Mesenchymal stem cells - a promising perspective in the orofacial cleft surgery.

Autologous bone grafts provide the golden standard for closure of oronasal fistulas in the cleft palate. Augmentation may be performed also by homografts and various xenogenic or alloplastic materials to prevent morbidity at the donor site but they may cause many problems (transmission of infections, immune response etc.). All the mentioned approaches also often reveal recurrences of the fistulas and prolong suffering of the cleft patients. Combination of mesenchymal stem cells (MSCs) and so called "platelet gel" seems to be a perspective method in this way. The platelet gel contains hydroxyapatite particles mixed with platelet rich plasma coagulated under effect of the calcium ions. The MSCs from the pelvic bone marrow aspirate are cultivated on a scaffold (collagen membrane) for 3-4 weeks before placement into the cleft defect. The method provides promising results in the alveolar clefts. Authors document a successful case of the secondary surgery in 25-year-old man with the unilateral complete cleft (Fig. 5, Ref. 10).

Condensing osteitis in oral region.

Condensing osteitis is defined as pathologic growth of maxillomandibular bones characterized by mild clinical symptoms. The bone thickening reflects the impaired bone rearrangement in response to mild infection of dental pulp. This clinical study describes case reports of patients sent to us with radiological findings and clinical examination that failed to lead to definitive diagnosis. On differential diagnosis, all bone tissue tumors were considered. Based on clinical and radiological findings (bone density and trabeculation of the bone) we settled on the diagnosis of osteitis condensans, which allowed us to remain in conservative therapy in terms of observing the patient (Fig. 3, Ref. 26). Full Text (Free, PDF) www.bmj.sk.

[Effectiveness of cisplatin with continuous infusion of 5-fluorouracil in neoadjuvant chemotherapy of carcinoma of the oral cavity]. / Efektivita cisplatiny s kontinuálnou infúziou 5-fluorouracilu v neoadjuvantnej chemoterapii karcinómov ústnej dutiny.

The effect of neoadjuvant chemotherapy regimen utilizing cisdiaminodichloroplatinum (CDDP) with continuous 5-day infusion of 5-fluorouracil (5-FU) was analyzed during the treatment of 23 patients with histologically established epidermoid carcinoma of the oral cavity. All but four patients were in clinical stage III or IV of the disease and seven of them had an inoperable tumor. No one had been treated previously. Complete response after three courses of the chemotherapy was obtained in 13 patients (56.5%) and partial response in 8 (34.8%). The overall response amounted to 91.3%. Only two tumors showed no response to the therapy after one and two courses respectively. The former patient did not continue the chemotherapy due to toxicity and the latter because of its minimal effect. During therapy the disease did not progress in any of the patients studied. Neoadjuvant chemotherapy with CDDP and continuous 5-FU infusion lasting 120 hours was found to be both tolerable and an effective part of the complex management of oral cavity carcinoma without the risk of delaying subsequent definitive treatment. (Tab. 9, Ref. 18).

[Toxicity of cisplatin with continuous infusion of 5-fluorouracil in neoadjuvant chemotherapy of carcinoma of the oral cavity]. / Toxicita cisplatiny s kontinuálnou infúziou 5-fluorouracilu v neoadjuvantnej chemoterapii karcinómov ústnej dutiny.

The intensity and dynamism of the toxicity of the neoadjuvant chemotherapy regimen utilizing cis-diaminodichloro-platinum (CDDP) with continuous 5-day infusion of 5-fluorouracil (5-FU) was recorded and analyzed during the treatment of 23 patients with histologically established epidermoid carcinoma of the oral cavity. The most frequent sign of toxicity was leukopenia and nausea/vomiting, both occurring in 78% of cases. Leukopenia was more frequent and serious than reported in other studies. On the contrary, nephrotoxicity was mild and less frequent (17%) compared to literary data. Diarrhea was associated with the administration of CDDP in 31%, minimal hair loss was recorded in 21% of cases. Other signs of toxicity were rare and mild. The degree of severity of toxicity was increasing with the number of treatment courses only with respect to hematologic parameters. No life-threatening complications were recorded. In seven cases continuous treatment had to be interrupted after three days due to leukopenia. With regard to toxicity, the applied treatment schedule (three courses) is fully acceptable, safe and suitable as neoadjuvant chemotherapy in the complex management of oral cavity carcinoma without the risk of delaying subsequent definitive treatment.