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1.
Artículo en Inglés | MEDLINE | ID: mdl-33151192

RESUMEN

Oral cancer treatment involving the maxilla and/or mandible often results in esthetic and functional deficits that can diminish the patient's quality of life. As a result, expeditious reconstruction of the defect and dental rehabilitation is desirable. Dental rehabilitation shortly after reconstruction with an osteocutaneous free flap and resection prosthesis is a persistent challenge for patients with oncologic defects where immediate dental rehabilitation is not a possibility. Additionally, conventional prosthesis fabrication techniques are impractical or impossible due to postoperative anatomical changes and limitations in clinical armamentarium. To address these limitations, a technique and a novel implant-supported prosthetic workflow for the oncologic patient were developed to provide interim dental rehabilitation for such clinical situations. This article describes the prosthesis fabrication technique, reports short-term outcomes, and evaluates patient-reported quality-of-life outcomes using the FACE-Q Head and Neck Cancer Module.


Asunto(s)
Implantes Dentales , Colgajos Tisulares Libres , Reconstrucción Mandibular , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Peroné/cirugía , Humanos , Calidad de Vida
2.
Spec Care Dentist ; 40(3): 315-319, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32396249

RESUMEN

INTRODUCTION: A definitive maxillary obturator prosthesis can be used to rehabilitate a maxillary defect with the aim of improving speech, deglutition, and elimination of oronasal regurgitation. The aims of this study were (1) to determine the time required to fabricate a definitive maxillary obturator prosthesis and (2) to compare the fabrication and follow-up times between a patient's first and second definitive maxillary obturator prosthesis. MATERIALS AND METHODS: A retrospective review was completed of patients that had maxillary definitive obturators fabricated following head and neck surgery from 2002 to 2018 (n = 173). Demographics, clinical data, date of surgery, start date of fabrication, follow-up dates, and prosthesis follow-up data were collected. RESULTS: The median time to delivery of the patient's first definitive maxillary obturator prosthesis from the date of surgery was 7.7 months for nonradiated patients and 9.6 months for radiated patients (P ≤ .05). Additionally, there was a significant difference in the median number of appointments to fabricate the 1st definitive maxillary obturator prosthesis as compared to the 2nd prosthesis (6 vs 5; P ≤ .05). CONCLUSION: Fabrication timelines differed based on history of radiotherapy and patient experience. This data is helpful to set expectations for patients and practitioners regarding the process for prosthesis fabrication and follow-up.


Asunto(s)
Neoplasias Maxilares , Obturadores Palatinos , Estudios de Seguimiento , Humanos , Maxilar , Estudios Retrospectivos
3.
Plast Reconstr Surg ; 146(3): 637-648, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32459736

RESUMEN

BACKGROUND: Maxillofacial reconstruction with vascularized bone restores facial contour and provides structural support and a foundation for dental rehabilitation. Routine implant placement in such cases, however, remains uncommon. This study aims to determine dental implant survival in patients undergoing vascularized maxillary or mandibular reconstruction through a systematic review of the literature. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the literature was queried for implant placement in reconstructed jaws using Medical Subject Headings terms on PubMed, Embase, and Cochrane platforms. Weighted implant survivals were calculated for the entire cohort and subcohorts stratified by radiotherapy. Meta-analyses were performed to estimate effect of radiation on implant osseointegration. RESULTS: Of 3965 publications identified, 42 were reviewed, including 1084 patients with 3636 dental implants. Weighted implant survival was 92.2 percent at a median follow-up of 36 months. Survival was 97.0 percent in 269 implants placed immediately in 60 patients versus 89.9 percent in 1897 delayed implants placed in 597 patients, with follow-up of 14 and 40 months, respectively. Dental implants without radiotherapy exposure had better survival than those exposed to radiation (95.3 versus 84.6 percent; p < 0.01) at a median follow-up of 36 months. Meta-analyses showed that radiation significantly increased the risk of implant failure (risk ratio, 4.74; p < 0.01) and suggested that implants placed before radiotherapy trended toward better survival (88.9 percent versus 83.4 percent, p = 0.07; risk ratio, 0.52; p = 0.14). CONCLUSIONS: Overall implant survival was 92.2 percent; however, radiotherapy adversely impacted outcomes. Implants placed before radiotherapy may demonstrate superior survival than implants placed after.


