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OBJECTIVES: The aim of this study is to evaluate long-term facial growth in adults previously treated for an isolated unilateral complete cleft lip, alveolus and palate by two-stage palatoplasty. MATERIALS AND METHODS: Unilateral cleft lip and palate (UCLP) patients of 17 years and older treated by two-stage palatoplasty were invited for long-term follow-up. During follow-up, lateral cephalograms were obtained (n = 52). Medical history was acquired from their medical files. Outcome was compared to previously published normal values and the Eurocleft study. RESULTS: Soft and hard palate closure were performed at the age of 8 (SD 5.9) months and 3 (SD 2.2) years, respectively. The mean maxillary and mandibular angle (SNA, SNB) were 74.9° (SD 4.2) and 75.8° (SD 3.8). Maxillary and maxillomandibular relationships (SNA, ANB) were comparable to all Eurocleft Centres, except for Centre D. We observed a significantly steeper upper interincisor angle compared to the Eurocleft Centres. CONCLUSIONS: This study describes the long-term craniofacial morphology in adults treated for a UCLP with hard palate closure at a mean age of 3 years. The mean maxillary angle SNA and mandibular angle SNPg were comparable to previous studies both applying early and delayed hard palate closure. The observed upper incisor proclination is likely caused by orthodontic overcorrection in response to the unfavourable jaw relationships. No clear growth benefit of this protocol could be demonstrated. CLINICAL RELEVANCE: The present study shows the long-term craniofacial morphology of UCLP adults after the Utrecht treatment protocol which includes two-stage palate closure.
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Labio Leporino/fisiopatología , Labio Leporino/cirugía , Fisura del Paladar/fisiopatología , Fisura del Paladar/cirugía , Desarrollo Maxilofacial/fisiología , Adolescente , Cefalometría , Labio Leporino/diagnóstico por imagen , Fisura del Paladar/diagnóstico por imagen , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
OBJECTIVE: In the treatment of bilateral cleft lip and palate (BCLP) patients, there is discussion about the management of the position of the premaxilla. This literature analysis summarises the literature on managing this condition. MATERIALS AND METHODS: A PubMed, Embase and Cochrane Library search was conducted resulting in 4465 articles which were screened on title and abstract. RESULTS: Seventy-one articles were available in full text, 16 of which were included in this literature analysis. We searched on keywords timing and technique, complications, growth of the maxilla and results after bone grafting the alveolar process. This literature analysis has shown that there are various ways to correct the position of the premaxilla. These can be divided into primary, early, late secondary and tertiary intervention before the age of 8 years, between the ages of 8 and 12 years and older than 12 years. Correction is done with surgery, orthodontics or a combination, with or without bone grafting. CONCLUSIONS: An osteotomy of the premaxilla in combination with secondary alveolar bone grafting appears to be the most successful technique. Combining early secondary alveolar bone grafting with osteotomy creates more room to ensure a watertight closure of the nasal mucosa resulting in fewer postoperative complications. Before surgery, the orthodontist should try to optimise the position of the premaxilla for its surgical correction prior to bone grafting. CLINICAL RELEVANCE: The treatment of BCLP patients is still based on experience and expert opinions. This literature analysis tries to give a summery on how to handle the protruded and displaced premaxilla.
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Labio Leporino/cirugía , Fisura del Paladar/cirugía , Maxilar/anomalías , Maxilar/cirugía , Adolescente , Trasplante Óseo , Niño , Preescolar , Labio Leporino/terapia , Fisura del Paladar/terapia , Humanos , Lactante , Maxilar/crecimiento & desarrollo , OrtodonciaRESUMEN
OBJECTIVE: Oral squamous-cell carcinoma (OSCC) still has a poor prognosis. Lymph node metastasis (LNM) is a major determinant of treatment decisions and prognosis. Serine protease inhibitor Kazal-type 5 (SPINK5) is the inhibitor of kallikrein 5 (KLK5) and KLK7. SPINK5, KLK5 and KLK7 are three of the genes of a recently validated LNM-predicting gene expression profile in OSCC. This study evaluates their clinicopathological role and value as biomarkers in OSCC. METHODS: Eighty-three patients with primary OSCC, treated surgically between 1996 and 2000, were included. Gene expression data were acquired from a previously reported study. Human papillomavirus (HPV) status was determined by an algorithm for HPV-16. Protein expression for KLK5, KLK7 and SPINK5 was semi-quantitatively determined in all 83 tumours by immunohistochemistry. All expression data were correlated with clinicopathological parameters. RESULTS: Concurrent loss of KLK5 and KLK7 correlates with worse disease-specific and overall survival (DSS and OS). Multivariate analysis proved that co-expression is an independent prognostic factor for DSS (p = 0.029) and OS (p = 0.001). CONCLUSION: This report demonstrates that concurrent loss of KLK5 and KLK7 associates with a poor clinical outcome in OSCC and could therefore serve as prognostic marker in this disease.
