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1.
Artículo en Inglés | MEDLINE | ID: mdl-33583151

RESUMEN

BACKGROUND: Odontogenic sinusitis (ODS) is distinct from non-odontogenic rhinosinusitis, and often requires multidisciplinary collaboration between otolaryngologists and dental providers to make the diagnosis. The purpose of this study was to develop international multidisciplinary consensus on diagnosing ODS. METHODS: A modified Delphi method was used to assess for expert consensus on diagnosing bacterial ODS. A multidisciplinary panel of 17 authors with ODS expertise from 8 countries (8 otolaryngologists, 9 dental specialists) was assembled. Each author completed 2 of 3 surveys (2 specialty-specific, and 1 for all authors). Thirty-seven clinical statements were created, focusing on 4 important diagnostic components: suspecting ODS; confirming sinusitis in ODS; confirming different dental pathologies causing ODS; and multidisciplinary collaborative aspects of diagnosing ODS. Target audiences were all otolaryngologists and dental providers. RESULTS: Of the 37 clinical statements, 36 reached consensus or strong consensus, and 1 reached no consensus. Strong consensus was reached that certain clinical and microbiologic features should arouse suspicion for ODS, and that multidisciplinary collaboration between otolaryngologists and dental providers is generally required to diagnose ODS. To diagnose ODS, otolaryngologists should confirm sinusitis mainly based on nasal endoscopic findings of middle meatal purulence, edema, or polyps, and dental providers should confirm dental pathology based on clinical examination and dental imaging. CONCLUSION: Based on multidisciplinary international consensus, diagnosing ODS generally requires otolaryngologists to confirm sinusitis, and dental providers to confirm maxillary odontogenic pathology. Importantly, both dental providers and otolaryngologists should suspect ODS based on certain clinical features, and refer patients to appropriate providers for disease confirmation.

2.
Med Hypotheses ; 146: 110419, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33309251

RESUMEN

Limited knowledge about the contagiosity and case fatality rate of COVID-19 as well as the still enigmatic route of transmission have led to strict limitations of non-emergency health care especially in head and neck medicine and dentistry. There are theories that the oral cavity provides a favorable environment for SARS-CoV-2 entry and persistence which may be a risk for prolonged virus shedding. However, intraoral innate immune mechanisms provide antiviral effects against a myriad of pathogenic viruses. Initial hints of their efficacy against SARS-CoV-2 are surfacing. It is hypothesized that intraoral immune system activity modulates the invasion pattern of SARS-CoV-2 into oral cells. Thus, the significance of intraoral tissues for SARS-CoV-2 transmission and persistence cannot be assessed. The underlying concept for this hypothesis was developed by the critical observation of a clinically asymptomatic COVID-19 patient. Despite a positive throat swab for SARS-CoV-2, molecular pathologic analysis of an oral perisulcular tissue specimen failed to detect SARS-CoV-2 RNA. More research effort is necessary to define the true origin of the contagiosity of asymptomatic COVID-19 patients.


Asunto(s)
/virología , Modelos Biológicos , Boca/virología , /patogenicidad , Esparcimiento de Virus , Adulto , Infecciones Asintomáticas , /inmunología , Reservorios de Enfermedades/virología , Femenino , Interacciones Microbiota-Huesped/inmunología , Humanos , Inmunidad Innata , Boca/inmunología , Pandemias , ARN Viral/aislamiento & purificación , Carga Viral
3.
Artículo en Inglés | MEDLINE | ID: mdl-33309263

RESUMEN

Medication-related osteonecrosis of the jaw (MRONJ) has become a serious concern for patients under antiresorptive treatment, especially in the oncological setting. Different approaches have been described in the management of MRONJ, including innovative autofluorescence-guided surgery. However, until now, there has been a lack of data regarding the outcome. OBJECTIVE: In this study, we evaluated the efficacy of minimally invasive autofluorescence-guided resection in MRONJ. STUDY DESIGN: Seventy-five patients with 82 lesions were included in this retrospective, single-center study. All included patients were diagnosed with MRONJ according to the American Association of Oral and Maxillofacial Surgeons guidelines and underwent autofluorescence-guided surgery with a minimum follow-up of 3 months. The primary outcome was complete integrity of the mucosa and absence of bone exposure. RESULTS: The MRONJ stages were stage 0 (3.7%), stage 1 (3.7%), stage 2 (75.6%), and stage 3 (17%). Overall, complete mucosal healing of all lesions after the first surgery was 81.7% (67 of 82), whereas it was 90.2% (74 of 82) after revision surgery. CONCLUSIONS: The study showed that autofluorescence-guided surgery is a safe and successful treatment option that can be considered for all stages of MRONJ.

