Decompression as a treatment for odontogenic cystic lesions of the jaw.

PURPOSE: To evaluate the effectiveness of decompression as the primary treatment of odontogenic cystic lesions of the jaw involving factors that affect relative shrinking speed and bone regeneration. PATIENTS AND METHODS: A total of 32 patients with odontogenic cystic lesions of the jaw underwent decompression with customized thermoplastic resin stents. Clinical examinations and pre- and postdecompression panoramic radiographs were analyzed. RESULTS: The mean relative speed of shrinkage of radicular cysts (RCs; 3.37 cm(2)/month) was faster than those of keratocystic odontogenic tumors (KCOTs; 2.87 cm(2)/month) and unicystic ameloblastomas (UABs; 2.71 cm(2)/month). The relative shrinking size increased linearly in a time-dependent manner for KCOTs (r = 0.849, P < .001), RCs (r = 0.681, P = .319), and UABs (r = 0.146, P = .730); a similar relation was detected between the primary radiolucent area of cystic lesions before decompression and relative shrinking speed after decompression in KCOTs (r = 0.481, P = .032), RCs (r = 0.260, P = .673), and UABs (r = 0.370, P = .366), but patient age did not affect the relative speed of shrinkage (P > .05). Furthermore, the increase in bone density was more significant in RCs than in KCOTs (P = .026) and UABs (P = .012) after decompression. CONCLUSION: Decompression was effective in reducing odontogenic cystic lesions of the jaw and increasing bone density. For aggressive lesions, secondary definitive surgery was necessary.

[Optimal design by customized plate on reconstruction of maxillary unilateral defect via free fibula flap].

PURPOSE: To optimize reconstruction of maxillary unilateral defect by free fibula flap rapidly through 3D printing technique. METHODS: 3D models of reconstruction of unilateral maxillary defect by free fibula flap was established via CAD/CAM, metal customized plates and resin osteotomy guides were designed and manufactured via 3D printing technique, simulating operation was performed on models in vitro, and reconstructive accuracy after surgical simulation was analyzed using SPSS 18.0 software package. RESULTS: Digital models involving reconstructive bone and affiliated devices (plates and guides) were established and fabricated rapidly. There was no significant difference between simulating point on computer and surgical simulating point in vitro. CONCLUSIONS: The optimized design and customized plate can increase the accuracy of reconstruction of maxillary defects with free fibula in vitro, which is helpful for accurate surgical reconstruction.

Quality of Life in Patients After Maxillectomy and Placement of Prosthetic Obturator.

PURPOSE: The aim of this study was to assess quality of life (QoL) and obturator functioning in patients having undergone a maxillectomy as a tumor ablative resection and rehabilitation with a prosthetic obturator. MATERIALS AND METHODS: The University of Washington Quality of Life scale version 4 (UW-QoLv4) and the Obturator Functioning Scale (OFS) were used to evaluate the self-reported QoL and obturator functioning. The effects of demographic and treatment variables on QoL were assessed using age, defect size, postoperative radiotherapy (RT), neck dissection, and dentition. RESULTS: The study included 16 men and 13 women with a mean age of 48.8 years. Of the 29 patients, 16 had a Brown Class 2a or smaller defect and 13 had a Brown Class 2b or larger defect. The mean OFS score (P = .004) and the physical (P = .001) and social-emotional function scores (P = .001) of the patients who received postoperative RT were significantly lower than those who did not receive postoperative RT. The subscales for swallowing (P = .008), saliva (P = .001), pain (P = .001), and shoulder function (P = .002) correlated strongly with postoperative RT on the UW-QoL. The subscales for pronunciation (P = .007) and saliva (P = .002) correlated significantly with RT on the OFS. The mean OFS scores were significantly lower for the patients with a Brown Class 2a or smaller defect than for Brown Class 2b or larger (P = .005). CONCLUSION: Postoperative RT was the strongest variable affecting QoL in patients with maxillectomy and prosthetic obturator reconstruction. The size of the defect slightly influenced the obturator function; however, it did not influence the overall QoL.

[Diagnosis and surgical approach of parapharyngeal space neoplasms].

PURPOSE: The aim of this study is to investigate the diagnosis and reasonable surgical approach for parapharyngeal space neoplasms. METHODS: A retrospective study was carried out from the data of 24 patients, who suffered from paralaryngeal space neoplasms and underwent surgical treatment from 1998 to 2006. The follow- up was carried out from 1 to 10 years. RESULTS: The patients had no specific symptoms initially. Most patients visited the doctor with cervical or submandibular masses and some of them with disorders of swallowing or speech. 87.5% of the neoplasms were benign and 12.5% were malignant. Neurogenic tumors and tumors originating from the parotid gland accounted the most. CT or MRI provided useful information such as their sizes, shapes, extents and the relationship between the neoplasm and surrounding tissues. The trans-cervical approach was used in 10 cases, the trans-parotid approach in 10 cases, the trans-mandible approach in 4 cases. One patient was dead, two patients were lost to follow up, the others had been cured without recurrence. CONCLUSIONS: CT and/or MRI are essentially useful tools for diagnosis and presurgical planning. Based on the trans-cervical approach, according to the size, origination and nature of the neoplasms, choose of the trans-parotid or the trans- mandibular approach for surgical treatment is reasonable. Supported by Natural Scientific Research Plan of Shanxi Province of China [Grant No.2006k09-G3(5) and 2005K14-G8(2)].