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Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/mortalidad , Calicreínas/genética , Neoplasias de la Boca/genética , Neoplasias de la Boca/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/genética , Biomarcadores de Tumor/aislamiento & purificación , Carcinoma de Células Escamosas/virología , Femenino , Regulación Neoplásica de la Expresión Génica , Papillomavirus Humano 16/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Tasa de SupervivenciaRESUMEN
BACKGROUND: Head and neck cancer (HNC) patients are prone to have a poor health-related quality of life after cancer treatment. This study investigated the effect of the nurse counselling and after intervention (NUCAI) on the health-related quality of life and depressive symptoms of HNC patients between 12 and 24 months after cancer treatment. METHODS: Two hundred and five HNC patients were randomly allocated to NUCAI (N=103) or usual care (N=102). The 12-month nurse-led NUCAI is problem-focused and patient-driven and aims to help HNC patients manage with the physical, psychological and social consequences of their disease and its treatment. Health-related quality of life was evaluated with the EORTC QLQ-C30 and QLQ H&N35. Depressive symptoms were evaluated with the CES-D. RESULTS: At 12 months the intervention group showed a significant (P<0.05) improvement in emotional and physical functioning, pain, swallowing, social contact, mouth opening and depressive symptoms. At 18 months, global quality of life, role and emotional functioning, pain, swallowing, mouth opening and depressive symptoms were significantly better in the intervention group than in the control group, and at 24 months emotional functioning and fatigue were significantly better in the intervention group. CONCLUSION: The NUCAI effectively improved several domains of health-related quality of life and depressive symptoms in HNC patients and would seem a promising intervention for implementation in daily clinical practice.
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Consejo , Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias de Cabeza y Cuello/terapia , Enfermeras y Enfermeros , Anciano , Anciano de 80 o más Años , Depresión/complicaciones , Depresión/epidemiología , Depresión/patología , Femenino , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Persona de Mediana Edad , Relaciones Enfermero-Paciente , Calidad de Vida , Conducta Social , Encuestas y CuestionariosRESUMEN
One hundred years ago the Great War, also known as the first world war, started. Historians consider the attack on the Austrian Archduke Franz Ferdinand on June 18, 1914 as the cause of the catastrophe. The initial war of movement turned into a 'Sitz Krieg', trench warfare. Many hundreds of thousands of military casualties were treated for a wide variety of facial wounds that resulted from the conflict. The origin of the specialisation oralmaxillofacial surgery is considered to be a consequence of these treatments. Several treatments dating from the first world war are still in use, such as the application of the 'dental splint' in fracture treatment, intra-oral transposition flaps for sealing small injuries and bone transplants from the iliac crest to restore defects of the jaw. In the Netherlands, which was neutral, experiences from the Great War were retained by the appointment in 1919 of a Lecturer in Oral Diagnosis and Oral Surgery at the University of Utrecht.
RESUMEN
OBJECTIVE: A small subset of patients with head and neck squamous cell carcinoma are non-smoking and non-drinking and have distinct clinical characteristics. We aimed to identify a possible different genetic profile for these patients when compared with their smoking and drinking counterparts. MATERIALS AND METHODS: The gene expression data previously detected from primary tumors located in the oral cavity and oropharynx, using DNA microarray was analyzed for their differential expression between non-smoking and non-drinking patients (n = 15) and smoking and drinking patients (n = 89). Student's T-test (P < 0.05) and 10-fold cross-validation procedure (100 times repeated) were performed to determine differentially expressed genes. RESULTS: Non-smoking and non-drinking patients were older, mostly female and had oral cavity-localized tumors, whereas smoking and drinking patients were younger male patients with 81% oral cavity and 19% oropharynx tumors. A set of 49 differentially expressed genes were detected. Among others, seven genes related to interferon-γ were upregulated and two genes linked to NFKB pathway were downregulated. CONCLUSIONS: Differentially expressed genes in non-smoking and non-drinking patients possibly indicate the presence of a different cellular response to carcinogenic events in these patients. Further studies are warranted to validate this gene set and explore possible therapeutic implications to improve prognosis for these patients.
