Review of the Current Medical and Surgical Treatment Options for Microstomia in Patients With Scleroderma.

BACKGROUND: Most patients with scleroderma suffer from microstomia, which can have debilitating consequences on their quality of life. Unfortunately, treatment options remain limited. No specific guidelines exist; hence, microstomia remains a challenge to treat in this patient population. OBJECTIVE: This review aims to evaluate the different medical and surgical treatment modalities currently available for microstomia in patients with scleroderma and make recommendations for future research. MATERIALS AND METHODS: A search of PubMed, Ovid MEDLINE, and Ovid Embase was conducted to identify articles discussing the treatment of microstomia in scleroderma. Twenty articles discussing surgical therapy and one article discussing medical therapy were reviewed. RESULTS: Mostly because of a scarcity of high-level evidence, no individual therapy has documented long-term efficacy. Some treatments demonstrate positive results and warrant further research. CONCLUSION: Given the variability of results, specific recommendations for the treatment of microstomia in patients with scleroderma are difficult to establish. A multifaceted approach that includes surgical and medical therapy is likely the best option to improve oral aperture in this patient population. Surgical treatments such as neurotoxins, autologous fat grafting, and ultraviolet A1 phototherapy may hold the most potential for improvement.

Effects of Dexamethasone and Photobiomodulation on Pain, Swelling, and Quality of Life After Buccal Fat Pad Removal: A Clinical Trial.

PURPOSE: In this study we aimed to compare the effects of photobiomodulation (PBM) and dexamethasone (DXM) on pain, swelling, and the quality-of-life (QOL) of patients submitted to buccal fat pad removal. PATIENTS AND METHODS: A total of 20 patients with pseudoherniation of buccal fat pad were included in the present study. The patients were divided randomly into 2 groups: the PBM group (660 nm, 100 mW, 6 seconds, 2 J/cm2) and the DXM group (4 mg every 8 hours for 3 days after the procedure). Pain levels were evaluated using a visual analog scale at days 2 and 4 after surgery, whereas the edema was evaluated by measuring the distance between 6 reference points: tragus, pogonion of the soft tissue, lateral eye commissure, the gonial angle, nose wing, and mouth commissure at days 2, 4, 7, 15, 30, 60, and 90. The QOL was evaluated using the Oral Health Impact Profile 14 questionnaire at days 2 and 4 after surgery. RESULTS: There were no differences between the PBM and DXM groups in pain or edema. In terms of the QOL, the PBM group was significantly more comfortable when chewing than the DXM group (P < .05) CONCLUSION: The use of PBM at a power of 100 mW and 2 J/cm2 per point had similar effects to oral DXM for the control of pain and edema, as well as in the QOL, except for masticatory function, which was significantly better in the PBM group.

Radiological approach for the newly incorporated T staging factor, depth of invasion (DOI), of the oral tongue cancer in the 8th edition of American Joint Committee on Cancer (AJCC) staging manual: assessment of the necessity for elective neck dissection.

The 8th edition of American Joint Committee on Cancer's (AJCC) Cancer Staging Manual was modified by incorporating depth of invasion (DOI) in the T categorization of oral cavity cancer. This is because DOI is strongly associated with cervical lymph node metastasis, which is the most important negative prognostic factor of oral cavity cancer. This major change in the AJCC Cancer Staging Manual caused re-staging of T category in several cases. Although, the DOI on MRI and CT (radiological DOI; r-DOI) strongly correlated with pathological DOI (p-DOI), it is often 2-3 mm larger than p-DOI. Due to this variance, estimation of p-DOI based on r-DOI may not be accurate. However, when a lesion is undetectable on MRI, p-DOI was often smaller than 4 mm. On the other hand, when MRI depicts lesions with styloglossus and hyoglossus muscle invasion, p-DOI was always larger than 4 mm. These correlations between MRI findings and p-DOI are important when assessing the need for elective neck dissection, as the National Comprehensive Cancer Network (NCCN) recommends elective neck dissection in cases with DOI greater than 4 mm.

Diode Laser Photocoagulation of Intraoral and Perioral Venous Malformations After Tridimensional Staging by High Definition Ultrasonography.