Asunto(s)
Trasplante Óseo/métodos , Implantación Dental Endoósea , Reconstrucción Mandibular/métodos , Oseointegración/fisiología , Colgajos Quirúrgicos/irrigación sanguínea , Humanos , Procedimientos Quirúrgicos Reconstructivos
4.
Clin Case Rep ; 8(2): 278-282, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32128173

RESUMEN

This clinical report describes the expeditious treatment of a geriatric patient with squamous cell carcinoma of the nose treated with total rhinectomy, craniofacial implant placement, and a nasal prosthesis.

5.
Clin Implant Dent Relat Res ; 22(1): 91-95, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31777154

RESUMEN

OBJECTIVES: The current pilot study aims to report short-term experience as it relates to acute radiotherapy treatment outcomes comparing patients with immediate dental implants in fibula free flap reconstructions to a historical cohort of patients with fibula free flap reconstructions without dental implants. MATERIALS AND METHODS: A retrospective review of patients who underwent segmental mandibulectomy, reconstruction with fibula free flaps, and adjuvant radiotherapy with (n = 10) and without immediate dental implants (n = 10) at a tertiary cancer center from 2015 to 2018 was performed (IRB #17-271). Incidence of postoperative complications, time to initiation of radiation therapy, development of acute toxicity, and patient reported outcome data were recorded. The radiation plans were evaluated to identify the mean and maximum doses received by the mandible and oral cavity as well as the locations of radiation global hot spots. RESULTS: There was a similar number of postoperative complications in both cohorts, with three events in the case group and two events in the control group. Patients with dental implants reported less trismus than control patients. Evaluation of the radiation treatment plans revealed similar median radiation global hot spots in both groups. CONCLUSIONS: The current study suggests that the presence of dental implants does not increase the risk of complications following surgery or during radiation treatment. Implants do not alter radiation dosimetry but do appear to positively impact early patient quality of life. Although longer follow-up is needed, based on this preliminary experience, cancer patients should be offered this type of reconstruction without fear of impacting radiation timing or delivery.


Asunto(s)
Implantes Dentales , Colgajos Tisulares Libres , Neoplasias de Cabeza y Cuello , Neoplasias Mandibulares , Procedimientos Quirúrgicos Reconstructivos , Trasplante Óseo , Humanos , Mandíbula , Proyectos Piloto , Calidad de Vida , Estudios Retrospectivos , Resultado del Tratamiento
6.
Plast Reconstr Surg Glob Open ; 7(10): e2475, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31772898

RESUMEN

Reconstruction of segmental maxillary or mandibular defects with osteocutaneous free flaps can be reliably accomplished; however, buccal or lingual rotation of the fibula during rigid fixation can render immediate endosseous implant position unusable for functional dental rehabilitation. To address this issue, a custom inset guide is introduced which utilizes surface topography of the immediately placed dental implant abutments and the patient's dentition to orient the fibula segments during inset. Use of this technique facilitates successful endosseous implant position to optimize postoperative functional rehabilitation.

7.
Int J Prosthodont ; 32(5): 448-450, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31486818

RESUMEN

Leiomyosarcoma is a rare malignant condition occurring in the maxillofacial region in which the mandible may be affected. Management of this tumor in the mandible may include segmental mandibulectomy, osteocutaneous fibula free-flap reconstruction, endosseous implants, and postoperative radiotherapy. Posttreatment malocclusion can be managed with an overpartial mandibular resection prosthesis. The purpose of this report is to describe the expeditious oral rehabilitation of an oncologic patient with posttreatment malocclusion, demonstrating the utility of an overpartial mandibular resection prosthesis.


