Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.238
Filtrar
2.
Dent Clin North Am ; 68(2): 259-276, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38417990

RESUMO

This article defines the fascial and spatial anatomy of the suprahyoid neck region, delineates the role of CT and MR imaging, discusses the inflammatory conditions of the jaws and adjacent spaces and their clinical symptomatology, and illustrates the appearance of these conditions.


Assuntos
Doenças Maxilomandibulares , Osteonecrose , Osteorradionecrose , Humanos , Arcada Osseodentária/diagnóstico por imagem , Doenças Maxilomandibulares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Osteonecrose/patologia
3.
J Craniomaxillofac Surg ; 52(3): 302-309, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38368207

RESUMO

The present study aimed to investigate outcomes following open surgery for extensive skull base ORN. Open surgery through a personalized sequential approach was employed to deal with five cases of extensive skull base ORN. Two patients with mild cases underwent regional debridement and sequestrectomy, and three patients with severe cases underwent extensive resection with reconstruction using free anterolateral thigh (ALT) flap. Biological glues and vascularized flaps were used for obturation of the skull base bony defect to prevent postoperative cerebrospinal fluid (CSF) leakage. The infections were controlled by antibiotic administrations which strictly followed the principles of antimicrobial stewardship (AMS). As results, both regional debridement plus sequestrectomy and extensive resection achieved satisfied outcomes in all patients. No severe complications and delayed hospitalization occurred. During the follow-up period (8-19 months), all patients were alive, pain free, without crusting or purulent discharge, and no sequestration or CSF leakage occurred. In conclusion, a personalized sequential approach including open surgery, pedicled/vascularized free flap reconstruction and AMS was advocated for patients with extensive skull base ORN.


Assuntos
Retalhos de Tecido Biológico , Osteorradionecrose , Procedimentos de Cirurgia Plástica , Neoplasias da Base do Crânio , Humanos , Osteorradionecrose/cirurgia , Osteorradionecrose/complicações , Base do Crânio/cirurgia , Neoplasias da Base do Crânio/cirurgia , Retalhos de Tecido Biológico/cirurgia , Vazamento de Líquido Cefalorraquidiano/cirurgia , Estudos Retrospectivos , Complicações Pós-Operatórias/cirurgia
4.
J Craniomaxillofac Surg ; 52(3): 355-362, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38368214

RESUMO

The aim of this study was to investigate the jawbone concentration of clindamycin (CLI) in patients with an osteonecrosis of the jaw (ONJ). Patients with medication-related ONJ (MRONJ) and osteoradionecrosis (ORN) with an antibiotic treatment with CLI were included. Plasma, vital and necrotic bone samples were collected. Plasma and jawbone samples were analyzed by liquid chromatography-tandem mass spectrometry. Patients with MRONJ exhibited a mean plasma CLI concentration of 9.6 µg/mL (SD ± 3.6 µg/mL) and mean concentrations of 2.3 µg/g CLI (SD ± 1.4 µg/g) and 2.1 µg/g CLI (SD ± 2.4 µg/g) in vital and necrotic bone samples, without statistical significance (p = 0.79). In patients with ORN, mean concentration in plasma was 12.0 µg/mL (SD ± 2.6 µg/mL), in vital bone 2.1 µg/g (SD ± 1.5 µg/g), and in necrotic bone 1.7 µg/g (SD ± 1.2 µg/g). Vital and necrotic bone concentrations did not differ significantly (p = 0.88). The results demonstrate that CLI concentrations are considerably lower than in plasma, but sufficient for most bacteria present in ONJ. Within the limitations of the study, it seems that CLI is a relevant alternative to other antibiotics in the treatment of ONJ because it reaches adequate concentrations in jawbone.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Osteonecrose , Osteorradionecrose , Humanos , Clindamicina/uso terapêutico , Estudos Prospectivos , Osteonecrose/induzido quimicamente , Osteorradionecrose/etiologia , Arcada Osseodentária , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Difosfonatos
5.
Indian J Pathol Microbiol ; 67(1): 162-165, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38358211

RESUMO

Extranodal Natural Killer/T Cell Lymphoma Nasal Type (EN-NK/T-CL-NT) is a non-Hodgkin extranodal lymphoma of unfavorable prognosis due to its aggressive nature. This neoplasm mainly affects the paranasal sinuses, nasopharynx, oropharynx, oral cavity, palate, and rarely intestinal, gastric and skin regions. 50-year-old female with a history of lymphoma in nasal and pelvic region. At four years of tumors-free, has facial asymmetry, accompanied by sub-palpebral, nasal and lip edema. Intraoral examination revealed a large ulceration suggestive of osteoradionecrosis. Gum biopsy shows Extranodal NK/T Cell Lymphoma Nasal Type (EN-NK/T-CL-NT). In this case we highlight the characteristics of EN-NK/T-CL-NT with a presentation of osteoradionecrosis-like. Unfortunately, the nature of this tumor led to the patient's death. Clinical follow-up of patients with cancer is imperative to mend and/or decrease treatment complications, as well as to identify second primary tumors or the spread of the underlying disease.


