required minimally invasive surgery using a pedicle flap. Under general anesthesia, the patient underwent tracheostomy, right modified radical neck dissection, segmental mandibulectomy, and mandibular reconstruction using Cosmofix® in combination with a pectoralis major myocutaneous flap. Postoperative facial morphology, occlusion, eating, swallowing, articulation, and other dysfunctions were minimal in both the cases. Adjuvant chemoradiotherapy was recommended. In conclusion, the utilization of the Cosmofix® system enabled both esthetic and functional reconstruction following segmental mandibulectomy for advanced lower gingival carcinoma.
Assuntos
Carcinoma , Neoplasias Gengivais , Reconstrução Mandibular , Procedimentos de Cirurgia Plástica , Masculino , Feminino , Humanos , Idoso de 80 Anos ou mais , Neoplasias Gengivais/cirurgia , Retalhos Cirúrgicos/cirurgia , Carcinoma/cirurgiaRESUMO
We report a case of advanced lower gingival carcinoma treated with a computer-assisted custom-made surgical guide and reconstruction plate system(TruMatch®)in combination with a pectoralis major myocutaneous flap. In a 74-year-old male patient, a neoplastic lesion with a 30×30 mm periapical induration was observed around an extraction socket of left mandibular third molar. After various examinations, we diagnosed lower gingival carcinoma(cT4aN2bM0, Stage â £A). The patient was a paraplegic with a spinal cord injury, and reconstruction of mandible with free flap was not indicated, requiring minimally invasive surgery. Therefore, a surgical guide and reconstruction plate were prepared preoperatively using the Tru- Match® system. Under general anesthesia, the patient underwent tracheostomy, left modified radical neck dissection, segmental mandibulectomy, and reconstruction of the mandible using this system in combination with a pectoralis major myocutaneous flap. Postoperatively, the patient had minimal dysfunction. Currently, at 18 months follow up postoperatively, good prognosis was observed. In conclusion, this is a useful surgical system with accurate and less invasive surgery for segmental mandibulectomy of advanced lower gingival carcinoma.
Assuntos
Neoplasias Ósseas , Carcinoma , Neoplasias Gengivais , Reconstrução Mandibular , Procedimentos de Cirurgia Plástica , Masculino , Humanos , Idoso , Neoplasias Gengivais/cirurgia , Retalhos Cirúrgicos/cirurgia , Mandíbula/cirurgia , Carcinoma/cirurgia , Neoplasias Ósseas/cirurgia , ComputadoresRESUMO
Oral and maxillofacial trauma is influenced by various factors, including regional characteristics and social background. Due to the coronavirus disease 2019 (COVID-19) pandemic, a state of emergency was declared in Japan in March 2020. In this study, we aimed to examine the dynamics of patients with oral and maxillofacial trauma over a 12-years period using interrupted time-series (ITS) analysis. Patients were examined at the Shimane University Hospital, Maxillofacial Trauma Center from April 2012 to April 2023. In addition to general patient characteristics, data regarding the type of trauma and its treatment were obtained from 1203 patients (770 men and 433 women). Group comparisons showed significant differences in age, trauma status, method of treatment, referral source, route, and injury occasion. ITS analysis indicated significant changes in combined nasal fractures, non-invasive reduction, and sports injuries (P < 0.05), suggesting COVID-19 significantly impacted oral and maxillofacial trauma dynamics. A pandemic of an infectious disease may decrease the number of minor trauma cases but increase the number of injuries from outdoor activities, resulting in no overall change in the dynamics of the number of trauma patients. Medical systems for oral and maxillofacial trauma should be in place at all times, independent of infectious disease pandemics.