Asunto(s)
Colgajos Tisulares Libres , Leiomiosarcoma , Maloclusión , Neoplasias Mandibulares , Reconstrucción Mandibular , Procedimientos Quirúrgicos Reconstructivos , Trasplante Óseo , Humanos , Mandíbula , Prótesis e Implantes , Colgajos Quirúrgicos
8.
J Indian Prosthodont Soc ; 19(3): 221-224, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31462860

RESUMEN

Aim: The aim of this study is to retrospectively, observe a consecutive series of patients with segmental mandibulectomy defects reconstructed with fasciocutaneous free flaps and mandibular resection prostheses, and to review treatment concepts for the management of such patients. Settings and Design: Observational study done at Memorial Sloan Kettering Cancer Center, New York, NY, USA. Materials and Methods: Records were reviewed of all patients who had fasciocutaneous free-flap reconstruction and fabrication of mandibular resection prostheses following segmental mandibulectomy between 2000 and 2017 at a tertiary cancer center. Mandibular resection prosthesis fabrication interval data, as well as follow-up interval data, were recorded. Statistical Analysis Used: Descriptive statistics. Results: Twenty-one consecutive patients had mandibular resection prostheses fabricated following segmental mandibulectomy and fasciocutaneous free-flap reconstruction during the study. The median time for mandibular resection prosthesis delivery following surgery was 9 months (range 4-41 months). There was a median of two-follow-up visits (range 0-4) within the first 90 days of mandibular resection prosthesis delivery. Conclusions: Oral rehabilitation with mandibular resection prosthesis following segmental mandibulectomy and fasciocutaneous free-flap reconstruction is an attainable treatment goal for the oncologic patient. Reviewing the proposed course of care is helpful for patient management.

9.
Int J Prosthodont ; 32(3): 241-247, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31034537

RESUMEN

PURPOSE: To report the feasibility of oral rehabilitation in patients who had undergone marginal mandibulectomy and to describe the factors that impact the selection of a mandibular resection prosthesis. MATERIALS AND METHODS: A retrospective review of patients who had undergone marginal mandibulectomy over a 14-year period at a tertiary care cancer center was undertaken. Measurements of the vertical height and width of the mandible and the distance between the alveolar crest and mandibular canal were measured after marginal mandibulectomy. The feasibility and success of tooth-borne or implant-supported resection prostheses were measured. RESULTS: Following marginal mandibulectomy, the median heights between the alveolar crest and lower border of the mandible were 21.8 mm, 17.7 mm, and 14.3 mm in the anterior, premolar, and molar regions, respectively. However, the median distances between the alveolar crest and the mandibular canal in the premolar and molar regions were only 3.98 and 3.4 mm, respectively. These residual bone measurements are not satisfactory for implant-supported mandibular resection prostheses, which can be considered only in the anterior region of the mandible. Patients with marginal mandibulectomy in the premolar and molar regions can only be rehabilitated with removable dentures, provided they have remaining stable teeth to clasp and anchor the removable denture. CONCLUSION: Implant-supported resection prostheses after marginal mandibulectomy are feasible only in the anterior segment of the mandible and are not possible in the premolar and molar regions.