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Carcinoma de Células Escamosas/genética , Perfilación de la Expresión Génica , Regulación Neoplásica de la Expresión Génica , Neoplasias de la Boca/genética , Neoplasias Orofaríngeas/genética , Adulto , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/genética , Femenino , Humanos , Sistema de Señalización de MAP Quinasas , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Proteínas Serina-Treonina Quinasas/metabolismo , Fumar/genética , Quinasa de Factor Nuclear kappa BRESUMEN
Patients with orofacial pains are generally treated by physicians. A small number of patients are treated for pain in the temporomandibular joint, the masticatory and the neck muscles, by dentists and orofacial surgeons. Among half of the patients being treated in neurological headache clinics, the temporomandibular joint and the masticatory muscles are the source of the pain. In order to achieve better research and a classification, the International Headache Society, consisting largely of neurologists, developed a classification system. A comparable development occurred among oral health specialists. Employing these 2 methods with the same patients leads to different diagnoses and treatments. Both the International Classification of Headache Disorders II and the Research Diagnostic Criteria for Temporomandibular Disorders are being revised. This creates the opportunity to establish a single classification for these orofacial pains, preferably within the new International Classification of Headache Disorders.
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Trastornos de Cefalalgia/clasificación , Trastornos de Cefalalgia/diagnóstico , Clasificación Internacional de Enfermedades/normas , Trastornos de la Articulación Temporomandibular/clasificación , Trastornos de la Articulación Temporomandibular/diagnóstico , Diagnóstico Diferencial , Dolor Facial/clasificación , Dolor Facial/diagnóstico , Humanos , MasticaciónRESUMEN
Selective serotonin reuptake inhibitors block the uptake ofserotonin into thrombocytes. One of the functions of serotonin in thrombocytes is to promote platelet aggregation. When serotonin levels are depleted after several weeks of treatment, the altered platelet function leads to increased risk of abnormal bleeding. In patients taking a combination of a selective serotonin reuptake inhibitor and a non-steroidal anti-inflammatory drug, the risk ofabnormal bleeding is thought to be even higher. A case is reported of abnormal bleeding after treatment in the oral cavity, associated with simultaneous use of a selective serotonin reuptake inhibitor and a non-steroidal anti-inflammatory drug. A large haematoma in the floor of mouth caused airway compromise which necessitated an emergency tracheotomy. Until greater insight is achieved by means of additional research, increased attentiveness for these patients seems to be called for and extra care should be employed. Additional haemostatic measures could be considered.
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Antiinflamatorios no Esteroideos/efectos adversos , Antidepresivos de Segunda Generación/efectos adversos , Hemorragia Posoperatoria/inducido químicamente , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Traqueotomía , Antiinflamatorios no Esteroideos/uso terapéutico , Antidepresivos de Segunda Generación/uso terapéutico , Interacciones Farmacológicas , Hematoma/complicaciones , Hematoma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Hemorragia Posoperatoria/complicaciones , Hemorragia Posoperatoria/cirugía , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéuticoRESUMEN
The current standard of care in alveolar cleft repair is timing the procedure in the mixed dentition stage and making use of autologous bone to restore the maxillary defect. Using a synthetic bone substitute bypasses the risk of donor site morbidity and reduces the operation time. In this study, the outcome of alveolar cleft repair using microporous beta-tricalcium phosphate (ß-TCP) was investigated in patients with unilateral cleft lip and palate. Twenty patients were enrolled prospectively in this study, divided between two centres. Continuity of the alveolar process, recurrence of oronasal fistulas, and eruption of teeth into the repaired cleft were evaluated at 1year postoperative. Also, cone beam computed tomography scans were analyzed using a volume-based semi-automatic segmentation protocol. No adverse events were reported. The mean residual bone volume in the repaired cleft at 1year postoperative was 65%. There was no recurrence of oronasal fistula. Furthermore, 90% of the teeth adjacent to the cleft erupted spontaneously and all patients showed a continuous alveolar process. Secondary alveolar grafting using microporous ß-TCP can safely be used in the clinical situation. Residual calcified tissue, canine eruption, and complication rates at the recipient site are comparable to those with autologous grafts.