Assuntos
COVID-19 , Análise de Séries Temporais Interrompida , Traumatismos Maxilofaciais , Humanos , COVID-19/epidemiologia , Feminino , Masculino , Traumatismos Maxilofaciais/epidemiologia , Adulto , Pessoa de Meia-Idade , Idoso , Japão/epidemiologia , Pandemias , Adulto Jovem , Adolescente , SARS-CoV-2/isolamento & purificação , Centros de Traumatologia/estatística & dados numéricos , Criança , Idoso de 80 Anos ou maisRESUMO
Key Clinical Message: A case of dentinogenic ghost cell tumor occurring simultaneously with a clinically diagnosed odontoma. The occurrence of epithelial and mesenchymal tumors at the same site is very rare, but should be kept in mind during pathological diagnosis. Abstract: Dentinogenic ghost cell tumor (DGCT) is a rare and benign odontogenic tumor composed of ghost cells, calcified tissue, and dentin. We present an extremely rare case of a 32-year-old female who was clinically diagnosed with an odontoma presenting with a painless swelling in her maxilla. Radiographic examination showed a well-defined radiolucent lesion with tooth-like calcified areas. The tumor was resected under general anesthesia. No recurrence was noted at the 12-month follow-up. Histopathological examination of the surgically resected tumor yielded a diagnosis of DGCT with odontoma.
RESUMO
Bone stabilization using osteosynthesis devices is essential in maxillofacial surgery. Owing to numerous disadvantages, bioresorbable materials are preferred over titanium for osteofixation in certain procedures. The biomaterials used for osteosynthesis in maxillofacial surgery have been subdivided into four generations. No study has compared the tissue responses generated by four generations of biomaterials and the feasibility of using these biomaterials in different maxillofacial surgeries. We conducted an in vivo animal study to evaluate host tissue response to four generations of implanted biomaterial sheets, namely, PLLA, PLLA/PGA, u-HA/PLLA, and u-HA/PLLA/PGA. New bone volume and pertinent biomarkers for bone regeneration, such as Runx2, osteocalcin (OCN), and the inflammatory marker CD68, were analyzed, and the expression of each biomarker was correlated with soft tissues outside the biomaterial and toward the host bone at the end of week 2 and week 10. The use of first-generation biomaterials for maxillofacial osteosynthesis is not advantageous over the use of other updated biomaterials. Second-generation biomaterials degrade faster and can be potentially used in non-stress regions, such as the midface. Third and fourth-generation biomaterials possess bioactive/osteoconductivity improved strength. Application of third-generation biomaterials can be considered panfacially. Fourth-generation biomaterials can be worth considering applying at midface due to the shorter degradation period.
RESUMO
Maxillofacial bone defects are treated by autografting or filling with synthetic materials in various forms and shapes. Electrospun nanobiomaterials are becoming popular due to their easy placement and handling; combining ideal biomaterials extrapolates better outcomes. We used a novel electrospun cotton-like fiber made from two time-tested bioresorbable materials, ß-TCP and PLLA/PGA, to check the feasibility of its application to maxillofacial bone defects through an in vivo rat mandibular bone defect model. Novel ß-TCP/PLLA/PGA and pure ß-TCP blocks were evaluated for new bone regeneration through assessment of bone volume, inner defect diameter reduction, and bone mineral density. Bioactive/osteoconductivity was checked by scoring the levels of Runt-related transcription factor x, Leptin Receptor, Osteocalcin, and Periostin biomarkers. Bone regeneration in both ß-TCP/PLLA/PGA and ß-TCP was comparable at initial timepoints. Osteogenic cell accumulation was greater in ß-TCP/PLLA/PGA than in ß-TCP at initial as well as late phases. Periostin expression was more marked in ß-TCP/PLLA/PGA. This study demonstrated comparable results between ß-TCP/PLLA/PGA and ß-TCP in terms of bone regeneration and bioactivity, even with a small material volume of ß-TCP/PLLA/PGA and a decreased percentage of ß-TCP. Electrospun ß-TCP/PLLA/PGA is an ideal nanobiomaterial for inducing bone regeneration through osteoconductivity and bioresorbability in bony defects of the maxillofacial region.