Asunto(s)
Implantes Dentales , Osteotomía Mandibular , Proceso Alveolar , Diente Premolar , Prótesis Dental de Soporte Implantado , Humanos , Mandíbula , Estudios Retrospectivos
10.
J Surg Oncol ; 120(2): 109-116, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30993699

RESUMEN

INTRODUCTION: Sarcomas of the mandible are extremely rare tumors, with osteosarcoma being the most common, followed by Ewing's sarcoma MATERIALS AND METHODS: A retrospective review of the clinical records, imaging studies, and pathology slides of patients with sarcoma of the mandible at a Tertiary Care Cancer Center from 1998 to 2014 was undertaken. The impact of neoadjuvant chemotherapy and postoperative radiotherapy with or without chemotherapy was studied, and factors impacting upon local control and disease-specific survival were analyzed. RESULTS: Twenty-two patients were treated over the study period, comprising of 15 males and seven females. External swelling, intraoral growth, or facial numbness were the presenting symptoms. Eighteen patients had osteosarcoma and four had the Ewing's sarcoma. Nine patients received neoadjuvant chemotherapy. All but one patient underwent surgery. Eleven had negative margins, with 90% recurrence-free survival at 3 years, compared to 10 with positive or close margins, leading to 67% recurrence-free survival. None of the patients receiving neoadjuvant chemotherapy developed recurrence and all were alive at 3 years. The impact of postoperative radiotherapy or adjuvant chemotherapy was not statistically significant. CONCLUSIONS: Wide surgical resection with negative margins remains the hallmark of surgical treatment.


Asunto(s)
Neoplasias Mandibulares/diagnóstico , Neoplasias Mandibulares/terapia , Sarcoma/diagnóstico , Sarcoma/terapia , Adolescente , Adulto , Anciano , Niño , Terapia Combinada , Femenino , Humanos , Masculino , Neoplasias Mandibulares/mortalidad , Márgenes de Escisión , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Pronóstico , Estudios Retrospectivos , Sarcoma/mortalidad , Tasa de Supervivencia , Adulto Joven
11.
Plast Reconstr Surg Glob Open ; 7(1): e2100, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30859051

RESUMEN

Full dental rehabilitation following segmental mandibulectomy or maxillectomy for oncologic tumor ablation should be the goal for every patient. But despite advances in technology and reconstructive techniques, many patients do not achieve timely or complete oral rehabilitation. Recognizing this fault, we recently adopted an innovative workflow to increase the number of patients undergoing dental restoration, irrespective of tumor pathology or need for adjuvant radiotherapy. Preoperatively, every osseous jaw reconstruction undergoes virtual surgical planning to incorporate the placement of endosseous implants into the fibula osteocutaneous free flap. The dental implants are then placed intraoperatively at the time of tumor ablation and reconstruction. Four-to-six weeks following the initial surgery, the patient returns to the operating room for vestibuloplasty and exposure of the dental implants. Within 3 days of the vestibuloplasty, a temporary dental prosthesis is placed in the dental clinic, and the patient can then begin radiation therapy if needed. Following adjuvant radiation therapy, the temporary prosthesis can be replaced with a permanent one. At our institution, this innovative workflow has allowed for earlier aesthetic restoration of the jaw and greatly expanded the number of patients able to achieve oral rehabilitation. Herein, we describe this innovative workflow and provide technical pearls for successful execution.

12.
Brachytherapy ; 18(3): 277-284, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30803923

RESUMEN

BACKGROUND: Intraoperative radiotherapy (IORT) is an effective strategy for the delivery of high doses of radiotherapy to a residual tumor or resection cavity with relative sparing of nearby healthy tissues. This strategy is an important component of the multimodality management of pediatric soft tissue sarcomas, particularly in cases where patients have received prior courses of external beam radiotherapy. PURPOSE: Tumor beds with significant topographic irregularity remain a therapeutic challenge because existing IORT technologies are typically most reliable with flat surfaces. To address this limitation, we have developed a novel strategy to create custom, prefabricated high-dose-rate (HDR)-IORT applicators designed to match the shape of an anticipated surgical cavity. METHODS AND MATERIALS: Silastic applicators are constructed using three-dimensional (3D) printing and are derived from volumetric segmentation of preoperative imaging. RESULTS: HDR preplanning with the applicators improves dosimetric accuracy and minimizes incremental operative time. In this report, we describe the fabrication process for the 3D-printed applicators and detail our experience utilizing this strategy in two pediatric patients who underwent HDR-IORT as part of complex base of skull sarcoma resections. CONCLUSIONS: Early experience suggests that usage of the custom applicators is feasible, versatile for a variety of clinical situations, and enables the uniform delivery of high superficial doses of radiotherapy to irregularly shaped surgical cavities.