4.
J Prosthet Dent ; 124(3): 274-349, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32811666

RESUMEN

This comprehensive review of the 2019 restorative dental literature is offered to inform busy dentists regarding remarkable publications and noteworthy progress made in the profession. Developed by the Scientific Investigation Committee of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to 1 of 8 sections of the report: (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information likely to influence day-to-day dental treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source material when greater detail is desired. As the profession moves toward evidence-based clinical decision-making, an incredible volume of potentially valuable dental literature continues to increase. It is the intention of this review and its authors to provide assistance in negotiating the extensive dental literature published in 2019. It is our hope that readers find this work useful in the clinical management of dental patients.


Asunto(s)
Caries Dental , Materiales Dentales , Oclusión Dental , Humanos , Periodoncia , Prostodoncia , Estados Unidos
5.
Clin Implant Dent Relat Res ; 22(3): 333-341, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32350989

RESUMEN

BACKGROUND: While some medical associations provide guidelines for the implant-prosthetic rehabilitation of head and neck cancer patients, the circulation and implementation in the everyday routine of practicing dentists remain unknown. PURPOSE: To analyze patterns of care for the prosthetic rehabilitation of head and neck cancer patients after radiotherapy in German speaking countries. MATERIALS AND METHODS: An online survey consisting of 34 questions separated into three sections, (a) general inquiries, (b) treatment concepts, and (c) patient cases, was forwarded to university hospital departments for Prosthetic Dentistry and Oral and Maxillofacial Surgery, and members of different medical associations. Statistical differences between groups were analyzed using chi-squared test (P < .05). RESULTS: From May to October 2019, 118 participants completed the survey. The majority practiced in university hospitals, had more than 5 years of work experience, and reported to be involved in <10 post radiation prosthetic rehabilitation cases per year. Rehabilitation protocols involving dental implants were implemented by oral/oral- and maxillofacial surgeons and prosthetic dentists, while general dentists favored implant-free solutions. Xerostomia was recognized as a common problem for a successful prosthetic rehabilitation. The subsequent treatment choice with either fixed dental prostheses or removable dentures was divided among participants. CONCLUSIONS: As treatment planning differed with regard to the participants' field of expertise and work environment, and most practitioners only handle a low number of cases, patients might benefit from centralization in larger institutes with a multidisciplinary structure. A high agreement between the practitioners' treatment concepts and the current state of research was observed. While the choice between a mucosa- or tooth-supported, and an implant-supported restoration depends on numerous individual factors, guidelines derived from longitudinal studies would enhance evidence-based treatment in this field.


Asunto(s)
Implantes Dentales , Neoplasias de Cabeza y Cuello , Prótesis Dental de Soporte Implantado , Humanos , Calidad de Vida , Encuestas y Cuestionarios
6.
J Prosthet Dent ; 122(3): 198-269, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31405523

RESUMEN

This comprehensive review of the 2018 dental literature is provided to inform busy dentists about progress in the profession. Developed by the Committee on Scientific Investigation of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to one of the 8 sections of the report including (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information that will likely influence day-to-day treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source materials if greater detail is desired. As the profession continues its march toward evidence-based clinical decision-making, an already voluminous library of potentially valuable dental literature continues to grow. It is the intention of this review and its authors to provide assistance in navigating the extensive dental literature published in 2018. It is our hope that readers find this work useful in the clinical management of patients moving forward.


Asunto(s)
Caries Dental , Materiales Dentales , Oclusión Dental , Humanos , Periodoncia , Prostodoncia , Estados Unidos
7.
Oral Dis ; 25(2): 497-507, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30325561