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Labio Leporino , Fisura del Paladar , Proceso Alveolar , Trasplante Óseo , Fosfatos de Calcio , HumanosRESUMEN
BACKGROUND: Non-smoking and non-drinking patients with head and neck squamous cell carcinoma have different clinical characteristics than their smoking and drinking counterparts. They are predominantly older female patients with oral cavity tumors, however, both groups show the same percentage of second primary tumors. Expression of tumor suppressor gene p53 and proliferation marker Ki-67 in mucosal epithelial cells was analyzed to study whether biomarker expression is associated with a history of smoking and drinking and with single and multiple tumors. METHODS: Non-smoking and non-drinking patients with multiple (n = 18) and single tumors (n = 15), smoking and drinking patients with multiple (n = 15) and single tumors (n = 14) were selected. For all groups, p53 and Ki-67 expression patterns in non-tumorous (tumor-adjacent) mucosa including positivity of dispersed single cells and clusters for p53 and for suprabasal expression of Ki-67 were immunohistochemically analyzed and compared. RESULTS: p53 expression was significantly higher in users of tobacco and alcohol than in non-users. Ki-67 expression was not affected by tobacco and alcohol usage. Both Ki-67 and p53 were similarly expressed in the groups with single and multiple tumors and hence not significantly related to the number of tumors. CONCLUSIONS: Non-smoking and non-drinking patients with squamous cell carcinoma have the same risk for developing multiple tumors as their smoking and drinking counterparts. As this occurs without an increased expression of p53 or Ki-67, the significance of these proteins as biomarkers indicating pre-malignant mucosal alterations is doubtful. Further research is needed to clarify this predisposition for developing multiple head and neck cancer.
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Biomarcadores de Tumor/metabolismo , Carcinoma de Células Escamosas/metabolismo , Neoplasias de Cabeza y Cuello/metabolismo , Antígeno Ki-67/metabolismo , Neoplasias Primarias Múltiples/metabolismo , Proteína p53 Supresora de Tumor/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas , Carcinoma de Células Escamosas/patología , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/patología , Factores de Riesgo , FumarRESUMEN
Body dysmorphic disorder (BDD) is a severe psychiatric disease with delusions about defects in appearance for which patients seek surgical help. This is the first European study to determine the half-year prevalence of BDD in a maxillofacial outpatient clinic. A total of 160 patients with maxillofacial problems completed a validated self-report questionnaire, while a staff member scored maxillofacial defects on a severity scale. Twenty-eight (17%) patients had excessive concerns about their appearance, which negatively influenced their psychosocial functioning; 16 patients (10%; 95%CI 5-15%) screened positive for BDD. The high prevalence of problems related to psychosocial functioning and the occurrence of BDD in maxillofacial patients means that maxillofacial surgeons should take psychological concerns about physical defects into account.
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Imagen Corporal , Anomalías Maxilofaciales/psicología , Trastornos Somatomorfos/epidemiología , Cirugía Bucal/psicología , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Maloclusión/psicología , Maloclusión/cirugía , Persona de Mediana Edad , Países Bajos , Prevalencia , Autoevaluación (Psicología) , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/psicología , Síndrome de la Disfunción de Articulación Temporomandibular/psicología , Síndrome de la Disfunción de Articulación Temporomandibular/cirugía , Adulto JovenRESUMEN
The aim of this study was to determine the optimal combination of preoperative examination methods to predict mandibular invasion by squamous cell carcinoma of the oral cavity. Data were gathered prospectively but evaluated retrospectively. The preoperative results of clinical examination, conventional radiography, bone single photon emission computed tomography (SPECT), computed tomography and magnetic resonance imaging were compared to the histological results of resection specimens from 67 patients with tumours, adjacent or fixed to the mandible, histologically confirmed as squamous cell carcinoma. The examination methods with acceptable sensitivity and specificity were selected and diagnostic algorithms were constructed using all possible combinations. The preferred diagnostic algorithm was found to be either computed tomography or magnetic resonance imaging, followed by a bone SPECT in cases where the first scan is negative. A negative bone SPECT rules out mandibular invasion (100% sensitivity). This algorithm accurately predicted mandibular invasion in 85% of the patients, without yielding false negative results. In this study group, application of such an algorithm would have resulted in a reduction of the number of unnecessary mandibular resections by 50%. The suggested, preferred, diagnostic algorithm shortens the preoperative screening process, avoiding unnecessary costs, as well as considerably reducing the number of unnecessary mandibular resections.
