RESUMEN
PURPOSE: The aim of this study is to analyze implant survival in patients who received radiotherapy treatment for oral malignancies and in patients who had suffered mandibular osteoradionecrosis. MATERIALS AND METHODS: We reviewed retrospectively 225 implants placed in 30 patients who had received radiotherapy as part of the oncologic treatment. Radiation doses ranged between 50 and 70 Gy. 39 implants were placed after a combined treatment of radiotherapy and chemotherapy. Data referred to tumour type and reconstruction, presence of osteoradionecrosis, region of implant installation and type of prostheses were recorded. Survival rates were calculated with cumulative Kaplan-Meier survival curves and compared between different groups with a log-rank test. RESULTS: 152 osseointegrated implants were placed in patients who presented previous reconstruction procedure. Five patients developed osteorradionecrosis as a complication of the radiotherapy treatment. Once osteoradionecrosis had healed in these patients, 41 implants were installed. The overall 5 year survival rate in irradiated patients was 92.6%. Irradiated patients had a marginally significantly higher implant loss than non-irradiated patients. (p = 0.063). The 5 year survival rate in the osteoradionecrosis group was of 48.3% and in the non-osteoradionecrosis group 92.3%, with a statistically significant difference between both groups. (p = 0.002). CONCLUSION: Osseointegrated implants enhance oral rehabilitation in most irradiated patients, even being an acceptable option for patients who had suffered osteoradionecrosis. Totally implant supported prostheses are recommended after irradiation providing functional, stable and aesthetically satisfactory rehabilitation.
Asunto(s)
Implantes Dentales , Neoplasias de la Boca/radioterapia , Procedimientos Quirúrgicos Ortognáticos , Oseointegración/fisiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trasplante Óseo/métodos , Carcinoma de Células Escamosas/radioterapia , Quimioradioterapia Adyuvante , Implantación Dental Endoósea/métodos , Prótesis Dental de Soporte Implantado/clasificación , Fracaso de la Restauración Dental , Femenino , Estudios de Seguimiento , Humanos , Masculino , Enfermedades Mandibulares/etiología , Persona de Mediana Edad , Terapia Neoadyuvante , Osteorradionecrosis/etiología , Dosificación Radioterapéutica , Procedimientos de Cirugía Plástica/métodos , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
Lateral pterygoid muscle dystonia is characterized by mandibular displacement towards the opposite side of the affected muscle. It may be associated with functional disorders affecting speech, swallowing, chewing and facial symmetry. Injection with botulinum toxin is recognized as the most effective treatment. Locating the lower head of the lateral pterygoid muscle for the injection is not difficult using electromyographic guidance; however, location of the upper head is more complicated, even with electromyography. We report a case of lateral pterygoidmuscle dystonia in which precise injection of the upper head was achieved with the aid of arthroscopy (AU)
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Toxinas Botulínicas Tipo A/administración & dosificación , Fármacos Neuromusculares/administración & dosificación , Distonía/tratamiento farmacológico , Artroscopía , Electromiografía , Músculos PterigoideosRESUMEN
Lateral pterygoid muscle dystonia is characterized by mandibular displacement towards the opposite side of the affected muscle. It may be associated with functional disorders affecting speech, swallowing, chewing and facial symmetry. Injection with botulinum toxin is recognized as the most effective treatment. Locating the lower head of the lateral pterygoid muscle for the injection is not difficult using electromyographic guidance; however, location of the upper head is more complicated, even with electromyography. We report a case of lateral pterygoid muscle dystonia in which precise injection of the upper head was achieved with the aid of arthroscopy.