RESUMEN

PURPOSE: The management of maxillary medication-related osteonecrosis of the jaw (MRONJ) is challenging. Therefore, identifying the proper treatment is important. This study aimed to evaluate the surgical treatment of maxillary MRONJ using single-layer closure with mucoperiosteal flap and double-layer closure with buccal fat pad flap (BFPF) and mucoperiosteal flap and to find the outcomes after rehabilitation with obturators. METHODS: A retrospective analysis was conducted and included all surgically treated and followed-up maxillary MRONJ cases in a single center. Demographics and clinical data, stage of MRONJ, surgical treatment, and treatment outcome were collected. RESULTS: Seventy-nine lesions were included. Removal of necrotic bone was followed by coverage with mucoperiosteal flap in 60 lesions and BFPF in 14 lesions. Seven lesions (five primarily and two following unsuccessful treatment with BFPF) underwent necrectomy and were reconstructed with obturators. Complete mucosal healing was achieved in 76.7% of the lesions covered with mucoperiosteal flap. BFPF led to complete mucosal healing in 85.7% of the lesions. No complications were observed in the defects rehabilitated with obturators. CONCLUSION: Removal of necrotic bone followed by closure with mucoperiosteal flap is reliable for MRONJ treatment. BFPF is effective for closure of MRONJ-related oroantral communications (OACs).


Asunto(s)
Osteonecrosis de los Maxilares Asociada a Difosfonatos/cirugía , Enfermedades Maxilares/cirugía , Repitelización , Colgajos Quirúrgicos , Tejido Adiposo/cirugía , Anciano , Anciano de 80 o más Años , Conservadores de la Densidad Ósea/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mucosa Bucal/cirugía , Periostio/cirugía , Estudios Retrospectivos
8.
Artículo en Inglés | MEDLINE | ID: mdl-30543726

RESUMEN

Double lip is a rare deformity that mainly affects the upper lip. The typical clinical image involves bilateral mucosal pads separated by a central groove that appear superimposed over the maxillary incisors. The deformity is rather noticeable and esthetically disturbing. Most cases of double lip are congenital, but syndromic appearance of double lip has been described. Surgical reduction of the tissue surplus is the treatment method of choice. The literature suggests excision of excess mucosa and the underlying tissues to correct double upper lip. This report discusses the advantages and pitfalls of resective techniques and suggests a novel, mucosa-sparing, transvestibular approach to correct double upper lip.


Asunto(s)
Labio/anomalías , Mucosa Bucal/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Adulto , Estética Dental , Femenino , Humanos , Labio/diagnóstico por imagen , Mucosa Bucal/diagnóstico por imagen
9.
J Oral Maxillofac Surg ; 76(12): 2650-2659, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30098956

RESUMEN

PURPOSE: A considerable proportion of oral squamous cell carcinoma (OSCC) recurrences involve the neck, which has a substantial impact on prognosis and is poorly understood. The purpose of this study was to analyze clinical and pathologic characteristics of regional recurrence of OSCC and identify possible risk factors. MATERIALS AND METHODS: A single-center retrospective cohort study was designed to address the study purpose. All patients who were treated surgically for primary OSCC with or without adjuvant therapy between 2010 and 2015 were considered for inclusion with respect to predefined criteria, and demographic, clinical, and pathologic variables were collected. The lymph node status after primary OSCC treatment (pN) was defined as the predictor variable, and the occurrence of regional recurrence served as the primary outcome variable. Further variables of special interest were the histologic differentiation (G status) of the primary OSCC and the values of the lymph node ratio and log odds of positive lymph nodes. Descriptive, inferential, and appropriate time-dependent (Kaplan-Meier analysis, Cox regression model) statistics were computed. The level of statistical significance was set at P ≤ .05. RESULTS: The study sample was composed of 171 patients (70 women and 101 men; average age, 62.4 years). Neck failure occurred in 18 patients (11%) either in combination with local recurrence (15 patients) or in isolation (3 patients). Poor histologic differentiation of the primary tumor was identified as an independent risk factor for regional recurrence. Most neck recurrences manifested in previously unaddressed levels (IV and V). CONCLUSIONS: Regional recurrence of OSCC might be associated with specific clinicopathologic parameters of the primary tumor. The importance of these parameters for OSCC prognosis assessment and recurrence prediction should be elucidated in further studies.


Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias de la Boca/cirugía , Recurrencia Local de Neoplasia/etiología , Adulto , Anciano , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/secundario , Femenino , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/secundario , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/diagnóstico , Neoplasias de la Boca/patología , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/patología , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo
10.
J Craniomaxillofac Surg ; 46(4): 534-537, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29510893

RESUMEN

PURPOSE: Diffuse sclerosing osteomyelitis (DSO) is a rare disease of the jaw bone. Its treatment is challenging. Different medical and surgical treatment protocols have been proposed; however, none of these treatment protocols produce reliable results. Recently, ibandronate administration has been attempted as a treatment alternative in acute cases of DSO. Due to the similar antiresorptive effect, we sought to explore the application of the human monoclonal antibody to the receptor activator of nuclear factor kappaB ligand (RANKL), denosumab, in the treatment of DSO. MATERIALS AND METHODS: One female patient with histologically verified DSO received subcutaneous injections of denosumab (Prolia® 60 mg). The further course of the disease was followed clinically and by radiography and scintigraphy. RESULTS: In this case, the use of denosumab displayed promising results in aiding pain relief and reducing inflammatory activity. CONCLUSION: We suggest that antiresorptive treatment with denosumab can be considered as an alternative treatment for patients suffering from DSO. However further studies, with respect to clarifying the mechanisms of action and defining the necessary medication dose as well as application intervals, have to be conducted.


Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Denosumab/uso terapéutico , Enfermedades Mandibulares/tratamiento farmacológico , Osteomielitis/tratamiento farmacológico , Conservadores de la Densidad Ósea/administración & dosificación , Denosumab/administración & dosificación , Femenino , Humanos , Inyecciones Subcutáneas , Mandíbula/diagnóstico por imagen , Enfermedades Mandibulares/diagnóstico por imagen , Persona de Mediana Edad , Osteomielitis/diagnóstico por imagen , Cintigrafía
11.
J Oral Maxillofac Surg ; 76(1): 190-198, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-28646645

RESUMEN

PURPOSE: This study evaluated the role of imaging staging examinations (positron-emission tomographic computed tomography [PET/CT] and contrast-enhanced computed tomography [ceCT]) for the assessment of the comorbidity status of patients with oral squamous cell carcinoma (OSCC). A binary null hypothesis was drafted: 1) imaging staging examinations do not augment knowledge about the comorbidity status of patients with OSCC and 2) there is no difference between PET/CT and ceCT in this regard. MATERIALS AND METHODS: A retrospective cohort study design was selected to address the research question. Patients with histologically confirmed OSCC who underwent whole-body staging by PET/CT or ceCT from 2012 through 2015 were considered for inclusion according to predefined criteria. Data collection was performed by the review of patient charts and histology, radiology, and nuclear medicine reports. The Charlson Comorbidity Index (CCI) was chosen to quantify comorbidity and was calculated before and after staging and then compared. The type of imaging staging examination (PET/CT or ceCT) served as the predictor variable and the CCI was determined as the primary outcome variable. Descriptive and inferential statistics were computed for the variable scale. The significance level was set at a P value less than or equal to .05. RESULTS: The sample was composed of 178 patients (71 women, 107 men; average age, 64.2 yr) of whom 109 (61%) underwent PET/CT and 69 (39%) underwent ceCT staging. The pre- and post-staging CCI notably differed. Neither imaging technique showed superior results. CONCLUSION: Relevant and otherwise covert comorbidities can be found by the performance of imaging staging examinations. This enables clinicians to better assess the peri-therapeutic risk and prognosis of patients with OSCC. Therefore, a detailed evaluation of incidental findings on imaging studies is warranted and recommended.


Asunto(s)
Carcinoma de Células Escamosas/diagnóstico por imagen , Neoplasias de la Boca/diagnóstico por imagen , Comorbilidad , Medios de Contraste , Femenino , Fluorodesoxiglucosa F18 , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
12.
J Neurol Surg A Cent Eur Neurosurg ; 79(3): 218-223, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29241272

RESUMEN

BACKGROUND: The incidence of pyogenic spondylodiscitis is increasing; however, the source of infection often remains obscure. We analyzed predisposing factors, pathogens, and outcome of patients undergoing surgical and/or conservative treatment of spondylodiscitis with a focus on the diagnostic work-up including a comprehensive maxillofacial assessment. PATIENTS: The analysis of prognostic factors comprised comorbidities, nicotine dependence, symptom duration, and oral cavity peculiarities. After a standardized diagnostic work-up, a detailed examination of the oral cavity was also performed. The outcome analysis included assessment of the patients' clinical status. RESULTS: Forty-one patients with pyogenic spondylodiscitis were investigated of whom 24% had undergone spinal surgery within 4 weeks before the infection. A total of 29% of patients were found to have a concomitant bacterial oral cavity disease, and in 22% the definitive source of infection remained unidentified. Among the 12 patients with oral cavity infections, 10 patients had periodontitis; 8, root canal pathologies; 6, periapical lesions, and another 8 patients, caries. In 25% of these patients, typical oral cavity pathogens were found in the intervertebral disk. The prevalence of oral cavity infections was associated with a history of nicotine dependence (p = 0.003). All other analyzed comorbidities did not differ compared with patients without an oral cavity focus. CONCLUSION: Oral cavity infections appear to be a frequent source of pyogenic spondylodiscitis, with smoking its most relevant associated risk factor. In case of an unidentified infection focus, a detailed diagnostic work-up including a mandatory maxillofacial assessment is strongly recommended.


