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Background and Objectives: An increasing incidence of non-melanoma skin cancer (NMSC) is noted, as well as an increasing cost of the treatment, with NMSC becoming a public health problem. We aimed to investigate the prevalence and treatment costs of surgically treated NMSC from the Oral and Maxillofacial Surgery Department of Cluj-Napoca County Hospital. Materials and Methods: We retrospectively analyzed the clinical data and the charge data of hospitalization from the informatic system of Cluj-Napoca County Hospital. All patients benefited from standard surgical excision with the reconstruction of the post-excisional defect. A statistical analysis of the costs related to the patients' features, period and conditions of hospitalization, materials, medication, and paraclinical investigations was performed. Results: Between 2015 and 2019, 133 patients with NMSC were addressed to our department, with basal cell carcinoma (BCC) being four-fold higher than squamous cell carcinoma (SCC). Most NMSC cases were diagnosed in stage I or II, and they benefited from local reconstruction. The treatment costs progressively increased in the last five years, reaching a total cost of EUR ~13.000 in 2019. The treatment cost per episode was higher for SCC compared to BCC, while the total cost of treatment in 5 years was higher for BCC. Low income, immunosuppression, comorbidities, flap reconstruction option, long-lasting surgery, and prolonged hospitalization were associated with an increased cost of the treatment. Conclusion: The prevalence and treatment cost of surgically treated NMSC of the head and neck region increased in the last five years, with high-cost drivers being related to patients and treatment options.
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Carcinoma Basocelular , Carcinoma de Células Escamosas , Neoplasias Cutáneas , Humanos , Prevalencia , Estudios Retrospectivos , Neoplasias Cutáneas/cirugía , Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/cirugía , Costos de la Atención en SaludRESUMEN
Background and Objectives: The research aimed at evaluating the capacity of salivary exosomal miR-10b-5p and miR-486-5p for oral and oropharyngeal cancer detection. Materials and Methods: The saliva samples were harvested from histopathological diagnosed oral and oropharyngeal squamous cell carcinoma patients and healthy volunteer subjects. The exosomes were isolated by differential ultracentrifugation and quantified by Nano Track Analysis. The microRNAs were extracted and quantified from salivary exosomes by quantitative Real-Time Polymerase Chain Reaction. Results: This research comprised fifty participants. When compared to healthy controls, salivary exosomal miR-486-5p was elevated and miR-10b-5p was reduced in oral and oropharyngeal squamous cell carcinoma. Moreover, miR-486-5p had a high expression level in stage II of cancer in comparison to the other cancer stages. The cancer samples presented an increased exosome dimension compared to the control samples. Conclusions: Salivary exosomal miR-10b-5p and miR-486-5p have an altered expression in oral and oropharyngeal cancer.
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Exosomas , MicroARNs , Neoplasias Orofaríngeas , Carcinoma de Células Escamosas de Cabeza y Cuello , Humanos , Exosomas/genética , Exosomas/metabolismo , Regulación Neoplásica de la Expresión Génica , Neoplasias Orofaríngeas/genética , Neoplasias Orofaríngeas/metabolismo , Carcinoma de Células Escamosas de Cabeza y Cuello/genética , Carcinoma de Células Escamosas de Cabeza y Cuello/metabolismoRESUMEN
Background. Medication-related osteonecrosis of the jaw (MRONJ) and osteoradionecrosis (ORN) are associated with severe disability and continuous pain, both of which are very difficult to control. This study aims to evaluate the outcome of platelet-rich fibrin (PRF) treatment compared to iodoform gauze packing and the primary suture of oral mucosa in patients with both MRONJ and ORN. Methods. Patients suffering from MRONJ and ORN who were treated in the Oral and Maxillofacial Surgery Clinic of Cluj-Napoca in the last 10 years were selected for this study from the hospital database. Results. PRF treatment proved to be a reliable method to help heal the necrotic bone sites. High-ASA risk patients and immunosuppressed patients are more prone to recurrence and persistent signs and symptoms. Intravenous bisphosphonates produce more intense symptomatology compared to oral administration. The posterior mandible is more difficult to treat compared to other sites. Conclusions. The quality of life of MRONJ and ORN patients may be improved by a protocol that reduces pain and hospitalization.