Asunto(s)
Toxinas Botulínicas Tipo A/administración & dosificación , Distonía/tratamiento farmacológico , Fármacos Neuromusculares/administración & dosificación , Músculos Pterigoideos , Artroscopía , Electromiografía , Femenino , Humanos , Persona de Mediana EdadRESUMEN
There are several pathologies that may cause alteration of the lower lip sensation, therefore a differential diagnosisis needed. Among these pathologies, we have focused on intrabone growing tumours such as Burkitts Lymphoma.Burkitts Lymphoma is a malignant tumour of B-Cell lymphocyte origin, classified as a Non-Hodgkin;sLymphoma. Three clinical subtypes are described: endemic, sporadic and HIV associated. It is characterizedby very fast growing, undifferentiated lymphocytes and bone marrow infiltration. A high incidence of BurkittsLymphoma has been reported in African children. It is known to have a good response to radiotherapy and chemotherapytreatment. This report describes the case of a 29 year-old Spanish man diagnosed with Burkitts Lymphoma,in which his first and only symptom was bilateral anaesthesia of the lower lip. We have also described theclinical evolution, steps for diagnosis and treatment (AU)
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Asunto(s)
Humanos , Masculino , Adulto , Enfermedades de los Nervios Craneales/etiología , Neoplasias Mandibulares/complicaciones , Linfoma de Burkitt/complicaciones , Neoplasias Mandibulares/diagnóstico , Linfoma de Burkitt/diagnósticoRESUMEN
There are several pathologies that may cause alteration of the lower lip sensation, therefore a differential diagnosis is needed. Among these pathologies, we have focused on intrabone growing tumours such as Burkitt's Lymphoma. Burkitt's Lymphoma is a malignant tumour of B-Cell lymphocyte origin, classified as a Non-Hodgkin's Lymphoma. Three clinical subtypes are described: endemic, sporadic and HIV associated. It is characterized by very fast growing, undifferentiated lymphocytes and bone marrow infiltration. A high incidence of Burkitt's Lymphoma has been reported in African children. It is known to have a good response to radiotherapy and chemotherapy treatment. This report describes the case of a 29 year-old Spanish man diagnosed with Burkitt's Lymphoma, in which his first and only symptom was bilateral anaesthesia of the lower lip. We have also described the clinical evolution, steps for diagnosis and treatment.
Asunto(s)
Linfoma de Burkitt/complicaciones , Enfermedades de los Nervios Craneales/etiología , Neoplasias Mandibulares/complicaciones , Nervio Mandibular , Adulto , Linfoma de Burkitt/diagnóstico , Humanos , Masculino , Neoplasias Mandibulares/diagnósticoRESUMEN
PURPOSE: Arthroscopic surgery has been shown to be an effective treatment for patients with temporomandibular disorders, relieving patients' symptoms and restoring adequate mandibular function. For those patients with poor arthroscopic outcomes, various treatment modalities are possible, such as nonsurgical therapy, open surgery, or repeat arthroscopic surgery. The purpose of this study was to evaluate our results with rearthroscopy in patients with temporomandibular joint dysfunction. PATIENTS AND METHODS: The clinical data and operative reports for 50 patients who underwent a second arthroscopic procedure from 1994 to 2004 were reviewed retrospectively. Outcome assessments were based on reductions in pain, measured using a visual analog scale, and improvements in maximal interincisal opening. The minimum follow-up period was 2 years. RESULTS: Significant differences were evident between presurgical and postsurgical pain at months 1, 6, 12, and 24. The mean score of preoperative pain on the visual analogue scale was 61.65 mm, which was reduced to 36.28 mm at 2-year follow-up. With regard to mandibular function, all patients presented with restricted mouth opening, with a mean preoperative maximal interincisal opening of 26.73 mm. Postoperatively, the maximal interincisal opening showed a statistically significant improvement (P < .05), and at 2-year follow-up, we obtained a total improvement of 7 mm. Only 8 patients (16%), who had an unsuccessful result after a second arthroscopy, underwent further surgical intervention (open surgery). CONCLUSION: Arthroscopic surgery is a reliable and effective procedure for temporomandibular joint dysfunction that improves pain and mouth opening, with the advantages of being minimally invasive and repeatable. Repeat arthroscopic surgery, with a proven history of fewer complications, can be attempted before open arthrotomy.
Asunto(s)
Artroscopía/métodos , Procedimientos Quirúrgicos Orales/métodos , Trastornos de la Articulación Temporomandibular/cirugía , Adolescente , Adulto , Artralgia/cirugía , Dolor Facial/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Rango del Movimiento Articular , Reoperación , Estudios Retrospectivos , Sinovitis/cirugía , Disco de la Articulación Temporomandibular/lesiones , Disco de la Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/patología , Adherencias Tisulares/cirugía , Insuficiencia del TratamientoRESUMEN
INTRODUCTION: Frey's Syndrome is defined by facial hyperhidrosis in the preauricular region unleashed by gustatory stimulus and caused mainly by parotidectomy. Several treatment and prevention measures have been proposed, with no conclusive results. Recently, injections of Botulinum Toxin have been suggested, obtaining encouraging results. The objective is to describe our experience in treating Frey's Syndrome with this drug. MATERIALS AND METHOD: Between 2004 and 2007, our team treated 10 patients suffering from Frey's Syndrome. All cases were caused by parotid resection. In 60%of cases a complete elevation of the SMAS (superficial musculoaponeurotic system) was carried out. In the remaining cases, such elevation was either not made or the SMAS was severely damaged. All patients were treated with intradermic injections of Botulinum Toxin. Recorded data were: units administered, affected area, time lapse until improvement in the symptoms, and the evolution after one, six and twelve months after the injection. Possible side effects were also recorded. RESULTS: The average treated area per patient was 26 cm2. An average of 38 units of Botulinum Toxin per patient was injected. Average time lapse until improvement was 5.5 days. Five patients were injected with a second dose after an average of 18 months from the first injection. On this occasion, the area affected was considerably smaller than that presented before the first injection. The most frequently reported side effect was dry mouth. CONCLUSION: Our team considers that treating Frey's Syndrome with Botulinum Toxin is effective. The effects of the treatment are long-lasting and side effects are minimal and temporary. A second injection is needed after 15 to 18 months of the first, although the affected area is usually smaller.