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Algoritmos , Carcinoma de Células Escamosas/patología , Diagnóstico por Imagen , Neoplasias Mandibulares/patología , Neoplasias de la Boca/patología , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico por Imagen/estadística & datos numéricos , Reacciones Falso Negativas , Reacciones Falso Positivas , Femenino , Predicción , Humanos , Imagen por Resonancia Magnética/estadística & datos numéricos , Masculino , Mandíbula/patología , Persona de Mediana Edad , Invasividad Neoplásica , Estudios Prospectivos , Radiografía Panorámica/estadística & datos numéricos , Estudios Retrospectivos , Sensibilidad y Especificidad , Tomografía Computarizada de Emisión de Fotón Único/estadística & datos numéricos , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Procedimientos Innecesarios/estadística & datos numéricosRESUMEN
BACKGROUND & AIMS: A "microbrachytherapy" was developed as treatment option for inoperable tumours by direct intratumoral injection of radioactive holmium-166 ( 166 Ho) microspheres (MS). 166 Ho emits ß-radiation which potentially enables a high, ablative, radioactive-absorbed dose on the tumour tissue while sparing surrounding tissues. MATERIALS & METHODS: Safety and efficacy of 166 Ho microbrachytherapy were evaluated in a prospective cohort study of 13 cats with inoperable oral squamous cell carcinoma without evidence of distant metastasis. RESULTS: Local response rate was 55%, including complete response or partial response (downstaging) enabling subsequent marginal resection. Median survival time was 113 days overall, and 296 days for patients with local response. Side effects were minimal. Tumour volume was a significant predictor of response. DISCUSSION: Response rate may be further improved by optimizing the intratumoral spatial distribution of 166 Ho MS. CONCLUSION: 166 Ho microbrachytherapy has potential as a minimally invasive, single procedure radio-ablation treatment of unresectable tumours with minimal morbidity.
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Braquiterapia/veterinaria , Carcinoma de Células Escamosas/veterinaria , Enfermedades de los Gatos/radioterapia , Holmio/uso terapéutico , Neoplasias de la Boca/veterinaria , Radioisótopos/uso terapéutico , Animales , Braquiterapia/métodos , Carcinoma de Células Escamosas/radioterapia , Gatos , Femenino , Holmio/administración & dosificación , Inyecciones/métodos , Inyecciones/veterinaria , Masculino , Microesferas , Neoplasias de la Boca/radioterapia , Estudios Prospectivos , Radioisótopos/administración & dosificaciónRESUMEN
The aim of this study was to identify which factors are related to specialist delay and to determine the length of the diagnostic pathway in head and neck cancer patients. Three hundred and six patients with a carcinoma of the larynx, pharynx or oral cavity were included in the study. Logistic regression analysis was used to identify risk factors for specialist delay. Large (T3-T4) tumors showed significantly less specialist delay than small (T1-T2) tumors (p=0.045, odds ratio [OR]=0.6). Pharyngeal (p=0.00, OR=0.2) and oral carcinomas (p=0.00, OR=0.2) had less specialist delay than glottic carcinomas. Hoarseness was associated with prolonged specialist delay (p=0.00, OR=5.9). Heavy drinking in combination with smoking (p=0.005, OR=0.3), a sore throat (p=0.02, OR=0.4) or having a lesion (p=0.03, OR=0.2) showed a shorter diagnostic period. The duration of the diagnostic process in a general hospital ranged from 0 to 570 days, with a median of 14 days. Only a small group of patients met the ideal management standards in our head and neck clinic. Although prolonged delay was associated with small (glottic) tumors, the diagnostic process takes a fairly long time. The results indicate that continued educational programs for professionals are warranted.