Asunto(s)
Braquiterapia/instrumentación , Diseño de Equipo , Neoplasias/terapia , Braquiterapia/métodos , Niño , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Neoplasia Residual , Impresión Tridimensional , Planificación de la Radioterapia Asistida por Computador , Radioterapia Ayuvante
13.
J Prosthet Dent ; 122(1): 82-87, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30782457

RESUMEN

STATEMENT OF PROBLEM: Treatment and timing considerations for patients seeking oral rehabilitation after marginal or segmental mandibulectomy (with osseous reconstruction) are not well understood. PURPOSE: The purpose of this retrospective review study was to report the type and timing of oral rehabilitation for mandibular defects without discontinuity and to describe additional treatment considerations for rehabilitation. MATERIAL AND METHODS: The records were reviewed of all patients who received a mandibular resection prosthesis after marginal mandibulectomy, marginal mandibulectomy with fasciocutaneous free-flap reconstruction, and segmental mandibulectomy with fibula free-flap reconstruction between 2000 and 2017 in the tertiary cancer care institution. Patients not treated by the Dental Service in the institution were excluded. The specific type of rehabilitation was noted, as was the time interval between primary surgery and prosthesis delivery. RESULTS: During the study period, 111 consecutive patients were treated by the Memorial Sloan Kettering Cancer Center Dental Service for mandibular rehabilitation. Forty-three patients underwent marginal mandibulectomy, 9 patients underwent marginal mandibulectomy with fasciocutaneous free-flap reconstruction, and 59 patients underwent segmental mandibulectomy with fibula free-flap reconstruction. Most patients in all 3 groups received mandibular resection prostheses without the use of endosseous implants. Only 4 (8%) patients who had undergone marginal mandibulectomy underwent endosseous implant placement, all of which followed marginal mandibulectomy in anterior mandibular segments without free-flap reconstruction. Patients who underwent marginal mandibulectomy with fasciocutaneous free-flap reconstruction were only restored with removable mandibular resection prostheses, and none had endosseous implants. In patients who underwent segmental mandibulectomy, 13 (22%) were rehabilitated with endosseous implants. The majority in this cohort (>50%) received radiation therapy as part of their treatment. The median time to oral rehabilitation was 8 months after marginal mandibulectomy, 14 months after marginal mandibulectomy with fasciocutaneous free-flap reconstruction, and 12 months after segmental mandibulectomy with fibula free-flap reconstruction. CONCLUSIONS: Timing for oral rehabilitation may differ depending on the treatment modality followed for mandibular tumors in the patient with oral cancer. However, most patients in this cohort underwent rehabilitation with removable mandibular resection prostheses regardless of the timing of care. Endosseous implants were used infrequently, but research is needed to better understand their potential role and indication in the patient with oral cancer.


Asunto(s)
Colgajos Tisulares Libres , Neoplasias Mandibulares , Reconstrucción Mandibular , Trasplante Óseo , Peroné , Humanos , Mandíbula , Osteotomía Mandibular , Prótesis e Implantes , Estudios Retrospectivos , Resultado del Tratamiento
14.
Laryngoscope ; 129(2): 409-414, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30247745

