Malignant external otitis following radiotherapy for oral cancer: A case report.

RATIONALE: Although an ototoxicity is well-known as adverse event of the radiotherapy, it is not widely known that immunosuppressed patients who underwent radiotherapy in head and neck region have risk of malignant external otitis. PATIENT CONCERNS: A 68-year-old man with diabetes, who had been diagnosed as intraosseous squamous cell carcinoma of the right mandible, underwent surgical resection. He received a total of 60 Gy/30Fr postoperative radiation. Four months after the course of radiation, he suffered from right aural fullness, otalgia and otorrhea. DIAGNOSES: Clinical examination revealed granulation and existence of Pseudomonas aeruginosa in the external auditory canal. Computed tomography showed expansive inflammation and erosion in the temporal bone. The patient is elderly and diabetes. These findings led to the diagnosis of malignant external otitis. INTERVENTIONS: The ear irrigation and administration of quinolones were started. Afterwards, fistula was formed in the oral cavity, and connected to the right external auditory canal. Therefore, irrigations were performed not only from ear but also from the oral fistula. OUTCOMES: Eight weeks after starting treatment, the malignant external otitis was completely healed. LESSONS: Physicians should raise awareness of malignant external otitis in immunosuppressed patients with oral cancer after radiotherapy.

Incidence and treatment of complications in patients who had third molars or other teeth extracted.

The aim of this study was to compare the incidence of complications after extraction of third molars (M3) or other teeth, and to describe their management. We made a retrospective cohort study of patients having M3 or other teeth extracted, and recorded complications up to two years' follow-up. A total of 142 complications developed after 2355 procedures (6%) - 7% after extraction of M3 compared with 5% after extractions of other teeth (p=0.024). The three most common complications were wound infection (2%), pain without apparent cause (<1%), and oroantral communication (<1%). Patients who had M3 extracted were at increased risk of complications compared with those who had other teeth extracted (Odds ratio (OR) 1.5, p=0.024), particularly for infection (OR 5.9, p<0.001) and hypoaesthesia (OR 8.4, p=0.027). Half of all patients with a complication were treated with antibiotics orally. The incidence of postoperative bleeding was 0.6% as a result of suboptimal management of antithrombotic drugs in extractions of teeth other than M3. Finally, optimal treatment of the complications was compared with the available evidence. Prevention and treatment of these complications could reduce the incidence, particularly of bleeding.

Soft obturator prosthesis for postoperative soft palate carcinoma: A clinical report.

An intraoral prosthesis with a soft flexible obturator was provided for a patient with a soft palate perforation after surgical and chemoradiotherapy treatments of a soft palate tumor. An obturator composed of movable and flexible silicone was attached to a structure similar to a palatal lift; it was therefore able to move according to the movement of the soft palate, which was confirmed by endoscopic examination. The application of this prosthesis resulted in complete disappearance of hypernasality and food reflux, and the patient was able to eat without particular limitation during daytime wearing. This type of prosthesis represents a potential prosthetic approach to a soft palate nasal-oral fistula.

Case for diagnosis. Palate perforation due to cocaine use

Abstract: We report a 42-year-old cocaine addicted female patient referred for evaluation of hard palate ulceration resulting in oro-sinus communication with difficulties in swallowing and phonation, an rhino-sinusitis. Acrylic and removable silicone prosthesis was prescribed to relieve severe functional disorders. It is essential that the patient permanently abandons cocaine use to perform surgical reconstruction.

[A Contrivance for Closure and Dressing of Orocutaneous Fistula Developed in Advanced Oral Cancer].

Orocutaneous fistula sometimes occurs in locallyadvanced unresectable or recurrent oral squamous cell carcinoma. The developed orocutaneous fistula results in constant leakage of saliva, ingested foods and liquids and decline in patients' quality of life(QOL). A 47-year-old Japanese man had received treatment for tongue carcinoma. At the routine follow-up, a cystic lesion in the right submandibular region was detected. Biopsyof the specimen of the cystic lesion revealed squamous cell carcinoma. After chemotherapy, an orocutaneous fistula between the right oropharyngeal and the right submandibular region developed and graduallyincreased. Although closure and dressing of the orocutaneous fistula with various materials was attempted, it was ultimatelyunsuccessful. Finally, application of a rubber film and silicone adhesive agent to the skin was successful for closure and dressing of the fistula. Orocutaneous fistula is one of major contributors to decline in patients' QOL. The sharing of information regarding effective methods or materials for closure and dressing of orocutaneous fistula is necessaryto maintain patients' QOL.

Case for diagnosis. Palate perforation due to cocaine use.

We report a 42-year-old cocaine addicted female patient referred for evaluation of hard palate ulceration resulting in oro-sinus communication with difficulties in swallowing and phonation, an rhino-sinusitis. Acrylic and removable silicone prosthesis was prescribed to relieve severe functional disorders. It is essential that the patient permanently abandons cocaine use to perform surgical reconstruction.

