Osseointegrated implant rehabilitation of irradiated oral cancer patients.

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.

Time used for orthodontic surgical treatment of dentofacial deformities in white patients.

PURPOSE: The aim of the present study was to assess the duration of each treatment phase that a patient with dentofacial disorders and eligible for orthodontic surgery undergoes and to identify those factors that determine the time. We have also included a description of the demographic and skeletal characteristics of the patients treated at our center, the surgery type, and movements performed. PATIENTS AND METHODS: A sample of 148 patients undergoing orthognathic surgery from 2004 to 2007 at Princesa University Hospital, Madrid, was studied. The demographic data of each patient, their facial pattern, skeletal disorders, and surgical movements performed were recorded, as was the duration of orthodontic treatment, both pre- and postoperatively, length of surgery, and length of hospital stay. RESULTS: The length of preoperative orthodontic treatment was 24 months and that of postoperative treatment was 12 months. The average operative time was 4 hours for those interventions in which both dental arches were involved, and the average length of hospital stay was 3 days. No relevant differences were found for the length of orthodontic treatment according to gender, age, or type of skeletal disorder. Differences were observed in the length of hospital stay between those patients who underwent segmentation of the maxilla and those who did not. CONCLUSIONS: The length of the different phases into which an orthodontic surgical treatment is divided can differ within some given limits. However, it does not depend on either the patients' demographic skeletal characteristics or the surgical movements performed.

Subperiosteal abscess of the orbit: an unusual complication of the third molar surgery.

Few procedures in oral surgery show severe complications with the potential to result in life-threatening problems. Subperiosteal orbital abscess is an extremely rare but transcendent complication arising spontaneously or after dental surgery. This report describes a case of subperiosteal abscess of the orbit in a 57-year-old man that occurred following the uneventful extraction of the left maxillary third molar. In the emergency department, proptosis and extraocular muscle dysfunction were marked but no decrease in visual acuity was observed. Echography, computed tomography scan, and magnetic resonance imaging allowed distinction from other types of orbital inflammation. Surgical drainage confirmed the diagnosis. In this patient, orbital abscess was probably caused by extension of the infection to the pterygopalatine and infratemporal regions progressing next to the inferior orbital fissure. This report highlights the difficulty in the clinical diagnosis of this complication.

Rim versus sagittal mandibulectomy for the treatment of squamous cell carcinoma: two types of mandibular preservation.

BACKGROUND: The role of conservative mandibulectomy for patients with bone invasion from squamous cell carcinoma remains poorly defined. However, marginal mandibular resection is biomechanically secure in its design while maintaining the mandibular continuity. This procedure has proven to be a successful method of treating squamous cell carcinoma with limited mandibular involvement. PURPOSE: The purpose of this study was to analyze our results after the use of a marginal technique for the treatment of oral and oropharyngeal cancer and to compare two types of mandibular conservative procedures: rim resection versus sagittal inner mandibulectomy. METHODS: A retrospective review of a cohort of 50 patients (global group) who underwent mandibular conservative resection for previously untreated squamous cell carcinoma was performed. Two subgroups were considered: rim group (n = 37) and sagittal group (n = 13). Clinical evaluation and preoperative radiologic studies were the means used to evaluate bony invasion and to decide on the extent of mandibulectomy. The treatment outcome after these two types of mandibular resection was calculated and compared using analysis by the Pearson chi(2) test, logistic regression model for multivariate analysis, and the Kaplan-Meier method to determine survival. RESULTS.: In the sagittal group, specimens from 2 patients (11.7%) demonstrated tumor invasion on decalcified histologic examination, whereas the rim group showed 11 cases (29.7%) with bone invasion. Local recurrence was observed in the follow-up of 10 patients. No statistical relationship was found between the presence of histologic bone invasion and the risk of local recurrence. The size of bone resection >4 cm (p =.002) and tumor invasion of surgical margins (p =.039) were found to be associated with increased local recurrence rates. In multivariate analysis, lymph node affectation significantly correlated with histologic mandibular involvement (p =.02). In the global group, the 5-year observed survival rate was 56.97%. Overall survival and rate of recurrence were comparable in both groups. In the global group, tumor infiltration beyond the surgical margin was statistically related with poor survival (p =.01). CONCLUSIONS: Analysis of this series disclosed that marginal mandibulectomy is effective in the control of squamous cell carcinomas that are close to or involving the mandible. In carefully selected patients, sagittal bone resection seems to be as appropriate as rim resection in the local control of these tumors.