Assuntos
Linfoma Extranodal de Células T-NK , Osteorradionecrose , Feminino , Humanos , Pessoa de Meia-Idade , Osteorradionecrose/diagnóstico , Osteorradionecrose/patologia , Linfoma Extranodal de Células T-NK/diagnóstico , Linfoma Extranodal de Células T-NK/radioterapia , Linfoma Extranodal de Células T-NK/patologia , Prognóstico , Pelve , Células Matadoras Naturais/patologia
7.
J Oral Maxillofac Surg ; 82(3): 332-340, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38199239

RESUMO

BACKGROUND: Advanced stage osteoradionecrosis (ORN) and medication-related osteonecrosis of the jaw (MRONJ) are challenging disease entities requiring multimodal therapy including surgical resection. However, risk factors associated with infection recurrence are poorly understood. PURPOSE: The purpose of this study was to identify risk factors associated with infection recurrence following resection of advanced stage ORN or MRONJ of the mandible. STUDY DESIGN, SETTING, SAMPLE: This was a retrospective cohort study including patients who underwent segmental mandibulectomy for management of ORN or MRONJ between 2016 and 2021 at the authors' institution. Subjects who did not have margin viability data were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: The primary predictor variable was viability of resection margins on histopathologic analysis (viable or nonviable). Secondarily, other risk factors categorized as demographic (age, sex, race), medical (comorbidities), and perioperative (reconstructive modality, antibiotic duration, microbiological growth) were evaluated. MAIN OUTCOME VARIABLE: The primary outcome variable was time to infection recurrence defined as time from surgical resection to clinical diagnosis of a fistula tract, abscess, or persistent inflammatory symptoms necessitating surgical intervention. COVARIATES: Not applicable. ANALYSES: Descriptive and bivariate statistics were used to identify associations between risk factors and time to infection recurrence. A significance level of P ≤ .05 was considered significant. RESULTS: The cohort consisted of 57 subjects with a mean age of 63.3 ± 10.0 years (71.9% Male, 75.4% White) treated for ORN (47.4%) or MRONJ (52.6%). A total of 19/57 (33%) subjects developed a recurrence of infection with 1 and 2 year survival of 75.8 and 66.2%, respectively. Nonviable resection margins were associated with earlier time to infection recurrence (P ≤ .001, hazard ratio (HR) = 11.9, 95% confidence interval (CI) = 3.84 to 36.7) as was younger age (P = .005, HR = 0.921, 95% CI = 0.869 to 0.976) and atypical pathogen growth on culture (P = .002, HR = 8.58, 95% CI = 2.24 to 32.8). CONCLUSIONS AND RELEVANCE: Histopathologic margin viability was associated with earlier time to infection recurrence following resection of advanced stage ORN or MRONJ of the mandible. Additional studies are needed to identify interventions that may improve outcomes in this demographic.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Osteonecrose , Osteorradionecrose , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Feminino , Estudos Retrospectivos , Margens de Excisão , Osteorradionecrose/cirurgia , Mandíbula/cirurgia , Fatores de Risco , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/cirurgia , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/tratamento farmacológico
8.
Curr Opin Support Palliat Care ; 18(1): 39-46, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38170197

RESUMO

PURPOSE OF REVIEW: Osteoradionecrosis (ORN) is a devasting complication of radiation therapy (RT), especially in head and neck cancers (HNC), and is still poorly understood. The aim of this review is to report its incidence and consider the risk factors associated with ORN to highlight prevention strategies to decrease its incidence. RECENT FINDINGS: The average incidence of ORN is between 2% and 23%, with incidence decreasing in more recent years with the introduction of modern RT technology and better oral health care. Smoking, diabetes mellitus, oropharyngeal and oral cavity cancers, pre- and post-RT dental extractions and a total radiation dose of over 60 Gy were all identified as risk factors for ORN. In prevention, strategies were mainly structured around minimising risk factors or targeting possible mechanisms of ORN's pathophysiology. SUMMARY: At present, the controversy surrounding the risk factors and pathogenesis of ORN makes it difficult to establish a set of prevention guidelines for its incidence. In order to achieve this, more research examining its aetiology must be conducted as well as a universal staging system within which ORN may be classified.