[Florid osseous dysplasia: Management of a symptomatic case]. / Dysplasie osseuse floride : gestion d'un cas symptomatique.

INTRODUCTION: Florid osseous dysplasia is a rare and benign fibro-osseous pathology, in which bone is replaced by fibrous tissue and metaplastic bone. It can remain asymptomatic for a long time and is most often discovered incidentally during a radiological examination. Sometimes, patients are seen because of an infectious complication. OBSERVATION: An edentulous 62 years-old woman was referred for a painful mandibular swelling preventing insertion of her removable denture. Clinical examination showed a chin swelling, a deformation of mandibular bone tables of approximately four centimeters in diameter, an intra-oral fistula and a suppuration. Radiological examination showed a mixed bone lesion blowing up the buccal and lingual cortical plates and a bone sequestrum. Blood test was normal and there were no other skeletal abnormalities. The diagnosis of florid osseous bone dysplasia was made thanks to the confrontation of the clinical, radiological and histological examinations. Excision of the bone sequestrum associated to remodeling osteoplasty was performed under general anesthesia. The removable denture was rebased to drivehealing. DISCUSSION: Surgical management of osseous bone dysplasia is legitimate only in the presence of complications not responding to medical treatment. In all other cases, therapeutic abstention and long term supervision are essential.

Use of a purified collagen membrane to aid closure of palatal fistulae.

INTRODUCTION: Fistula formation following closure of palatal clefts remains a difficult clinical complication. A significant recurrence rate has also been reported following attempted closure. We present our results of fistula closure augmented with Bio-Gide(®), a purified porcine collagen membrane designed to promote guided tissue regeneration. METHODS: We reviewed the records of 263 patients operated between 1993 and 2011 for closure of palatal fistula. The patients selected comprised 61 who underwent fistula closure augmented with Bio-Gide and 202 with other techniques in the absence of Bio-Gide. We reviewed the age at surgery, sex, location of fistula, cleft type and outcome. Operation success was defined as an asymptomatic patient along with visible confirmation of closure of the fistula. RESULTS: The overall fistula closure rate was 75% in the Bio-Gide group and 63% in the non-Bio-Gide group (p = 0.070) and 86% versus 61% in the unilateral cleft palate patients (p = 0.027). DISCUSSION: Bio-Gide has improved the success rate in fistula closure in this study. Using this technique, fistula closure can be performed as a day case procedure and does not need to transgress any original suture lines; an additional advantage is that this procedure does not require harvesting of any autologous tissue to augment the repair.

[Early bucco-naso-sinus communication and shutter prosthetic treatment: About a clinical case]. / Communication buco-naso-sinusienne ancienne et traitement prothétique obturateur: A propos d'un cas Clinique.

The authors describe the early neglected oral communication of maxillary sinus and nasal cavity, causing reflux of liquid and sometimes solids through the nose, followed by immediate intrabuccal flow or posterior pharyngeal with fetidness. The objective of this work was to improve the therapy of immediate or delayed oral communication of maxillary sinus with nasal cavity and eventually and the quality of life.

Obturator Prostheses for Melanotic Neuroectodermal Tumor of Infancy in the Maxilla.

Melanotic neuroectodermal tumor of infancy frequently affects the maxilla. A communication between the oral and nasal cavities can be created by surgery. The authors rehabilitated a young patient with obturator prostheses to correct feeding. The association of the obturators with orthodontic devices provided proper maxillary growth and eruption of teeth. The outcomes were very satisfactory after a 3-year follow-up, and dental implants are planned.

The patent nasopalatine duct: a potential cause of unclear pain in the anterior maxilla.

OBJECTIVE: The aim of this report is to describe symptoms that can suggest the presence of a patent nasopalatine duct and to illustrate three cases. SUMMARY: Patent nasopalatine ducts connecting the oral cavity with the nasal cavity are extremely rare. This malformation can be considered a developmental abnormality. Clinically, patent nasopalatine ducts appear as single or double spherical or oval apertures lateral or posterior to the incisive papilla. This type of anatomical malformation can be associated with an unclear pain sensation in the anterior maxillary region, which may be misinterpreted for example as toothache of endodontic origin. However, persisting nasopalatine ducts can also exist as an asymptomatic abnormality with no clinical sign of discomfort. Accordingly, understanding the differential diagnosis of a possible patent nasopalatine duct can prevent a general practitioner from performing unnecessary interventions, such as endodontic treatments, apical surgeries, or tooth extractions.

Presurgical management of unilateral cleft lip and palate in a neonate: a clinical report.

A cleft lip and palate consists of fissures of the upper lip and/or palate, and is the most commonly seen orofacial anomaly that involves the middle third of the face. Early treatment of patients with a cleft lip and palate is important because of esthetic, functional, and psychological concerns. Nasoalveolar molding provides excellent results when started immediately after birth. This clinical report describes the presurgical management of an infant with a complete unilateral cleft of the soft palate, hard palate, alveolar ridge, and lip.