RESUMO
Oral dysfunction and dysphagia after oral cancer treatment are linked to altered nutritional status. We aimed to identify specific oral functions related to nutritional status. We conducted a cross-sectional study from September 2019 to December 2021, recruited 75 participants (median age: 72.0 years), including 52 males and 23 females, collected background data, and evaluated oral function. The Mini Nutritional Assessment-Short Form (MNA-SF) scores were divided into three groups (normal nutritional status, at risk of malnutrition, and malnourished), and a multi-group comparison was conducted for each oral function measurement (microorganisms, oral dryness, occlusal force, tongue pressure, masticatory function, and Eating Assessment Tool [EAT-10]). The primary tumor site was the tongue in 31 patients (41.3%), gingiva in 30 (40.0%), and others in 14 (18.7%). Multiple comparisons revealed significant differences in occlusal force, tongue pressure, masticatory function, and EAT-10 levels, categorized as Type I (Transport type) and Type III (Occlusion type) postoperative oral dysfunctions, between each MNA-SF group. Multiple regression analysis showed a statistically significant association with MNA-SF in terms of masticatory function and EAT-10 levels, categorized as Type I. Type I and Type III are risk factors for malnutrition, confirming that different types of postoperative oral dysfunction require unique nutritional guidance.
Assuntos
Desnutrição , Neoplasias Bucais , Idoso , Estudos Transversais , Feminino , Avaliação Geriátrica , Humanos , Masculino , Desnutrição/complicações , Neoplasias Bucais/complicações , Estado Nutricional , Pressão , LínguaRESUMO
OBJECTIVES: It has been reported that in many cancer types, the evaluation of complications and side effects of treatment differs between subjective and objective evaluations. The purpose of this study is to verify whether the evaluation of postoperative oral dysfunction following oral cancer treatment was consistent subjective and objective evaluations. MATERIALS AND METHODS: This cross-sectional study collected background data and evaluated the oral function (microorganisms, oral dryness, occlusal force, tongue pressure, masticatory function and eating assessment tool [EAT-10]) of 75 patients from September 2019 to December 2021. The postoperative oral dysfunction-10 (POD-10) was used for the subjective assessment of dysfunction in oral cancer patients. Also, Matsuda-Kanno classification was used for the objective assessment. The kappa coefficient between POD-10 and oral dysfunction was calculated for the degree of agreement. The relationship between oral function measurements and POD-10 was examined by multiple regression analysis. RESULTS: The patients' median age was 72.0 (25-75 percentile: 64.0-78.0) and 69.3% were male. The kappa coefficients indicating the degree of agreement with POD-10 were 0.41 (P < 0.01) for occlusal force, 0.27 (P = 0.01) for masticatory function, and 0.59 (P < 0.01) for EAT-10. Multiple regression analysis showed a significant association of occlusal force (ß = -0.33, P = 0.03) and EAT-10 (ß = 0.80, P < 0.01) with POD-10. CONCLUSIONS: For postoperative oral dysfunction type III (occlusal type), the evaluations of subjective and objective evaluations tended to be consistent. However, for type I (transport type) and II (oral hygiene type), these evaluations may be prone to overestimation or underestimation by either the medical professional or the patient.
Assuntos
Neoplasias Bucais , Língua , Idoso , Força de Mordida , Estudos Transversais , Feminino , Humanos , Masculino , Mastigação , Neoplasias Bucais/cirurgia , PressãoRESUMO
The advent of bioresorbable materials to overcome limitations and replace traditional bone-reconstruction titanium-plate systems for bone fixation, thus achieving greater efficiency and safety in medical and dental applications, has ushered in a new era in biomaterial development. Because of its bioactive osteoconductive ability and biocompatibility, the forged composite of uncalcined/unsintered hydroxyapatite and poly L-lactic acid (u-HA/PLLA) has attracted considerable interest from researchers in bone tissue engineering, as well as from clinicians, particularly for applications in maxillofacial reconstructive surgery. Thus, various in vitro studies, in vivo studies, and clinical trials have been conducted to investigate the feasibility and weaknesses of this biomaterial in oral and maxillofacial surgery. Various technical improvements have been proposed to optimize its advantages and limit its disadvantages. This narrative review presents an up-to-date, comprehensive review of u-HA/PLLA, a bioactive osteoconductive and bioresorbable bone-reconstruction and -fixation material, in the context of oral and maxillofacial surgery, notably maxillofacial trauma, orthognathic surgery, and maxillofacial reconstruction. It simultaneously introduces new trends in the development of bioresorbable materials that could used in this field. Various studies have shown the superiority of u-HA/PLLA, a third-generation bioresorbable biomaterial with high mechanical strength, biocompatibility, and bioactive osteoconductivity, compared to other bioresorbable materials. Future developments may focus on controlling its bioactivity and biodegradation rate and enhancing its mechanical strength.