Assuntos
Neoplasias de Cabeça e Pescoço , Osteorradionecrose , Humanos , Osteorradionecrose/epidemiologia , Osteorradionecrose/etiologia , Osteorradionecrose/prevenção & controle , Neoplasias de Cabeça e Pescoço/radioterapia , Fumar , Fatores de Risco , Estudos Retrospectivos
9.
Radiol Imaging Cancer ; 6(1): e230155, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38276904

RESUMO

Interpretation of posttreatment imaging findings in patients with head and neck cancer can pose a substantial challenge. Malignancies in this region are often managed through surgery, radiation therapy, chemotherapy, and newer approaches like immunotherapy. After treatment, patients may experience various expected changes, including mucositis, soft-tissue inflammation, laryngeal edema, and salivary gland inflammation. Imaging techniques such as CT, MRI, and PET scans help differentiate these changes from tumor recurrence. Complications such as osteoradionecrosis, chondroradionecrosis, and radiation-induced vasculopathy can arise because of radiation effects. Radiation-induced malignancies may occur in the delayed setting. This review article emphasizes the importance of posttreatment surveillance imaging to ensure proper care of patients with head and neck cancer and highlights the complexities in distinguishing between expected treatment effects and potential complications. Keywords: CT, MR Imaging, Radiation Therapy, Ear/Nose/Throat, Head/Neck, Nervous-Peripheral, Bone Marrow, Calvarium, Carotid Arteries, Jaw, Face, Larynx © RSNA, 2024.


Assuntos
Neoplasias de Cabeça e Pescoço , Osteorradionecrose , Lesões por Radiação , Humanos , Recidiva Local de Neoplasia , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/terapia , Lesões por Radiação/diagnóstico por imagem , Lesões por Radiação/etiologia , Lesões por Radiação/terapia , Tomografia por Emissão de Pósitrons/métodos
10.
São Paulo; s.n; 20240104. 86 p.
Tese em Português | LILACS, BBO - Odontologia | ID: biblio-1524408

RESUMO

Os pacientes portadores de câncer de cabeça e pescoço realizam tratamento, de radioterapia podendo ou não estar associados à quimioterapia e/ou cirurgias. A qualidade de vida dos mesmos é afetada em função dos efeitos colaterais causados pelos tratamentos. Mucosite, hiposalivação, perda do paladar, trismo e osteorradionecrose são os efeitos colaterais que mais acomentem os pacientes em tratamento para câncer de cabeça e pescoço. A osteorradionecrose é considerada um evento tardio e a maior complicação pós tratamento de radioterapia. Foi realizada uma busca sistemática nas bases de dados eletrônicas MEDLINE / PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Open Gray e busca manual, sem restrição de idioma e tempo. Os critérios de elegibilidade foram os seguintes: 1) ser revisão sistemática; 2) abordar sobre os efeitos orais e complicações após quimioterapia e/ou radioterapia em pacientes adultos portadores de câncer de cabeça e pescoço e 3) RS baseadas em estudos clínicos prospectivos/ retrospectivos e ECR (estudo clínico randomizado). A elegibilidade foi determinada de acordo com os critérios de exclusão para:1) RS que descrevessem a o tratamento para as sequelas da ORN; 2) as RS baseadas em relatos de casos ou estudos in vitro sobre ORN; 3) ORN em ossos não gnáticos (temporal); 4) não abordarem sobre incidência, tratamento ou prevenção da ORN e 5) revisão da classificação da ORN. Foram identificados 1321 artigos, mas apenas 13 foram considerados elegíveis. A fase de elegibilidade, qualidade metodológica (AMSTAR 2) foi conduzida por dois examinadores independentes e calibrados (RMS e GS), e um terceiro examinador (MSANM) foi consultado para a resolução de incongruências. O número de pacientes avaliados para o desenvolvimento de ORN ao longo do tratamento foi 33.762 sendo que desses, 2.094 desenvolveram a lesão, representando uma incidência de 6,2%. Quanto a localização a mandíbula é o local de maior acometimento. A exodontia após a radioterapia foi apontada como o maior fator causal para o desenvolvimento de ORN. A abordagem de tratamento para a ORN com pentoxifilina e tocoferol demonstrou eficácia superior em relação ao uso de antibioticoterapia e câmera hiperbárica. Baseado no risco de viés, é baixo o nível atual de evidência para as abordagens preventivas e curativas da ORN.