Objective: To determine optimal settings for use of diode lasers to treat vascular malformations in the head and neck. Background: Diode lasers are generally accepted as effective tools to treat vascular malformations in the head and neck, yet there are no standardized treatment protocols for this treatment approach. Settings for these lasers, in addition to laser type and size and lesion depth are important variables for designing appropriate treatments for vascular malformations. Materials and methods: Vascular venous malformations (VeMs) were classified into five groups according to high-definition ultrasound measurements of superficial dimensions (<1, 1-3, and >3 cm) and lesion extension depth (≤5, and >5 mm). Using a 800 ± 10 nm diode laser for surgical procedures, we treated lesions by two different approaches: trans-mucous/cutaneous photocoagulation (8 and 12 W pulsed wave for cutaneous and mucosal lesions, respectively) and intralesional photocoagulation using a laser set to 13 W in the pulsed wave modality to treat both cutaneous and mucosal lesions. Results: We treated 158 vascular VeMs. According to preoperative staging, there were 52 lesions in Group A (superficial dimension <1 cm), 28 in Group B1 (superficial dimension from 1 to 3 cm, extension depth ≤5 mm), 16 in Group B2 (superficial dimension from 1 to 3 cm, extension depth >5 mm), 42 in Group C1 (superficial dimension >3 cm, extension depth ≤5 mm), and 12 in Group C2 (superficial dimension >3 cm, extension depth >5 mm). All Group A lesions showed complete healing after a single laser treatment, whereas 7%, 10%, 12%, and 16% of lesions classified in Groups B1, B2, C1, and C2, respectively, required further treatments. Conclusions: The laser settings defined in this study were associated with a reduced number of laser applications needed for effective treatment of vascular VeMs. Moreover, the cooling of irradiated tissues, together with prolonged application of a topical regenerative gel, provided good treatment acceptability, reduced the number of postoperative complications, and promoted faster healing of covering tissues.

Tratamento cirúrgico de lipoma: relato de dois casos / Surgical Treatment of Lipoma: Report of two cases

O lipoma é um tumor mesenquimal benigno, considerado um dos mais comuns dos tecidos moles. Ocorre, principalmente, no tronco, nas porções proximais das extremidades do corpo e na região de cabeça e pescoço, com incidência de 15 a 20% dos casos. Quando apresentado em região oral e maxilofacial, é relativamente raro, tendo uma incidência relativa de 1% - 4% dos tumores que acometem essa região. Clinicamente a lesão intraoral apresenta-se como aumento de volume nodular, assintomática, bem-circunscrita, de crescimento lento, com superfície lisa e consistência macia, que pode ser séssil ou pedunculada, de tamanho diverso, com coloração variando de amarelo discreto, em lesões superficiais, a rosa, semelhante à mucosa em lesões mais profundas. O trabalho tem como objetivo relatar dois casos de lipomas em regiões maxilofaciais, tratados cirurgicamente sob anestesia local e geral. Os pacientes encontram-se em acompanhamento, sem sinais de recidiva. É importante o correto diagnóstico clínico e anatomopatológico da lesão, para que seja definido o tratamento ideal e um bom prognóstico, já que essa lesão apresenta uma baixa taxa de recidiva... (AU)

Lipoma is a benign mesenchymal tumor, considered one of the most common one in soft tissues. They mainly occur in the trunk, in the proximal portions of the extremities of the body and in the region of the head and the neck, with incidence of 15 to 20% of cases. When present in the oral and maxillofacial regions, it is relatively rare, with a relative incidence of 1% -4% of the tumors affecting this region. Clinically, the intraoral lesion presents as a nodular volume increase, asymptomatic, well-circumscribed, slow-growing, with smooth surface and soft consistency - which may be sessile or pedunculated - of different size, with a coloration ranging from discrete yellow in superficial lesions to a mucosa-like pink in deeper lesions. The aim of this study is to report two cases of lipomas in maxillofacial regions surgically treated under local and general anesthesia. Patients are being followed up without signs of relapse. The appropriate clinical and pathological diagnosis of the lesion is important to define the ideal treatment and a good prognosis, since this lesion presents a low rate of recurrence... (AU)

[Dynamics of clinical changes and healing of purulent wounds in application of nanocapsules of phosphatidylcholine in complex of treatment of patients, suffering the oral cavity floor phlegmon].

Substantiation of expediency for nanocapsules of phosphatidylcholine (lipin) application, owing antihypoxant, antioxydant and immunostimulating action in complex of treatment of patients, suffering odontogenic phlegmon of oral cavity floor (OPHOCF), is presented. The preparation application have promoted a trustworthy reduction of exudation of purulent content, as well as more rapid occurrence of granulations and the wound epithelization.

Topical Ankaferd hemostat application for the management of oral cavity bleedings in children with hemorrhagic diathesis.

Ankaferd blood stopper (ABS) is a hemostatic agent used topically for controlling bleedings of skin or mucosal surfaces in Turkey. It is currently topically used in bleedings of body injuries, traumas, and minor or major surgical interventions. Here we have evaluated 12 pediatric patients with hemorrhagic diathesis on whom Ankaferd was used for oral bleedings. Topical Ankaferd was administered for hemorrhages of oral cavity during 15 bleeding attacks. ABS administrations successfully stopped the bleedings, except for one patient with oral hemorrhage who did not respond to ABS application. Ankaferd is effective for oral bleedings of children with bleeding diathesis especially when other measures have failed.