RESUMEN

OBJECTIVES/HYPOTHESIS: The current role of maxillofacial prosthetic care for head and neck cancer patients is not well understood. Additionally, perceived barriers for service provision are unknown. The purpose of this study was to evaluate the current role of maxillofacial prosthetic care at National Cancer Institute (NCI)-designated comprehensive cancer centers and to identify perceived barriers to care. STUDY DESIGN: Multicenter, cross-sectional survey of head and neck division leaders at NCI-designated comprehensive cancer centers. METHODS: Each head and neck division leader from the 47 NCI-designated comprehensive cancer centers was invited to participate. The main outcomes of this study were: 1) to evaluate the current role of maxillofacial prosthetics for the surgically treated head and neck cancer patient within NCI-designated comprehensive cancer centers and 2) to identify perceived barriers to care. Measured outcomes were obtained from an anonymous online survey and reported. RESULTS: Twenty-eight of the 47 head and neck service chiefs responded (60% response rate). Respondents expressed preference for prosthetic rehabilitation for hard palate/upper gum, auricular, and nasal defects. Local flap or free tissue transfer was preferred for lower gum and soft palate defects. Cost-related factors were among the most reported perceived barriers to maxillofacial prosthetic care. CONCLUSIONS: Maxillofacial prosthetics have an important role in the rehabilitation of the head and neck cancer patient. Perceived barriers for services exist, particularly as it relates to cost. Providers should be aware that these issues are likely to be more severe in regional or community centers. LEVEL OF EVIDENCE: NA Laryngoscope, 129:409-414, 2019.


Asunto(s)
Instituciones Oncológicas/estadística & datos numéricos , Atención Integral de Salud/estadística & datos numéricos , Neoplasias de Cabeza y Cuello/cirugía , Implantación de Prótesis Maxilofacial/estadística & datos numéricos , Prótesis Maxilofacial/estadística & datos numéricos , Estudios Transversales , Humanos , National Cancer Institute (U.S.) , Encuestas y Cuestionarios , Estados Unidos
15.
Quintessence Int ; 50(1): 40-48, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30411093

RESUMEN

Successful intraoral rehabilitation for patients with head and neck cancer can be extremely challenging to both the patient and the physician due to anatomical, functional, and esthetic changes from the cancer and its treatment. The measures with optimal oral hygiene to prevent or minimize the sequelae of cancer treatments are fundamental to preservation of function and avoidance of complications of therapy. In patients with loss of teeth, endosseous (dental) implants offer an option to improve intraoral rehabilitation. This review presents the indications, problems, and relevant issues pertaining to the use of endosseous implants in a head and neck oncologic population. The problems associated with the traditional approaches for cancer treatment including surgery, radiotherapy, and chemotherapy, as well as those with antiresorptive medications are discussed as they relate to consideration for endosseous implants. This information can aid dental practitioners to select appropriate candidates for implant surgery, minimize postoperative complications, and maximize the successful oral rehabilitation of this patient population.


Asunto(s)
Implantación Dental Endoósea/métodos , Implantes Dentales , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/rehabilitación , Rehabilitación Bucal/métodos , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Estética Dental , Humanos , Higiene Bucal
16.
J Prosthet Dent ; 121(4): 703-707, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30580980

RESUMEN

STATEMENT OF PROBLEM: Electron backscatter radiation from dental materials can contribute to soft tissue injury in patients undergoing head and neck radiation therapy. PURPOSE: The dose enhancement from the materials used for prosthodontic restoration of the dentition has not been well quantified. This study reports the magnitude of backscatter dose from the contemporary dental materials lithium disilicate and zirconia as compared with high-noble alloy and investigates the role of a spacer material in mitigating this effect. MATERIAL AND METHODS: Three flat slabs of dental materials high-noble alloy, lithium disilicate, and zirconia with thicknesses of 1.5 and 3 mm were irradiated with 6-MV photons from a clinical linear accelerator. Measurements were made using a thin-window parallel-plate ionization chamber placed at 0, 1, 3, and 5 mm from the material. One millimeter of poly(methyl methacrylate) or thermoplastic material was used to cover the dental material and measure the effect on the adjacent dose enhancement. RESULTS: Dose enhancements between 8% and 50% were recorded adjacent to the dental restoration materials. The largest enhancements occurred for the material of the highest density, the high-noble alloy. Dose enhancement was substantially lower for lithium disilicate (8%) and zirconia (30%). The thickness of the restoration material did not significantly affect dose enhancement. The dose enhancement decreased with distance from the material, dropping to <10% for all materials at 3 mm. CONCLUSIONS: Contemporary dental restorations enhance the backscatter dose. The presence of dental restorations may warrant the use of a stent to create separation from these materials as this can mitigate the effect.