Assuntos
Osteorradionecrose , Revisão Sistemática , Neoplasias de Cabeça e Pescoço , Radioterapia
11.
Clin Oral Investig ; 28(1): 77, 2024 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-38182685

RESUMO

OBJECTIVE: To review the available prospective literature on hyperbaric oxygen (HBO) therapy for periodontal conditions. MATERIALS AND METHODS: A comprehensive electronic and manual search was performed to identify clinical studies on adult patients who underwent hyperbaric oxygen therapy for periodontal treatments. A systematic literature search was conducted in PubMed, Cochrane, and Dentistry Oral Sciences Source databases. RESULTS: Fourteen articles were included in the final literature review, of which five were RCTs and 11 were prospective clinical studies. Four studies discussed HBO as an adjunct to nonsurgical treatment of periodontitis, eight reported on HBO and osteoradionecrosis, and one examined HBO in bisphosphonate-related necrosis of the jaws. CONCLUSIONS: HBO has shown superior efficacy compared to antibiotics as a prophylactic measure in preventing osteoradionecrosis (ORN) in patients with a history of high mandibular irradiation. Clinicians should consider referring such patients for HBO therapy before and after tooth extractions. However, for the surgical excision of existing ORN lesions, HBO therapy does not yield significant benefits but does not negatively impact outcomes either. Regarding the treatment of periodontitis patients, the variability among studies prevents definitive conclusions. HBO therapy as an adjunct to SRP in periodontitis treatment produces mixed results. CLINICAL RELEVANCE: This study's clinical relevance lies in its exploration of the potential benefits of HBO for periodontal conditions. Also, it provides clinicians with insights into when and how to integrate HBO therapy into their treatment approaches, particularly for patients with a history of irradiation and those undergoing complex dental procedures.


Assuntos
Doenças da Gengiva , Oxigenoterapia Hiperbárica , Osteorradionecrose , Doenças Periodontais , Periodontite , Adulto , Humanos , Osteorradionecrose/terapia , Estudos Prospectivos , Periodontite/terapia
12.
Spec Care Dentist ; 44(1): 184-195, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-36872650

RESUMO

AIMS: Radiation caries (RC) is a highly prevalent and chronic complication of head and neck radiotherapy (HNRT) and presents a challenge for clinicians and patients. The present study aimed to assess the impact of RC on the morbidity and mortality outcomes of head and neck squamous cell carcinoma (HNSCC) patients. METHODS AND RESULTS: Patients were divided into three groups: (1) RC (n = 20), (2) control (n = 20), and (3) edentulous (n = 20). Information regarding the number of appointments, dental procedures, osteoradionecrosis (ORN), prescriptions, and hospital admissions were collected. Mortality outcomes were assessed through disease-free survival (DFS) and overall survival (OS) rates. RC patients required more dental appointments (p < .001), restorations (p < .001), extractions (p = .001), and antibiotic and analgesic prescriptions (p < .001). Kaplan-Meier subgroup analyses showed a significantly increased risk of ORN in RC compared to edentulous patients (p = .015). RC patients presented lower DFS rates (43.2 months) than the control and edentulous groups (55.4 and 56.1 months, respectively). CONCLUSIONS: RC impacts morbidity outcomes among cancer survivors due to increased demand for medication prescriptions, multiple specialized dental appointments, invasive surgical treatments, increased risk of ORN, and increased need for hospital admissions.


Assuntos
Cárie Dentária , Neoplasias de Cabeça e Pescoço , Osteorradionecrose , Humanos , Carcinoma de Células Escamosas de Cabeça e Pescoço/complicações , Suscetibilidade à Cárie Dentária , Neoplasias de Cabeça e Pescoço/radioterapia , Osteorradionecrose/complicações , Osteorradionecrose/cirurgia , Cárie Dentária/epidemiologia , Morbidade , Estudos Retrospectivos
16.
Oral Oncol ; 148: 106649, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38035508

RESUMO

INTRODUCTION: Head and neck cancer ranks as the seventh most common cancer worldwide. Proton therapy is widely used in head and neck cancer. Osteoradionecrosis(ORN) is currently a commonly investigated side effect of proton therapy. A meta-analysis is needed to investigate this topic. MATERIAL/METHODS: Two authors searched three databases, including PubMed, Embase, and Cochrane Library; the search period was from inception to June 2023. The search keyword was set to be ((("osteoradionecrosis") OR ("osteonecrosis")) AND ("proton")). RESULTS: We initially collected 410 articles, and after article selections, 22 articles remained in our systematic reviews. Due to the overlapping of patient populations, 17 studies were finally included in our meta-analysis. The pooled grade 3 or more ORN rate is 0.01(95 % CI = 0.01-0.03). Subgroup analysis showed that IMPT didn't reduce grade 3 or more ORN compared with 3DCPT (p = 0.15). CONCLUSIONS: Our meta-analysis showed that severe ORN rarely occurred in proton therapy for head and neck cancer patients.