Asunto(s)
Toxinas Botulínicas Tipo A/uso terapéutico , Neurotoxinas/uso terapéutico , Sudoración Gustativa/tratamiento farmacológico , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
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Introduction: Freys Syndrome is defined by facial hyperhidrosis in the preauricular region unleashed by gustatory stimulus and caused mainly by parotidectomy. Several treatment and prevention measures have been proposed, with no conclusive results. Recently, injections of Botulinum Toxin have been suggested, obtaining encouraging results. The objective is to describe our experience in treating Freys Syndrome with this drug.Materials and method: Between 2004 and 2007, our team treated 10 patients suffering from Freys Syndrome. Allcases were caused by parotid resection. In 60% of cases a complete elevation of the SMAS (superficial musculoaponeurotic system) was carried out. In the remaining cases, such elevation was either not made or the SMAS was severely damaged. All patients were treated with intradermic injections of Botulinum Toxin. Recorded data were: units administered, affected area, time lapse until improvement in the symptoms, and the evolution after one, six and twelve months after the injection. Possible side effects were also recorded.Results: The average treated area per patient was 26 cm2. An average of 38 units of Botulinum Toxin per patient was injected. Average time lapse until improvement was 5.5 days. Five patients were injected with a second dose after an average of 18 months from the first injection. On this occasion, the area affected was considerably smaller than that presented before the first injection. The most frequently reported side effect was dry mouth.Conclusion: Our team considers that treating Freys Syndrome with Botulinum Toxin is effective. The effects of the treatment are long-lasting and side effects are minimal and temporary. A second injection is needed after 15 to 18 months of the first, although the affected area is usually smaller (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Sudoración Gustativa/terapia , Toxinas Botulínicas/uso terapéutico , Hiperhidrosis/terapia , InyeccionesRESUMEN
OBJECTIVES: The objective was to present a novel technique for antrostomy performed before sinus elevation in atrophic maxilla for subsequent implant placement. MATERIAL AND METHODS: The study included 10 sinus elevations performed by the proposed technique in nine consecutive patients presenting with inadequate posterior maxillary height. The technique is described, calculating the antrostomy surface area, volume of bone tissue obtained and final height attained in each case. A total of 16 implants were placed. RESULTS: All ten elevations were accomplished. Mean antrostomy surface area was 0.55 mm2, mean bone volume obtained was 0.56 cm3 and mean height attained was 11.7 mm from a baseline mean height of 5.6 mm. Out of the 16 implants, 14 were inserted immediately after the elevation and 2 were inserted in a second step, after ossification; 93.7% of the implants were osseointegrated at 6 months after prosthesis placement. CONCLUSION: The use of bone scrapers to create antrostomy for sinus elevation is a simple and very safe procedure. It provides a variable amount of particulate bone graft that is easily handled and highly useful for packing the cavity that will elevate the sinus membrane.
Asunto(s)
Trasplante Óseo/instrumentación , Trasplante Óseo/métodos , Implantación Dental Endoósea/métodos , Maxilar/patología , Maxilar/cirugía , Atrofia , Diseño de Equipo , Femenino , Humanos , MasculinoRESUMEN
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Objectives: The objective was to present a novel technique for antrostomy performed before sinus elevation in atrophic maxilla for subsequent implant placement.Material and methods: The study included 10 sinus elevations performed by the proposed technique in nine consecutive patients presenting with inadequate posterior maxillary height. The technique is described, calculating the antrostomy surface area, volume of bone tissue obtained and final height attained in each case. A total of 16 implants were placed.Results: All ten elevations were accomplished. Mean antrostomy surface area was 0.55 mm2, mean bone volume obtained was 0.56 cm3 and mean height attained was 11.7 mm from a baseline mean height of 5.6 mm. Out of the 16 implants, 14 were inserted immediately after the elevation and 2 were inserted in a second step, after ossification; 93.7% of theimplants were osseointegrated at 6 months after prosthesis placement.Conclusion: The use of bone scrapers to create antrostomy for sinus elevation is a simple and very safe procedure. It provides a variable amount of particulate bone graft that is easily handled and highly useful for packing the cavity that will elevate the sinus membrane