The Role of Maxillofacial Prosthetics for the Surgically Treated Patient at National Cancer Institute-Designated Comprehensive Cancer Centers.

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.

[Risk factors generally neglected in oral surgery and implantology: the high LDL-cholesterol and the insufficient level of vitamin D]. / Des facteurs de risque généralement négligés en chirurgie orale et en implantologie : le taux élevé de LDL-cholestérol et le taux insuffisant de la vitamine D.

INTRODUCTION: Vitamin D deficiency is widespread throughout the world. Vitamin D has an important role in the regulation of phosphocalcic metabolism as well as in a large number of biological and metabolic processes. According to some studies, there is a correlation between vitamin D and LDL-cholesterol levels. A deficiency of vitamin D and / or a high level of LDL-cholesterol could represent risk factors for bone healing and osteointegration of dental implants. The purpose of our study is to demonstrate the reality of the problem of deficiency or deprivation in vitamin D in a population of patients requiring oral and / or implant surgery. MATERIAL AND METHODS: 46 cases of patients having undergone oral surgery together with preoperative blood test were analyzed. The results of the dosages of 25-hydroxy-vitamin D (25-OH-D), total cholesterol, LDL-cholesterol, HDL-cholesterol were collected and compared with reference values. Statistical tests were performed to determine the possible correlations between the 25-OH-D level and other blood parameters. RESULTS: 38 patients out of 46 (82.6 %) are defective in vitamin D, and 7 patients out of 46 (15.2 %) are deficient. LDL-cholesterol levels were high in 15 patients out of 33 (45.5 %). There was a non-significant correlation between LDLcholesterol and vitamin D levels. Total cholesterol was high in 42 % of patients. We observed a significant correlation between total cholesterol and vitamin D levels. CONCLUSION: According to our study, it appears that a preoperative assessment including the dosage of vitamin D, total cholesterol and LDLcholesterol may be of interest in patients requiring oral and / or implant surgery by correcting if necessary blood parameters and promoting bone metabolism.

INTRODUCTION: La déficience en vitamine D est largement répandue dans le monde. Or la vitamine D a un rôle important dans la régulation du métabolisme phosphocalcique ainsi que dans un grand nombre de processus biologiques et métaboliques. Selon certaines études, il existerait une corrélation entre le taux de vitamine D et le taux de LDL-cholestérol. Une déficience en vitamine D et/ou un taux élevé de LDL-cholestérol pourraient représenter des facteurs de risques de cicatrisation osseuse et d'ostéointégration d'implants dentaires. Le but de notre étude est d'objectiver, dans une population de patients devant bénéficier d'une chirurgie orale et/ou implantaire, la réalité du problème de déficience ou de carence en vitamine D. Matériel et méthode : 46 dossiers de patients ayant bénéficié d'une intervention chirurgicale buccodentaire et d'une prise de sang ont été analysés. Les résultats du dosage de 25-hydroxyvitamine D (25-OH-D), cholestérol total, LDL-cholestérol, HDL-cholestérol ont été recueillis et comparés aux valeurs de références. Des tests statistiques ont été réalisés afin d'établir les corrélations éventuelles entre le taux de 25-OH-D et les autres paramètres sanguins. Résultats : 38 patients sur 46 (82,6 %) sont déficients en vitamine D, et 7 patients sur 46 (15,2 %) sont carencés. Le taux de LDLcholestérol est élevé chez 15 patients sur 33 (45,5 %). Il existe une corrélation non significative entre le taux de LDL-cholestérol et le taux de vitamine D. Le taux de cholestérol total est élevé chez 42 % des patients. Nous observons une corrélation significative entre le taux de cholestérol total et le taux de vitamine D. CONCLUSION: D'après notre étude, il apparaît qu'un bilan préopératoire incluant le dosage de la vitamine D, du cholestérol total et du LDLcholestérol pourrait s'avérer intéressant afin de corriger si nécessaire ces paramètres sanguins et favoriser le métabolisme osseux dans un contexte de chirurgie orale et/ou implantaire.

Clinical survey over the past 35 years at the clinic for maxillofacial prosthetics Tokyo Medical and Dental University.

PURPOSE: The purpose of this survey was to examine the overview of maxillofacial prosthetic treatment at our department, in order to ascertain the actual status of patients and discuss future needs. METHODS: Subjects were all patients who visited Clinic for Maxillofacial Prosthetics, Dental Hospital, Tokyo Medical and Dental University (TMDU) in the period from January 1, 1980 to December 31, 2014. Using medical records of the Clinic for Maxillofacial Prosthetics, Dental Hospital, TMDU, patients' data including sex, address, referring institution, and primary condition were analyzed throughout the period. RESULTS: The number of patients over 35 years was 6219, with a man-to-woman ratio of 6:4. The number of patients in their 60s, 70s, and 80s showed an increasing trend. Patients with tumors accounted for about 50 % of cases in 1980-1984 and increased to 80 % in 2010-2014. CONCLUSIONS: The survey showed an increasing number of elderly patients and patients with tumors. This suggests that more awareness and education about maxillofacial prosthetics are needed.

["Double barrel" free fibula flap and vascular risk. A national investigation in France]. / Lambeau libre de péroné en « double barre ¼ et risque vasculaire. Enquête nationale.

INTRODUCTION: The free fibula flap is the most commonly used flap for mandibular reconstruction thanks to its multiple advantages. Its main drawback is the thin width of the bone section. The "double barrel" fibula flap is a solution to this problem allowing reconstruction of both basilar and alveolar ridges for a stable prosthetic dental rehabilitation. The authors wanted to assess its use, in France, to evaluate its reliability, and to determine its indications. PATIENTS AND METHODS: The authors sent a questionnaire to the 25 French Maxillo-Facial University Hospital Departments. Questions concerned the surgical technique, its indications, and the operative results, between January 2002 and December 2007. RESULTS: Out of the 18 teams who answered, 16 used a free fibula flap for mandibular reconstruction but only seven used the double barrel technique, for a total of 24 double barrel reconstructions. Only one total necrosis was reported. The indications for double barrel fibula flap were nearly all for corpus reconstruction and the operating overtime was less than one hour. DISCUSSION: The international literature review analysis gives results which compare to French ones, with a weak rate of necrosis despite the intermediate rectangular ostectomy. This technique may be recommended especially since it does not increase the operative time much and it improves dental restoration.