Assuntos
Neoplasias de Cabeça e Pescoço , Osteorradionecrose , Terapia com Prótons , Humanos , Osteorradionecrose/etiologia , Terapia com Prótons/efeitos adversos , Neoplasias de Cabeça e Pescoço/radioterapia , Estudos Retrospectivos
17.
Laryngoscope ; 134(1): 166-169, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37401754

RESUMO

OBJECTIVE: To report the microorganisms and their antibiotic sensitivity profile from tissue cultures and stains at the time of anterolateral thigh fascia lata (ALTFL) rescue flap for management of mandibular osteoradionecrosis (ORN). METHODS: Retrospective chart review of patients who underwent ALTFL rescue flap for native mandibular ORN between 2011 and 2022. RESULTS: Twenty-six cases comprising 24 patients (mean age 65.4 years, 65.4% male) with mandibular ORN from whom tissue cultures and gram stain were obtained at the time of ALTFL rescue flap. 57.7% grew bacterial species, while 34.6% grew fungal species. Multibacterial speciation was noted in 26.9% of cultures. A combination of bacterial and fungal growth was also seen in 15.4% of cases. All gram-positive cocci (GPC) were pansensitive to antibiotics except for one case of Staphylococcus aureus, which was resistant to levofloxacin. Gram-negative bacilli (GNB) species were isolated in 50.0% of cases. All fungal growth was due to Candida species. No growth was noted in 23.1% of cases. Multidrug resistance was noted in 53.8% of cases when GNB was isolated. CONCLUSION: We report 76.9% of our cases of mandibular ORN had microbial growth from tissue cultures obtained at the time of the ALTFL rescue flap. Fungal growth was noted in a substantial number of cases and should be obtained as a specimen when pursuing culture-driven antibiotic therapy. Most GPCs were pansensitive to antibiotics, while GNBs were often the harbinger of multidrug resistant mandibular ORN. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:166-169, 2024.


Assuntos
Antibacterianos , Farmacorresistência Bacteriana , Doenças Mandibulares , Osteorradionecrose , Idoso , Feminino , Humanos , Masculino , Mandíbula/cirurgia , Doenças Mandibulares/tratamento farmacológico , Doenças Mandibulares/microbiologia , Doenças Mandibulares/cirurgia , Osteorradionecrose/tratamento farmacológico , Osteorradionecrose/microbiologia , Osteorradionecrose/cirurgia , Estudos Retrospectivos , Retalhos Cirúrgicos
18.
Acta Odontol Scand ; 82(1): 48-54, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37772879

RESUMO

AIM: Investigating the prevalence of mandibular ORN in a single Swedish Oncology Center. METHODS: A total of 450 patients, treated with radiotherapy for squamous cell carcinoma in the oropharynx between 2004 and 2014 were included. Three different techniques of radiotherapy were studied. ORN diagnosis was set when clinical signs according to Marx were observed, or if radiological signs were staged according to Schwartz and Kagan. RESULTS: Using the staging system, 90 patients (20%) were diagnosed with ORN. The mean age of the ORN patients was 56.6 years, the older the patient the lower the risk of developing ORN (p = .01). The risk of developing ORN for patients receiving Intensity Modulated Radiotherapy was lower compared to patients treated with the other techniques in the multivariable analysis. Brachytherapy significantly increases the risk of ORN. The risk of ORN increased by 8% each year after radiation (p = .04). The mean time to the ORN diagnosis was 3.9 years. In the multivariate analysis, the risk of ORN increased by 13% each year after radiation (p = .0013). CONCLUSION: The mean radiation dose was of greater importance for the risk of ORN than the maximum dose. Elderly people with oropharyngeal cancer were less prone to develop ORN.


Assuntos
Doenças Mandibulares , Neoplasias Orofaríngeas , Osteorradionecrose , Humanos , Idoso , Pessoa de Meia-Idade , Seguimentos , Osteorradionecrose/etiologia , Osteorradionecrose/epidemiologia , Doenças Mandibulares/etiologia , Doenças Mandibulares/epidemiologia , Neoplasias Orofaríngeas/radioterapia , Neoplasias Orofaríngeas/patologia , Mandíbula/patologia , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...