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Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Células Escamosas/diagnóstico , Adolescente , Anciano , Anciano de 80 o más Años , Femenino , Neoplasias de Cabeza y Cuello/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias de Células Escamosas/fisiopatología , Derivación y Consulta , Factores de TiempoRESUMEN
Surgical treatment of malignancies involving the oral cavity often results in an altered anatomical situation, which may severely hamper oral function. Postoperative radiotherapy resulting in reduced salivary secretion further worsens functions such as speech, chewing (mastication) and swallowing. In order to improve oral functioning, the use of dental implants was proposed. To reconstruct the edentulous mandible, especially in cases involving postoperative irradiation, implant-borne prosthetic construction on four permucosal implants has been advocated, but this treatment concept has some practical drawbacks. As the chewing force is reduced as a result of irradiation of the masticatory muscles, it is hypothesized that a fixed prosthetic construction on only two implants is a feasible alternative. Up until now 10 patients have been treated successfully according to this concept at the authors' clinic.
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Carcinoma de Células Escamosas/radioterapia , Implantes Dentales , Prótesis Dental de Soporte Implantado , Dentadura Parcial Fija , Suelo de la Boca/efectos de la radiación , Neoplasias de la Boca/radioterapia , Anciano , Carcinoma de Células Escamosas/cirugía , Fracaso de la Restauración Dental , Diseño de Dentadura , Retención de Dentadura , Prótesis de Recubrimiento , Femenino , Estudios de Seguimiento , Humanos , Neoplasias de la Boca/cirugía , Satisfacción del PacienteRESUMEN
To improve the starting point for placement of dental implants, 45 patients suffering from atrophied edentulous mandibles, with a vertical height varying between 7.3 and 15.8mm, were treated by alveolar vertical distraction osteogenesis (VDO). The mean follow-up period was 3 years, ranging from 1 to 7 years. Associated complications, as occurred during instalment of the distractor device, VDO period and consolidation phase, and also after dental implant placement, were evaluated. Observed complications were: early fractures (2%), late fractures (17%), bleeding or haematoma (4%), infections (6%), skin perforation (2%), mucosal dehiscence (8%), sensory disturbances (28%), sagging chin (13%) and failure of dental implants (13%). In 10 patients 2 complications and in 1 patient 3 complications were monitored. All complications occurred in the first year. It is concluded that VDO to restore vertical bone height in patients with mandibular atrophy is a surgically delicate technique with a high risk of various complications. The likelihood of the most striking complication, namely fracture occurrence, increases with decreasing residual bone height.
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Mandíbula/cirugía , Osteogénesis por Distracción/efectos adversos , Trastornos Somatosensoriales/etiología , Dehiscencia de la Herida Operatoria/etiología , Infección de la Herida Quirúrgica/etiología , Adulto , Anciano , Implantación Dental Endoósea/efectos adversos , Femenino , Humanos , Estudios Longitudinales , Masculino , Mandíbula/anomalías , Mandíbula/inervación , Fracturas Mandibulares/etiología , Persona de Mediana Edad , Osteogénesis por Distracción/instrumentación , Osteogénesis por Distracción/métodosRESUMEN
A simple, modified method to evaluate changes in the nasolabial soft tissues after orthognathic surgery is presented. Eighteen healthy volunteers were photographed in a standardized manner with a 2-month interval. Pictures were taken with the soft tissues in repose and 'maximum closed mouth smile'. Discrepancies for repose and dynamic excursions (x and y coordinates) were calculated for the landmarks alare, crista philtri and cheilion. Multiple analysis of variance revealed no significant interaction for intra-observer variance and time of recording. Coefficients of reliability (repose: 90-99%, dynamic excursion (cheilion): >95%), Spearman correlation coefficients (repose: >0.8, dynamic: >0.6) and squared correlation (repose: >75%, dynamic: >50%) showed this method to be reliable for repose and dynamic excursions. The error of measurement was less than 1.8 mm for both repose and dynamic excursions (SD(differences)=0.9 mm). This is smaller than mean differences in nasolabial soft-tissues excursions found between the pre- and post-Le Fort I osteotomy situation in a previous study using video imaging. The discrepancies found were in keeping with other earlier reports for 2D and 3D measuring methods. The method as proposed is simple, cost effective and can be used to evaluate soft-tissue changes after orthognathic surgery.