Needle breakage during local anesthesia in the oral cavity--a retrospective of the last 50 years with guidelines for treatment and prevention.

Needle breakage in the oral cavity after local anesthesia is a common complication with possible serious complications of injuring vital structures. There are different possible reasons for needle breakage, with a main focus on preventable mistakes in treatment. In this study, an analysis of literature of the last 50 years as well as own cases has been performed to renew knowledge and prevention and therapy strategies for this serious complication. A systematic, multilingual review of medical literature from 1900 until today was conducted and information was evaluated systematically. In the majority of cases needle fracture happened during inferior alveolar nerve block. It is mainly a problem due to inadequate technique or the use of too thin needles for the performance of inferior alveolar nerve block. Different arguments about possible therapy strategies and methods exist. Basically, if a hypodermic needle fractures, it should be removed surgically under general anesthesia. To localize the fragment, use of either multi-plane X-rays or fluoroscopy with at least two reference needles in place or, if possible, of three-dimensional CT scans is recommended. This article shows, that despite progression in material, needle fracture is still an existing, preventable problem, if some basic rules are followed.

Regional anesthesia for office-based procedures in otorhinolaryngology.

Local and topical anesthetic techniques have long been used for office-based procedures in otorhinolaryngology. There are numerous advantages to using local and topical anesthesia for office-based procedures, including a shorter recovery period, decreased health care cost, and the maintenance of a conscious patient who can communicate with the surgeon and maintain his or her own airway during the procedure. In this manuscript, we review the local and topical anesthetic techniques that can be used for otorhinolaryngic procedures including anesthesia of the external face, ear, nose, oral cavity, nasopharynx, oropharynx, hypopharynx, and larynx.

[Prevention of inflammatory complications after osteoplastic operations in oral cavity].

It was established that every patient carried out through the oral osteoplastic operation needs immunoprophylaxis to avoid postoperative complications. It doesn't depend on the initial level of the immunity. Asa casual prophylaxis Licopid is recommented. But only one prophylaxis willbenot enough if the anamnesis has any chronical oralfacial disease. The great attention should be taken to the immunocorrection.

Iatrogenic pyogenic osteomyelitis of C-1 and C-2 treated with transoral decompression and delayed posterior occipitocervical arthrodesis. Case report.

The authors describe a case of osteomyelitis of the craniocervical junction caused by iatrogenic infection of the spine during corticosteroid injection therapy. This 58-year-old diabetic man presented with acute exacerbation of neck pain that had began 4 months prior to admission. He did not experience the associated fever, chills, or sweats, but he did notice transient weakness in the right upper extremity. A computed tomography (CT) scan of the cervical spine demonstrated a destructive process involving the odontoid and the left occipitocervical and atlantoaxial joints that was not present on a CT obtained 2 months earlier, just before trigger-point and left-sided C1-2 facet joint corticosteroid injections. A diagnosis of staphylococcal osteomyelitis was made, and initial treatment with external immobilization and appropriate antibiotic therapy failed to control radiographically demonstrated and clinical progression. The patient was successfully treated using staged anterior decompression and posterior instrumented fusion with prolonged antibiotic therapy. To the authors' knowledge this case is the first reported instance of iatrogenic pyogenic osteomyelitis of the craniocervical junction successfully treated with anterior decompression and delayed posterior arthrodesis.

[Implantation with natursil as a method for repair of dental defects and normalization of oral homeostasis]. / Implantatsiia s ispol'zovaniem natursila kak sposob vosstanovleniia defektov zubnykh riadov i normalizatsii narushenii gomeostaza polosti rta.

Parameters of homeostasis in the oral liquid during adentia, after implantation of titanium implants gated in generally accepted way and also with usage of natursilum from Silybum marianum were studied. Application of natursilum in surgery and in postoperative period promoted optimization of an implant osteointegration and normalized physicochemical and metabolic parameters of the oral liquid.

Memory and midazolam conscious sedation.

OBJECTIVE: To investigate the degree of amnesia seen in patients undergoing minor oral surgery with intravenous midazolam sedation. SETTING: Hospital out-patients in the UK in 1995-6. SUBJECTS: 24 patients undergoing minor oral surgery procedures under local anaesthetic, with or without midazolam sedation, as determined by clinical need. METHOD: Picture cards were shown to patients before and during the procedure. Post-operatively, before discharge and 1 week later, the patients were questioned about their memory of both the pictures and procedure. RESULTS: The sedated group demonstrated more amnesia for the pictures shown after the start of treatment, but their memory of the pretreatment pictures was initially better than that of the non-sedated patients. The non-sedated patients exhibited no memory loss for the surgical procedure. Recall of the surgery was very variable among the sedated patients, from some remembering all aspects, to others with no recollection after the venepuncture. Overall, the sedated patients exhibited significantly greater amnesia for the surgical procedure. The degree of amnesia in the sedated group was also investigated with respect to pretreatment anxiety levels, sedation level achieved and the dose of midazolam administered. The first two variables did not exhibit any effect on the memory loss, but higher doses (> 5 mg) were associated with more consistent amnesia especially for the later stages of the procedure. CONCLUSION: Midazolam can produce useful amnesia in many patients and the memory loss can be high for both artificial and procedural stimuli. However this study suggests that the amnesia is not completely reliable, especially at lower doses.