Asunto(s)
Discitis/etiología , Boca/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Discitis/cirugía , Femenino , Humanos , Disco Intervertebral , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos , Estudios Retrospectivos , Factores de Riesgo , Fumar , Resultado del Tratamiento
13.
J Craniomaxillofac Surg ; 45(4): 558-569, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28238561

RESUMEN

PURPOSE: Magnetic resonance imaging (MRI) is an excellent imaging modality for displaying peripheral nerves. Since the knowledge about MRI of the inferior alveolar nerve (IAN) is limited, this pilot study aims to identify the prospects and limitations of MRI of the IAN, with special consideration of metal artifacts. MATERIALS AND METHODS: Initially, in vitro MRI of a dental implant was performed to establish an optimized protocol for metal artifact reduction using WARP sequences (a software package provided by Siemens Healthcare, Erlangen, Germany) including view angle tilting (VAT) and slice-encoding metal artifact correction (SEMAC) techniques. MRI with this optimized protocol was performed in three volunteers and four patients presenting with postoperative IAN impairment. Measuring the evaluable area and the artifact size was performed to assess the benefit of the specific artifact reduction sequences. RESULTS: In vitro imaging of a dental implant demonstrated that WARP sequences with VAT and SEMAC techniques led to a volume reduction of the artifact of up to 69.1%. Observations in both volunteers and patients with neurosensory IAN impairment showed a distinct artifact reduction with the MRI protocol adapted to metallic materials. Additionally VAT and SEMAC techniques improved the imaging due to further artifact reduction. As a main drawback of the VAT technique, the image quality was compromised by a blurring effect. Still, on 3-T MRI the resolution was high enough to reveal even fine structures. Imaging of the IAN was successful in all cases despite metallic material in the region of interest, and structural IAN changes could be detected in correlation with clinical symptoms. CONCLUSION: In contrast to conventional radiography and computed tomography, MRI can directly depict the IAN and provide reliable information on its position and exact course within the mandible. MRI offers an objective assessment of IAN injuries, supporting the decision-making process regarding surgical exploration and microneural repair. With the advent of specialized MRI techniques such as VAT and SEMAC, reduction of metal artifacts is considerably improved.


Asunto(s)
Artefactos , Implantes Dentales , Imagen por Resonancia Magnética , Nervio Mandibular/diagnóstico por imagen , Humanos , Técnicas In Vitro , Metales , Proyectos Piloto
14.
J Craniomaxillofac Surg ; 45(4): 579-584, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28216228

RESUMEN

PURPOSE: Elective neck dissection (END) is a common primary treatment strategy for oral tongue squamous cell carcinoma (OTSCC), although uncertainty remains regarding the necessary extent of END for strictly unilateral early stage OTSCC. The authors evaluated two END variations, unilateral and bilateral, to determine the optimal extent. MATERIALS AND METHODS: A retrospective cohort study was performed on patient data from two departments of oral and maxillofacial surgery. All previously untreated patients from both clinics who were diagnosed with early-stage (pT1-2) unilateral OTSCC were included. The following variables were collected: age, gender, END type/extent, tumor localization, later nodal metastasis, and TNM status. Statistical analyses were performed (p < 0.05). RESULTS: A total of 150 patients were identified, 105 receiving unilateral END and 45 bilateral END. The rates of postoperative positive lymph nodes were 21.9% for ipsilateral END and 26.7% for bilateral END (bilateral END: all positive nodes ipsilateral). In all, 14 patients in the ipsilateral group developed nodal metastasis during tumor aftercare (11 patients ipsilateral, 3 patients contralateral neck). In the bilateral group, nodal metastasis was later observed in 4 cases (8.9%; 3 cases ipsilateral, 1 case contralateral neck). Statistical analysis could not detect significant differences between the END procedures. CONCLUSION: As both procedures lead to similar results in preventing or omitting possible later nodal metastasis, the two methods seem to be valuable alternatives. In conclusion, we recommend bilateral END because of advantages with regard to oncologic safety and esthetic outcome, but the decision for END should always be according to the patient's general health status, comorbidities, and individual tumor risk profile.


Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Disección del Cuello/métodos , Neoplasias de la Lengua/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Estudios de Cohortes , Procedimientos Quirúrgicos Electivos , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Carcinoma de Células Escamosas de Cabeza y Cuello , Neoplasias de la Lengua/patología , Adulto Joven
15.
J Oral Maxillofac Surg ; 75(5): 969-977, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-27916470

RESUMEN

PURPOSE: To examine oral squamous cell carcinoma (OSCC) specimens for programmed death ligand-1 (PD-L1) expression and presence of programmed death-1 (PD-1)-positive tumor-infiltrating lymphocytes (TILs) and to determine possible clinicopathologic implications. It was hypothesized that PD-L1 expression and PD-1-positive TIL presence in OSCC would have no clinical relevance. MATERIALS AND METHODS: The authors implemented a retrospective cohort study design. The study cohort was chosen in compliance with predefined inclusion criteria. Demographic, clinical, and histopathologic data were gathered. Tissue microarrays were obtained from paraffin-embedded OSCC specimens and analyzed immunohistochemically for PD-L1 expression and PD-1-positive TIL infiltration. PD-L1 positivity of OSCC specimens served as the predictor variable and neck node metastasis served as the primary outcome variable. Descriptive and inferential statistics were computed and the significance level was set at a P value less than or equal to .05. RESULTS: The study sample was composed of 88 patients (48 men, 40 women; mean age, 61.34 yr). Marked PD-L1 expression was detected in 29% of OSCC specimens (26 of 88) and 83% of specimens (73 of 88) exhibited a high rate of PD-1-positive TIL infiltration. PD-L1 positivity of OSCC samples was significantly associated with the anatomic origin of OSCC (P = .039), presence of cervical metastasis (P = .039), and high PD-L1-positive TIL infiltration (P = .033). CONCLUSION: A considerable proportion of OSCCs exhibited marked PD-L1 expression. This could be associated with clinical parameters. PD-L1 expression in OSCC might differ depending on its anatomic origin. PD-1-positive TILs could be detected in most OSCC specimens. These findings might indicate a potential role for the PD-1 and PD-L1 pathway in OSCC.


Asunto(s)
Antígeno B7-H1/biosíntesis , Carcinoma de Células Escamosas/metabolismo , Neoplasias de la Boca/metabolismo , Receptor de Muerte Celular Programada 1/biosíntesis , Anciano , Antígeno B7-H1/análisis , Carcinoma de Células Escamosas/química , Estudios de Cohortes , Femenino , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/química , Receptor de Muerte Celular Programada 1/análisis , Estudios Retrospectivos , Transducción de Señal
16.
J Craniomaxillofac Surg ; 44(12): 1945-1951, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27836551

RESUMEN

The purpose of this study was to examine the behavior of dental implants in patients diagnosed with MRONJ and to analyze the characteristics of peri-implant MRONJ. It was hypothesized that peri-implant parameters are not associated with peri-implant MRONJ. A retrospective study design was selected to address the research purpose. Patients with confirmed MRONJ and the simultaneous presence of dental implants who presented between 2010 and 2016 served as the study cohort. Predefined inclusion and exclusion criteria were applied. Demographic, clinical and radiological data were collected and analyzed statistically with respect to the variable scale (significance level p ≤ 0.05). The study sample was composed of 34 patients (female: 16; male: 18; average age: 70.6 years) with a total of 117 dental implants the majority of whom had received antiresorptive drug therapy within oncologic treatment protocols. Peri-implant MRONJ occurred in 15 patients (44%). Signs of peri-implantitis (present around 46/117 implants; 39%) appeared to be associated with the occurrence of peri-implant MRONJ. Patients receiving antiresorptive drugs in high doses seem to be at risk of developing MRONJ in the vicinity of dental implants. Peri-implantitis may be associated with the etiology of peri-implant MRONJ.