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Cara/anatomía & histología , Osteotomía Le Fort , Fotograbar , Adulto , Cefalometría/métodos , Métodos Epidemiológicos , Femenino , Humanos , Labio/anatomía & histología , Masculino , Nariz/anatomía & histología , SonrisaRESUMEN
In a case of long-term sensory loss in the tongue following third molar extraction, a novel, efficient and effective psychophysical test was used. This initial test, which includes the presentation of pairs of a real and fake stimulus, and a forced-choice response, was applied to determine whether relatively thick or thin afferent fibres of the lingual nerve were affected. The results suggested that thick fibres on the right tongue side were mainly affected. Sensory loss was confirmed and its extent assessed by a standard test determining thresholds of light touch. Furthermore, sensory function was determined by an objective test based on inhibitory reflexes in masseteric electromyographic activity following electrical stimulation of oral tissue. Reflex features that are important for within-patient diagnosis are a difference between the injured and control sides in latency of the first reflex, and also in depth-contrast in signal amplitude between both sides at the post-stimulus time of the trough of an inhibition on the uninjured side. In agreement with the findings from the psychophysical tests, the finding of the absence of an early component of both inhibitions suggested sensory loss related to dysfunction of fast-conducting, relatively thick afferent fibres of the lingual nerve. Apart from being used for medicolegal reasons, the objective reflex test may have conclusive prognostic value or may influence surgical therapeutic decisions.
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Hipoestesia/etiología , Traumatismos del Nervio Lingual , Reflejo/fisiología , Lengua/inervación , Adulto , Frío , Estimulación Eléctrica/instrumentación , Estimulación Eléctrica/métodos , Femenino , Humanos , Enfermedad Iatrogénica , Neuronas Aferentes/fisiología , Neuronas Eferentes/fisiología , Estimulación Física/instrumentación , Estimulación Física/métodos , Placebos , Recuperación de la Función , Umbral Sensorial/fisiología , Extracción Dental/efectos adversosRESUMEN
Since the introduction of osteosynthesis materials for rigid internal fixation after anatomical reduction there is an ongoing discussion about the treatment of condylar fractures of the mandible. Sixty patient files were analyzed and 28 patients were seen for re-examination and a x-orthopantomogram was taken. Functionality was graded with the Helkimo index at an average of 3.0 years follow-up. The clinical dysfunction index showed: severe symptoms in 11%, moderate symptoms in 39%, mild symptoms in 39% and 11% had no symptoms. Index for occlusal state showed: 21% severe occusal disturbances, 61% moderate occlusal disturbances and 18% no occlusal disturbances. According to the anamnestic dysfunction index 89% of the patients were symptom-free. The clinical outcome group showed a significant left/right ramus length difference compared with a 20-person control group. The re-examined group did not significantly differ from the control group. Conservative treatment for condylar fractures was successful in only 46% according to the 1999 consensus criteria described by Bos et al.
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Cóndilo Mandibular/lesiones , Fracturas Mandibulares/terapia , Adolescente , Adulto , Anciano , Oclusión Dental , Dieta , Femenino , Estudios de Seguimiento , Humanos , Técnicas de Fijación de Maxilares , Masculino , Maloclusión/clasificación , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/fisiopatología , Fracturas Mandibulares/diagnóstico por imagen , Fracturas Mandibulares/fisiopatología , Persona de Mediana Edad , Examen Físico , Radiografía Panorámica , Rango del Movimiento Articular/fisiología , Factores de Tiempo , Resultado del TratamientoRESUMEN
A 72-year-old woman was referred to a department of oral and maxillofacial surgery because of a unilateral skin eruption of the face after extraction of the right first upper molar, a few days earlier. She had been diagnosed with chronic lymphocytic leukaemia some years before. It appeared to be herpes zoster or'shingles'from the second branch of the trigeminal nerve. Treatment included hospital admission with intravenous antiviral therapy and analgetics. Herpes zoster of the face is a severe infection and requires early treatment. Post herpetic neuralgia is a serious complication of herpes zoster and may adversely affect the quality of life.