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Background: The COVID-19 era has been a bleak period for both cancer and non-cancer patients, with delayed non-emergency treatments, such as for non-melanoma skin cancer (NMSC). This study aimed to evaluate how the treatment of NMSC patients was influenced by the management of the COVID-19 pandemic in an Eastern European Maxillofacial Surgery center. Materials and Methods: A total of 176 patients with a histopathological diagnosis of head and neck NMSC who were surgically treated in Cluj-Napoca Emergency County Hospital between 2016 and 2022 were included in this study, and divided into two samples, pre-pandemic (2016-2019) and COVID-19 (2020-2022) periods. Results: The pandemic presented with a decrease of 46.15% in patients' hospitalization, with wealthy and educated patients being prevalent. Even if the waiting time for surgery was increased, the stage of cancer and preference method for reconstruction did not differ. Despite the lower addressability of NMSC patients during the pandemic, there were no changes in surgical treatment. Conclusions: During COVID-19, the number of patients was reduced, with a longer waiting time for surgery, but without any changes in tumor stage and treatment preferences. However, the benefit of removing a cancer tumor is higher compared to the risk of developing COVID-19 infection during hospitalization.
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Background. The management of odontogenic infections varies across the globe. To shed light on the subject, this study delves into the practices of the Oral and Maxillofacial Department at Cluj-Napoca County Hospital. Material and Methods. This comprehensive retrospective analysis of 10 years of clinical experience covered a range of factors, including demographics, clinical and investigations factors, medical and surgical treatment approaches, and follow-up. Additionally, the study examined the change in trends over the course of the COVID-19 pandemic. Results. While head and neck infection occurrence had a decreasing trend before the COVID-19 pandemic, during the pandemic era the number of patients almost doubled. The infections were prevalent in the submandibular space, teeth being the prevalent cause. Young adults are prone to suffer from odontogenic infections. High levels of C reactive protein, ASA II-IV risk, and hepatic dysfunction indicated a longer time of hospitalization. The majority of antibiograms were negative, and the positive ones indicated Streptococcus and Staphylococcus species as prevalent pathogens. Extra- or intraoral surgical drainage and wide-spectrum antibiotics proved to be the workhorse for odontogenic infections. Conclusion. This study advances our understanding of oral and maxillofacial surgery and offers actionable strategies for improving patient outcomes in similar healthcare institutions worldwide.
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INTRODUCTION: Ameloblastoma is a borderline bone tumor that origins from the residual epithelium of the teeth germs, the epithelium of the enamel organ or the epithelium of odontogenic cysts. Ameloblastoma management is challenging owing to the necessity of tumor radical excision and the functional and aesthetic reconstruction of the surgical defect. The fibula-free flap (FFF) provides a high-quality and predictable mandibular reconstruction due to the high-caliber vascular pedicle, the bone length that can reconstruct large defects, the possibility for implants-based prosthetic reconstruction, and the possibility of harvesting a composite flap that can replace the mucosa, hence protecting the underlying bone reconstruction. CASE REPORTS: We report adult female and elder male patients, who were addressed to our hospital for mandible swelling and histopathological results of ameloblastoma. The lesions were treated by segmental mandibulectomy and FFF reconstructions. Osteosynthesis plates and screws were enough for the female patient's reconstruction of the lateral mandible defect and a load-bearing plate was necessary for the male patient's reconstruction of the surgical defect that included the anterior part of the mandible. The facial artery was used in both cases, and the surgeries lasted approximately 8 hours. No recurrence was observed at the follow-up and the aesthetic function was well re-established. CONCLUSION: Radical treatment of ameloblastoma is mandatory. The aesthetic function could be properly maintained by FFF. Also, the FFF reconstruction is a reliable method for head and neck large bone and soft tissue defects, microvascular anastomosis on facial artery offering a good blood SUPPLY OF THE FLAP. KEY WORDS: Ameloblastoma, Fibula-free flap, Maxillofacial reconstruction, Radical treatment.