Asunto(s)
Osteonecrosis de los Maxilares Asociada a Difosfonatos/complicaciones , Periimplantitis/complicaciones , Anciano , Implantes Dentales/efectos adversos , Femenino , Humanos , Masculino , Periimplantitis/diagnóstico por imagen , Radiografía Panorámica , Estudios Retrospectivos , Factores de Riesgo
17.
J Craniomaxillofac Surg ; 44(10): 1618-1629, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27622971

RESUMEN

PURPOSE: To evaluate the efficacy of grafting materials in lateral and vertical ridge augmentations. MATERIALS AND METHODS: A systematic review of the literature on the clinical use of grafting materials of the years 1995 to April 2015 was conducted using electronic search of PubMed and Cochrane libraries and hand search of eight print journals. A total of 184 papers were included, comprising 6182 patients. Parameters evaluated were observation period [months], bone formation [histologic area%], defect fill [%], horizontal and vertical gain [mm], loss of augmented volume [mm], complication rate [%], and implant survival rate [%]. Results are expressed as weighted means ± SD. RESULTS: Results were obtained after a weighted mean observation period of 27.4 months (range 3-168 months). Bone formation in the augmented areas varied from 33.2 ± 14.9% for allogeneic grafts to 56.0 ± 25.6% for mixtures of autogenous and other grafting materials. Defect fill in dehiscence defects ranged from 51.0 ± 13.6% (synthetic) to 85.8 ± 13.4% (xenogeneic) for the different materials, with an overall weighted mean of 79.8 ± 18.7%. Weighted mean horizontal gain for all particulate grafting materials was 3.7 ± 1.2 mm, with variation between 2.2 ± 1.2 mm (synthetic) and 4.5 ± 1.0 mm (mixtures of autogenous bone with allogeneic/xenogeneic grafting material) without statistical significance. Weighted overall mean vertical gain was 3.7 ± 1.4 mm. Vertical gain was substantially higher when space-making barrier materials such as titanium meshes were used; however this was also associated with strong increase in complication rate. Block grafts achieved higher horizontal gain by approximately 1 mm. The use of block grafts achieved significantly increased vertical gain compared to particulate material only when autogenous block grafts from extraoral donor sites were used. CONCLUSION: Horizontal and vertical gain by 3.7 mm on average can be achieved using particulate materials. This can be increased by using titanium meshes. Substantial vertical gains beyond this dimension require the use of extraoral bone block grafts.


Asunto(s)
Aumento de la Cresta Alveolar/métodos , Trasplante Óseo/métodos , Sustitutos de Huesos/uso terapéutico , Implantación Dental Endoósea/métodos , Humanos , Osteogénesis , Resultado del Tratamiento
18.
Int J Dermatol ; 55(11): 1281-1288, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-27420481

RESUMEN

OBJECTIVES: This study was designed to investigate the associations between clinical, pathologic, and therapeutic parameters of facial basal cell carcinoma (BCC) and recurrence rates in patients treated at an advanced care center. METHODS: A retrospective cohort study was performed. Patients who presented to an advanced care center within a 6-year period with facial BCC and who received surgical treatment were included for further review according to predefined inclusion criteria. The predictor variable was defined as "negative-margin (R0) resection after the first surgery". The primary outcome variable was defined as "BCC recurrence". Descriptive and inferential statistics were computed. The significance level was set at P ≤ 0.05. RESULTS: A total of 71 patients (29 female, 42 male; average age: 71.76 years) were found to meet all of the study inclusion criteria. All BCCs had been referred, and 50.7% had been submitted to previous surgery. The mean ± standard deviation tumor diameter was 2.3 ± 1.8 cm. Recurrence of BCC was observed in 11 patients (15.5%). Large tumor diameters, increased patient age, and failure to achieve R0 resection at the first surgical appointment significantly increased recurrence rates. CONCLUSIONS: Complete facial BCC excision at the first surgical appointment is pivotal in reducing the likelihood of recurrence. The influence of the anatomic location of facial BCC on recurrence rates may be limited.


Asunto(s)
Carcinoma Basocelular/patología , Neoplasias Faciales/patología , Recurrencia Local de Neoplasia , Neoplasias Cutáneas/patología , Factores de Edad , Anciano , Anciano de 80 o más Años , Anestesia/métodos , Carcinoma Basocelular/cirugía , Neoplasias Faciales/cirugía , Femenino , Frente , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Neoplasia Residual , Nariz , Estudios Retrospectivos , Factores de Riesgo , Neoplasias Cutáneas/cirugía , Colgajos Quirúrgicos , Factores de Tiempo , Carga Tumoral
19.
J Craniomaxillofac Surg ; 44(8): 1073-80, 2016 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-27263757