Asunto(s)
Materiales Dentales , Porcelana Dental , Aleaciones Dentales , Diseño de Prótesis Dental , Humanos , Ensayo de Materiales , Dosis de Radiación , Circonio
17.
J Cancer Educ ; 34(2): 329-333, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-29196905

RESUMEN

Management of patients undergoing treatment for cancer requires a multidisciplinary team including general dentistry providers; however, the relative knowledge and training of general dentists in the management of this patient population are relatively unknown. The purpose of this study was to assess the oncology curricula of postgraduate general dentistry training programs, from the perspective of the program directors, to better understand the opportunities for and/or barriers to dental care for cancer patients. A cross-sectional survey was sent to the 275 Commission on Dental Accreditation-accredited programs; 82 program directors responded (response rate, 30%). More than 50% of respondents indicated "none" or "little" curricular emphasis on cancer biology, bone marrow transplantation, immunotherapy, or prosthetics for use during head and/or neck surgery. Conversely, more than 50% of respondents indicated "moderate" or "substantial" emphasis on acute oral effects of cancer-related therapy, long-term oral effects of cancer-related therapy, antiresorptive medication pharmacology, radiotherapy techniques and biological effects, and osteonecrosis of the jaw. Residents had the most experience with radiotherapy patients and the least with bone marrow or transplantation patients. Overall, general dentistry program directors were enthusiastic to participate in the multidisciplinary team but reported challenges to including oncology curricula in residency training programs. Training for general dentistry providers in formalized postgraduate residency programs may be variable or limited-as a result, communication regarding patient management is critical. Opportunities exist to enhance the general dentistry curricula and, thereby, improve access to dental care for patients receiving treatment for cancer.


Asunto(s)
Curriculum , Educación en Odontología , Internado y Residencia , Oncología Médica/educación , Estudios Transversales , Educación de Posgrado en Odontología , Humanos , Encuestas y Cuestionarios , Estados Unidos
18.
J Surg Oncol ; 117(8): 1729-1735, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29723421

RESUMEN

Rehabilitation of oral functions following surgery on the jaws is a goal that is often difficult to achieve. Removable dentures supported by remaining teeth or gum are often unstable and seldom satisfactory. On the other hand, endosseous (dental) implants offer a mechanism to provide stability to the dentures. This review, discusses factors related to the tumor, patient, treatment, and physicians which impact upon the feasibility and success of dental implants in patients with oral cancer.


Asunto(s)
Implantes Dentales , Dentaduras , Neoplasias de la Boca/rehabilitación , Selección de Paciente , Pérdida de Hueso Alveolar/complicaciones , Antineoplásicos/efectos adversos , Osteonecrosis de los Maxilares Asociada a Difosfonatos/etiología , Conservadores de la Densidad Ósea/efectos adversos , Humanos , Arcada Edéntula/etiología , Arcada Edéntula/rehabilitación , Osteotomía Mandibular/efectos adversos , Maxilar/cirugía , Neoplasias de la Boca/terapia , Grupo de Atención al Paciente , Complicaciones Posoperatorias , Radioterapia/efectos adversos
19.
Oral Oncol ; 66: 46-51, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-28249647

