ABSTRACT
Two guidelines about opioid use in chronic pain management were published in 2017: the Canadian Guideline for Opioids for Chronic Non-Cancer Pain and the European Pain Federation position paper on appropriate opioid use in chronic pain management. Though the target populations for the guidelines are the same, their recommendations differ depending on their purpose. The intent of the Canadian guideline is to reduce the incidence of serious adverse effects. Its goal was therefore to set limits on the use of opioids. In contrast, the European Pain Federation position paper is meant to promote safe and appropriate opioid use for chronic pain. The content of the two guidelines could have unintentional consequences on other populations that receive opioid therapy for symptom management, such as patients with cancer. In this article, we present expert opinion about those chronic pain management guidelines and their impact on patients with cancer diagnoses, especially those with histories of substance use disorder and psychiatric conditions. Though some principles of chronic pain management can be extrapolated, we recommend that guidelines for cancer pain management should be developed using empirical data primarily from patients with cancer who are receiving opioid therapy.
Subject(s)
Analgesics, Opioid/therapeutic use , Cancer Pain/drug therapy , Chronic Pain/drug therapy , Opioid-Related Disorders/prevention & control , Practice Guidelines as Topic , Analgesics, Opioid/adverse effects , Canada , Europe , Humans , Pain ManagementABSTRACT
Introducción: En la actualidad, se considera que el injerto microvascularizado de peroné es la mejor opción de tratamiento para las reconstrucciones mandibulares de defectos óseos mayores de 6 cm. No obstante, debido a su limitada altura, presenta una importante desventaja en cuanto a la rehabilitación protésica, particularmente en aquellos casos de resecciones mandibulares parciales con una hemimandíbula contralateral dentada. Material y métodos: Presentamos un caso clínico de mixoma mandibular tratado mediante resección quirúrgica y reconstrucción mandibular primaria mediante injerto microvascularizado de peroné, al que se sometió a distracción osteogénica vertical para optimizar la posterior rehabilitación implantológica. Resultados: La discrepancia de altura se solucionó completamente y se colocaron tres implantes osteointegrados en el área distraída, lo cual permitió una rehabilitación protésica muy satisfactoria, tanto estética como funcionalmente. Conclusiones: La distracción osteogénica vertical de peroné constituye una excelente opción terapéutica para igualar la altura del peroné a la del reborde alveolar de la hemimandíbula dentada contralateral, tras la reconstrucción de defectos mandibulares extensos, de cara a una posterior rehabilitación implantológica, lo que permite llevar a cabo ésta con resultados, tanto funcionales como estéticos, muy satisfactorios. Además, no presenta los inconvenientes de otras técnicas empleadas en estos pacientes, como el peroné en doble barra (mayor dificultad técnica y mayor riesgo de trombosis en el pedículo) y el empleo de injertos onlay (morbilidad añadida en la zona de toma del injerto)(AU)
Introduction: Free vascularized fibular flap is considered the treatment of choice in mandibular reconstruction for extensive bone defects. But, when the reconstruction involves a dentate mandible, the fibula has the limit as it doesnt offer sufficient bone height to restore the alveolar arch up to the occlusal plane. Therefore, the deficiency in bone height makes implant placement impractical. Materials and methods: We report a case of vertical distraction osteogenesis of a free vascularized fibula flap used to reconstruct a hemimandible after resection of an odontogenic myxoma. The distraction device was applied intraorally. Distraction of 0.5 mm per day was performed followed by 3 months of consolidation period. Results: The vertical discrepancy between the fibula and the native hemimandible was corrected. The increase of vertical bone height was stable and enabled placement of dental implants without any complications. Conclusions: We believe that vertical distraction osteogenesis of free vascularized flaps is a reliable technique that optimizes implant positioning for ideal prosthetic rehabilitation, after mandibular reconstruction following tumour surgery(AU)
Subject(s)
Humans , Male , Adult , Osteogenesis , Bony Callus/surgery , Peroneal Nerve/pathology , Peroneal Nerve/surgery , Prostheses and Implants , Myxoma/diagnosis , Myxoma/surgery , Radiography, Panoramic/methods , Radiography, Panoramic , /methods , Bony Callus/injuries , Bony Callus , MyxomaABSTRACT
El quiste dentígero o folicular es un quiste odontogénico deldesarrollo. Está revestido por el epitelio del folículo dentario, y suele estaren relación con un diente permanente incluído. Presentamos el caso clínicode un paciente en el que se observa la aparición de un quiste dentígeroa partir del saco folicular de un tercer molar incluído no exodonciado,y lo comparamos con la evolución de un cordal incluído y su saco folicularcontralaterales en los que se realizó la exodoncia. El tratamiento definitivodel quiste dentígero asociado a un tercer molar incluído es quirúrgico,con la exodoncia de la pieza y enucleación del quiste. Los sacosfoliculares mayores de 2 mm asociados a terceros molares incluídos evolucionanen numerosas ocasiones a quistes foliculares. Está indicada la exodonciade dichos cordales para evitar la evolución a quiste dentígero
The dentigerous cyst or follicular cyst is a developmentalodontogenic cyst. It is covered by the epithelium of the dental follicle,and it tends to be related to an impacted permanent tooth. Thecase report of a patient who was seen to develop a dentigerous cystarising from the follicle of an impacted non-extracted third molaris presented. This is then compared with the evolution of thecontralateral impacted third molar and its follicle that was extracted.The definitive treatment for a dentigerous cyst associated with animpacted third molar is surgical, the extraction of the tooth andenucleation of the cyst. Follicles measuring more+ than 2 mm andthat are associated with impacted third molars often develop intofollicular cysts. The extraction of these third molars is indicated inorder to avoid the development of a dentigerous cyst
Subject(s)
Male , Adult , Humans , Dentigerous Cyst/surgery , Dental Sac/surgery , Molar, Third/surgery , Tooth, Unerupted/surgery , Radiography, PanoramicABSTRACT
Presentamos la evolución de una paciente de 19 años de edad con un adenoma pleomorfo de parótida que tras varios tratamientos, incluyendo vaciamiento ganglionar cervical y radioterapia, desarrolló linfedema facial. Debido a la repercusión de tipo emocional que originó en la paciente, se planificó tratamiento físico rehabilitador con drenaje linfático manual con el que mejoró tanto subjetiva como objetivamente (AU)