RESUMEN

INTRODUCTION: The delineation of the necrotic bone is a crucial step in the surgical treatment of medication-related osteonecrosis of the jaw (MRONJ). Several different approaches have been described including the innovative technique of fluorescence-guided surgery. However, until now there is a lack of data regarding the outcome. Therefore, the aim of the present study is to investigate the long-term success rates of fluorescence-guided surgery in the treatment of MRONJ. PATIENTS AND METHODS: 54 Patients were prospectively assigned for surgical treatment of medication-related osteonecrosis of the jaw using fluorescence-guided surgery. Patients received doxycycline 100 mg twice a day for at least seven days preoperatively. Surgical treatment of MRONJ included complete removal of necrotic bone, which was monitored using the visual enhanced lesion scope (Velscope), followed by smoothening sharp bony edges and meticulous wound closure. Procedure success was assessed as postoperative maintenance of full mucosal coverage without pain, infection or bone exposure during regular follow-up. RESULTS: The study included a total of 54 patients (32 female and 22 male, mean age 71.4 ± 9.2 years). In the last follow-up an intact mucosa and absence of exposed bone, pain or signs of infection was identified in 47 of 54 patients (87%) and 56 of 65 lesions (86.2%) after first surgery using fluorescence-guidance. In 4 patients with 6 lesions a second fluorescence-guided surgery was necessary to achieve complete mucosal closure. Respectively, including the case with second surgical attempt 51 of 54 patients (94.4%) and 62 of 65 lesions (95.4%) showed complete mucosal healing. CONCLUSION: The study shows that fluorescence-guided surgery is a safe and successful treatment option which can be considered for all stages of MRONJ. The technique seems also promising for MRONJ cases under denosumab.


Asunto(s)
Osteonecrosis de los Maxilares Asociada a Difosfonatos/cirugía , Imagen Óptica , Procedimientos Quirúrgicos Orales/métodos , Distribución por Edad , Anciano , Anciano de 80 o más Años , Osteonecrosis de los Maxilares Asociada a Difosfonatos/diagnóstico por imagen , Osteonecrosis de los Maxilares Asociada a Difosfonatos/patología , Difosfonatos/efectos adversos , Femenino , Fluorescencia , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Ortognáticos , Estudios Prospectivos
20.
J Oral Maxillofac Surg ; 74(1): 79-86, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26259692

RESUMEN

PURPOSE: To determine the proportion of patients with cervical metastases caused by maxillary oral squamous cell carcinoma (OSCC) and to identify any clinical or pathologic parameters that might be associated with the occurrence of metastatic neck disease. MATERIALS AND METHODS: A retrospective cohort study of all patients managed with primary surgical resection of maxillary OSCC at the authors' institution from 2006 through 2013 was performed. Cervical lymph node dissection and adjuvant therapy were performed as warranted by preoperative staging examinations or histopathologic evaluation or as recommended after multidisciplinary consultation, and regular follow-up protocols were followed. In this analysis, each maxillary OSCC was assigned to an anterior or a posterior anatomic group based on the location of the primary lesion, with the anatomic tumor location serving as the predictor variable and the occurrence of cervical lymph node metastases as the outcome variable. Descriptive and inferential statistics were calculated with a significance level set at a P value less than .05 and post hoc power analyses were performed. RESULTS: The study sample was composed of 92 patients (38 women, 54 men; average age, 60.9 yr). Overall, 27 patients developed cervical metastases (29.3%). Neck disease was present in 15 patients (16.3%) at initial presentation. Delayed cervical metastases were diagnosed in 12 patients (13%) and manifested after an average period of 11.17 months. The anatomic location of the OSCC within the maxillary structures (anterior vs posterior) and the histologic grade greatly influenced the occurrence of metastatic neck disease. No associations were found for the variables tumor size and resection status. CONCLUSION: In this series, cervical lymph node metastases were frequent and to some degree predictable based on anatomic location and tumor grade.


Asunto(s)
Carcinoma de Células Escamosas/patología , Metástasis Linfática/patología , Neoplasias Maxilares/patología , Anciano , Carcinoma de Células Escamosas/secundario , Causas de Muerte , Quimioterapia Adyuvante , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Predicción , Humanos , Ganglios Linfáticos/patología , Masculino , Persona de Mediana Edad , Cuello/patología , Disección del Cuello/métodos , Terapia Neoadyuvante , Clasificación del Tumor , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Neoplasias Palatinas/patología , Radioterapia Ayuvante , Estudios Retrospectivos , Factores de Riesgo
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