Use of polyetheretherketone in the fabrication of a maxillary obturator prosthesis: a clinical report.

To treat a patient who needed a replacement for a maxillary obturator prosthesis, a new obturator prosthesis was fabricated from polyetheretherketone (PEEK), a material often used in medicine but seldom in dentistry. This material provided the patient with a better-adjusted, more functional, and lighter prosthesis.

Management of orocutaneous fistulas using a vacuum-assisted closure system.

BACKGROUND: The vacuum-assisted closure (VAC) system has been used to manage complicated wounds. The purpose of this study was to describe a novel technique in using the VAC system for orocutaneous fistulas. METHODS: A retrospective study was performed on 10 patients treated at the National Cancer Centre, Singapore, who developed postoperative orocutaneous fistulas. Hydrogum dental paste was used as a sealant together with the VAC system to close the fistulas. We used either the RENASYS or VAC ATS system with 50 mm Hg to 125 mm Hg continuous suction. RESULTS: The 10 patients developed 11 fistulas. The median age of this cohort was 67 years (range, 33-80 years). Nine patients had successful closure of their fistulas with VAC therapy whereas 1 patient had unsuccessful VAC therapy and required flap reconstruction. The median time to fistula closure was 19 days (range, 6-36 days). The median time to radiotherapy after surgery was 46 days (range, 26-62 days). CONCLUSION: VAC therapy is an effective treatment option for orocutaneous fistulas.

Palatal perforation, the most rarely observed complication after deviated septum surgery.

Numerous complications after septoplasty have been identified in the literature. Blindness and palatal perforation are among the rarest complications. The palatal perforation experienced by the presented patient was because he was not thoroughly examined before surgery. Secondly, we wanted to emphasize the fact that care must be taken during septoplasty operation, particularly while performing the intervention to the inferior septal area.

Vacuum-assisted closure for complicated wounds in head and neck region after reconstruction.

OBJECTIVE: The aim of this study is to suggest that negative pressure wound therapy (NPWT) is an excellent alternative for managing complicated wounds after head and neck reconstruction. SUMMARY BACKGROUND DATA: Management of complicated wounds such as wound infection or persistent saliva leakage from poor wound healing with dead space is challenging in head and neck reconstruction. The NPWT is a useful device widely used in treating many complicated wounds. In this study, we applied this device on complicated wounds after head and neck reconstruction and share our experience and modifications. METHODS: From January 2004 to December 2009, 13 male patients (mean age: 50.0 years) were included. Eleven patients were reconstructed with free flap transfer and the other two patients received a local flap for repair immediately after tumour ablation. Among them, 12 patients (92%) had complicated wounds with infection and one patient (8%) with partial loss of the free flap. Eight of these 13 patients (62%) had saliva leakage and fistula formation. For those who had a free flap transfer, the vacuum-assisted closure (VAC) system was applied with modifications to the complicated wound 2 weeks later, after better neo-vascularisation around the free flap. Watertight suturing on the mucosal side is needed to ensure air sealing and enhance wound healing acquired by the VAC system. RESULTS: All wounds demonstrated adequate control of wound infection, quick obliteration of dead space and rapid growth of granulation tissue under the NPWT. Eleven patients (85%) had wound healing with secondary intention; one (8%) needed a further skin grafting; and one patient (8%) needed a free flap transfer due to partial flap loss in a severe wound infection even after the NPWT application. The average duration of the NPWT usage was 10.8 days (4-24 days); most of the wounds healed within 1 week after the NPWT application. CONCLUSION: The NPWT is an excellent alternative for managing complicated wounds after head and neck reconstruction. It is safe and comfortable for the patient and provides good results in infection control, dead space obliteration and improvement of wound healing.

Case series of undetected intranasal impression material in patients with clefts.

We report the cases of two female patients in their twenties who had had corrective surgery for bilateral cleft lip and palate as babies. They had both had residual palatal fistulas and had had further treatment that required repeated dental impressions. Several years later both had complained of persistent nasal discomfort and discharge, and routine clinical examination and investigations had failed to identify the cause. Full examination of the whole nasal cavity under general anaesthesia, in both cases, showed the presence of displaced dental impression material in the nasal floor. Removal resulted in complete resolution of symptoms.

The nance obturator, a new fixed obturator for patients with cleft palate and fistula.

In patients with fistulas that impair function (e.g., feeding, resonance, intelligibility), obturators are used to improve feeding and reduce nasal air emission by occluding the abnormal opening between the oral and nasal cavities. This report describes a novel method for occluding an anterior palatal fistula in patients with cleft palates. The new design for a fixed obturator is based on the Nance appliance, which was originally used as a space maintainer, but has been redesigned for closing an anterior palatal fistula in a patient with cleft lip and palate. The Nance obturator may be used when the surgical closure of the fistula is not feasible and a removable device is not successful. As it is a fixed device, it does not require remaking with maxillary growth. The new design may also function as a fixed space maintainer to preserve molar anchorage and maxillary transverse width.