RESUMEN

OBJECTIVE: To determine clinicopathologic factors on survival in patients with head and neck synovial sarcoma. PATIENTS AND METHODS: We retrospectively identified patients with molecularly confirmed synovial sarcomas of the head and neck (SS-HN), either by the presence of SS18-SSX fusion transcript by RT-PCR or SS18 gene rearrangement by FISH, who were managed at our institution over a 20-year period (1996-2015). Kaplan-Meier survival analysis and log-rank test were performed to evaluate variables related to disease specific survival (DSS). Fisher exact test was performed to evaluate variables related to local recurrence. RESULTS: Thirty-four patients (20 males and 14 females, mean of 31years) with SS18-SSX fusion-positive SS-HN were identified. The parapharyngeal region of the neck was the most common site. The mean tumor size was 4.8cm (0.8-10cm). Two-thirds (n=23) of cases had a monophasic histology. The 2, 5 and 10-year DSS rates were 97%, 79% and 68%. The 5-year DSS rates for the adult/pediatric cohort were 74%/88%. Recurrence showed significant effect on DSS (p=0.021). There was no significant effect on DSS with age, therapy modality, tumor site, surgical margin, tumor size (⩽5cm vs. >5cm) and histopathologic subtype. Tumor site (i.e. skull base/paranasal sinus region) was associated with local recurrence (p=0.003). CONCLUSION: In our cohort DSS rate was associated with recurrence. Tumors located in the skull base/paranasal sinus region were associated with a higher rate of local recurrence. Thus appropriate selection of high risk patients who can benefit from multimodality therapies might improve survival.


Asunto(s)
Neoplasias de Cabeza y Cuello/patología , Proteínas de Fusión Oncogénica/genética , Proteínas Proto-Oncogénicas/genética , Proteínas Represoras/genética , Sarcoma Sinovial/patología , Adulto , Anciano , Terapia Combinada , Femenino , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/genética , Neoplasias de Cabeza y Cuello/terapia , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Sarcoma Sinovial/diagnóstico por imagen , Sarcoma Sinovial/genética , Sarcoma Sinovial/terapia , Análisis de Supervivencia
20.
Oral Oncol ; 64: 44-51, 2017 01.
Artículo en Inglés | MEDLINE | ID: mdl-28024723

RESUMEN

OBJECTIVE: To determine the prevalence and correlation of various risk factors [radiation dose, periodontal status, alcohol and smoking] to the development of osteoradionecrosis (ORN). PATIENTS AND METHODS: The records of 1023 patients treated with IMRT for oral cavity cancer (OCC) and oropharyngeal cancer (OPC) between 2004 and 2013 were retrospectively reviewed to identify patients who developed ORN. Fisher exact tests were used to analyze patient characteristics between ORN patients with OCC and OPC. Paired Wilcoxon tests were used to compare the dose volumes to the ORN and contralateral non-ORN sites. To evaluate an association between ORN and risk factors, a case-control comparison was performed. One to 2 ORN-free patients were selected to match each ORN patient by gender, tumor site and size. General estimation equations models were used to compare the risk factors in ORN cases and matched controls. RESULTS: 44 (4.3%) patients developed ORN during a median follow-up time of 52.5months. In 82% of patients, ORN occurred spontaneously. Patients with OPC are prone to develop ORN earlier compared to patients with OCC (P=0.03). OPC patients received a higher Dmax compared to OCC patients (P=0.01). In the matched case-control analysis the significant risk factors on univariate analysis were poor periodontal status, history of alcohol use and radiation dose (P=0.03, 0.002 and 0.009, respectively) and on multivariate analysis were alcohol use and radiation dose (P=0.004 and 0.026, respectively). CONCLUSION: In our study, higher radiation dose, poor periodontal status and alcohol use are significantly related to the risk of developing ORN.


Asunto(s)
Enfermedades Maxilomandibulares/etiología , Neoplasias de la Boca/radioterapia , Neoplasias Orofaríngeas/radioterapia , Osteorradionecrosis/etiología , Radioterapia de Intensidad Modulada/efectos adversos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de Riesgo
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