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Ameloblastoma , Colgajos Tisulares Libres , Neoplasias Mandibulares , Procedimientos de Cirugía Plástica , Adulto , Humanos , Masculino , Femenino , Anciano , Ameloblastoma/cirugía , Neoplasias Mandibulares/cirugía , Mandíbula/cirugíaRESUMEN
BACKGROUND Odontogenic keratocysts are odontogenic cysts that increase in dimension based on growth factors and have a high recurrence rate. The radiological features of odontogenic keratocysts can be confusing owing to their similarity with other intraosseous cysts. The aim of treatment is to minimize patient morbidity and to reduce the risk of recurrence, along with complete surgical excision. CASE REPORT We report a case of a young man who presented to our hospital for a cystic lesion located in the posterior left mandible with clinical and radiological features of a dentigerous cyst. The lesion was treated accordingly for this diagnosis by enucleation. During surgery, a thick and firm cystic membrane was identified. Histopathological examination of the specimen established the final diagnosis of odontogenic keratocyst by identifying squamous epithelium with focal parakeratosis and ulceration and a diffuse inflammatory lymphoplasmacytic infiltrate. The patient's evolution was favorable, with no sign of recurrence on cone beam computed tomography examination at the 6-month follow-up and with healing of the surgical defect. CONCLUSIONS The diagnosis of odontogenic keratocyst is challenging, requiring preoperative 3-dimensional imaging and biopsy for extensive lesions. Adjuvant biochemical and immunological examination of cystic aspirate could sometimes be helpful for making a correct diagnosis. The treatment needs to be individualized according to the patient's age and the tumor's histopathological type and features. If the histopathological examination of surgical specimen indicates a more aggressive lesion than expected, a careful and individualized follow-up is imperative. No reintervention is needed if the patient does not present evidence of recurrence.
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Quistes Odontogénicos , Tumores Odontogénicos , Humanos , Masculino , Quistes Odontogénicos/diagnóstico por imagen , Quistes Odontogénicos/cirugía , Tumores Odontogénicos/patología , RadiografíaRESUMEN
BACKGROUND: Dentigerous, follicular, cysts are developmental odontogenic cysts of reduced adamantine epithelium origin, associated with an impacted tooth. They are the second most frequent cystic pathology after inflammatory cysts. Although the frequency of dentigerous cysts associated with upper third molars is far lower than the mandibular ones, their complications are nothing but ordinary. Most of the times asymptomatic, being discovered during routine x-ray examinations, maxillary follicular cysts can grow to important size, altering the position of adjacent teeth, producing osteolysis of the nearby bone structures, as well as infectious complications, antral and orbital pathology. CASE REPORT: The present manuscript describes the clinical, radiological, pathological and therapeutical aspects of a giant follicular cyst with antral and pterygomaxillary extension, associated with an impacted upper third molar. CONCLUSION: The most efficient treatment of maxillary follicular cysts consists in the surgical removal of the lesion along with the involved tooth. Complete excision is mandatory to prevent recurrence. Extension into adjacent structures might complicate the surgery Preoperative evaluation and rigorous planning are essential, especially in large-sized lesions. Pathological examination is outmost importance in order to exclude aggressive transformations. KEY WORDS: Dentigerous follicular cyst, Maxillary sinus extension, Pterygomaxillary space.
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Quiste Dentígero , Quiste Folicular , Enfermedades de los Senos Paranasales , Diente Impactado , Quiste Dentígero/complicaciones , Quiste Dentígero/diagnóstico por imagen , Quiste Dentígero/patología , Quiste Dentígero/cirugía , Quiste Folicular/complicaciones , Quiste Folicular/diagnóstico por imagen , Quiste Folicular/patología , Quiste Folicular/cirugía , Humanos , Masculino , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/cirugía , Enfermedades de los Senos Paranasales/complicaciones , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Enfermedades de los Senos Paranasales/patología , Enfermedades de los Senos Paranasales/cirugía , Diente Impactado/diagnóstico por imagen , Diente Impactado/etiología , Diente Impactado/cirugía , Adulto JovenRESUMEN
The aim of the present work was to prepare a series of novel restorative giomers and investigate the morphology, the physico-chemical properties (residual monomer, fluoride release), and the cytotoxicity of the new materials. The experimental giomers were prepared as light-cured pastes by blending different resin matrices comprising aromatic/aliphatic/urethane (di) methacrylates, with hybrid fillers containing pre-reacted glasses (PRGs), a radiopaque glass, and nano fluorhydroxyapatite. Polyalkenoic acids based on acrylic acid/itaconic acid/N-acryloyl -L-leucine modified or not with methacrylic groups, together with a superficially active glass, were used to prepare the PRGs. The fluoride ion release of the experimental giomers was investigated within a period of 60 days of storage in bidistilled water while using a fluoride ion selective electrode. Beautifil II commercial product was used as a reference. Cell cytotoxicity tests were done in vitro, in accordance with ISO 10993-122012 proceedings. Human dermal fibroblasts and umbilical endothelial vein cultures were used. The values that were obtained for cumulative fluoride release for all experimental giomers were higher than for the Beautifil II product, being more than twice the ones that were obtained for the commercial product after 60 days of storage in bidistilled water. The experimental biomaterials showed similar and/or better results when compared to the commercial one; this effect was maintained in all tested conditions.