Is surgery necessary in stage III and stage IV cancer of the head and neck that responds to induction chemotherapy?

OBJECTIVE: To study the influence of surgery in patients who achieve a response to induction chemotherapy. DESIGN: Nonrandomized retrospective study. SETTING: Comprehensive cancer center. PATIENTS: The records of all patients with state III and stage IV squamous cell carcinoma of the oral cavity, oropharynx, and hypopharynx were reviewed at the Queensland Radium Institute, South Brisbane, Australia, in the years 1970 through 1990. INTERVENTIONS: There were 314 patients where induction chemotherapy was used as part of a curative treatment. Complete response occurred in 20 patients, partial response in 110 patients, nonresponse in 162 patients, and unknown response in 22 patients. To assess the impact of surgery, the responders were divided into two treatment groups: one group (n = 57) received chemotherapy surgery, and radiotherapy (C/S/XRT), and a second group (n = 73) received chemotherapy and radiotherapy (C/XRT). MAIN OUTCOME MEASURES: Five-year survival, local failure, nodal failure, and distant failure. RESULTS: The 5-year actuarial survival for the chemotherapy responders and nonresponders was 58% and 43%, respectively (P < .05). When analyzed by treatment group, those receiving C/S/XRT had a 65% 5-year survival (95%) confidence intervals [CIs], 53 to 78) and those receiving C/XRT had a 56% 5-year survival (95% CI, 44 to 70). However, when the complete responders were assessed, those receiving C/S/XRT had a 90% 5-year survival (95% CI, 72 to 99) vs a 51% survival (95% CI, 18 to 89) for those treated with C/XRT. For the partial responders, the survival for the groups C/S/XRT and C/XRT were 59% (95% CI, 45 to 79) and 53% (95% CI, 41 to 67), respectively. Chemotherapy responders were less likely to fail locally if they were treated with C/S/XRT than with C/XRT (21% vs 43%, P < .01). CONCLUSION: The results suggest that surgery still has a role to play in patients who achieve a response with chemotherapy, even when the response is complete.

An approach to some dilemmas and complications of office oral surgery.

This article reviews an eclectic collection of problems. There is no particular reason why any one of them was chosen other than that they are more likely to occur in the course of practice than some other complications such as an oro-antral fistula or trauma to the lingual nerve or tissue emphysema. These latter and some other predicaments were discussed in the course of the talks given by the author at the 28th Australian Dental Congress in March 1995. The problems discussed in this paper are: 1. Dentoalveolar abscess anaesthesia. 2. Inability to obtain effective anaesthesia. The complications: 1. Post-extraction haemorrhage. 2. Syncope. 3. Postoperative infection.

Cost-effectiveness of homoeopathic treatment in a dental practice

Dentists who accept social security patients in Germany today are bound by a large number of rules and regulations which impose severe limits on their free choice of treatment, cost-effectiveness being a prime consideration. The treatment of acute conditions predominates in a modern compulsory insurance practice. The author analysed his own case record and the statistics provided by the KZV (association of dental practitioners for patients with compulsory insurance) for the period from 1983 to 1990 to establish the effect of introducing consistent use of homoeopathic treatment from the end fo 1984 on the frequency with which certain standard treatments were required. The results were compared with the average figures of other dentists and a computation made of potential economic advantages at a national level

Perioral dermabrasion: clinical and experimental studies.

From 1985 through 1989, 54 patients with wrinkles around the lips and in the chin area were treated by dermabrasion. Significant improvement, lasting longer than three years, was achieved using both types of abrading tool: the wire brush and the diamond fraise. The side effects of dermabrasion were permanent but very slight bleaching in 66% of the patients and formation of milia in less than 20%. The surgical technique is described in detail. Dermabrading tools were tested at different speeds on excess cheek skin at facelift. Histological examination showed that the diamond fraise left a smooth abraded surface and the wire brush left an uneven surface. EMLA cream, usually used for skin surface analgesia, was tested as an adjunct to anesthesia in dermabrasion. EMLA's analgesic performance alone was insufficient in the sensitive perioral region, but it elevated pain threshold and decreased the required amount of local anesthetic solution. Five types of dressing were used and the speed of epithelialization and postoperative comfort were compared. At present Vigilon is the most suitable dressing for dermabrasion. The main advantage of dermabrasion over the chemical peel is the absence of severe depigmentation.