RESUMEN
This retrospective non-randomized 10-year follow-up study compared 147 patients with squamous cell carcinoma (SCC) of the oral cavity requiring hemimandibulectomy, treated by surgical resection, therapeutic neck dissection and radiotherapy. The 5-year survival rates were compared related to localization, size of the tumour, infiltration of locoregional lymph nodes, distant metastases, histopathological grading, radicality of surgery, and invasion of tumour into the mandible. Occurrence of tumour relapse and its localization was studied. The mean 5-year survival rate was 26%. Patients with SCC of the mandibular alveolar process had higher rates; the lowest rates occurred in SCC of the buccal mucosa. Survival rate was significantly lower with insufficient resection of the tumour (85% relapse). An important number of patients with radical resection died within 3 months of surgery. In almost 55% of the mandibles tumour was not present. In 5% of infiltrated mandibles, dissemination into inferior alveolar nerve was proven. Decreasing survival rate was seen with increasing size of tumour and higher histological grade. Therapeutic neck dissection significantly reduces survival rate and increases the percentage of lymph node relapse. Elective neck dissection should be performed in SCC requiring hemimandibulectomy. Primary reconstruction should reverse the high percentage of postoperative complication arising from increased radicality.
Asunto(s)
Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/cirugía , Mandíbula/cirugía , Neoplasias Mandibulares/mortalidad , Neoplasias Mandibulares/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/radioterapia , Protocolos Clínicos , Femenino , Humanos , Estimación de Kaplan-Meier , Modelos Logísticos , Metástasis Linfática , Masculino , Neoplasias Mandibulares/patología , Neoplasias Mandibulares/radioterapia , Persona de Mediana Edad , Mucosa Bucal/patología , Disección del Cuello , Invasividad Neoplásica , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Dosificación Radioterapéutica , Radioterapia Adyuvante , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
The impact of orthognathic surgery for class III malocclusion on ventilation during sleep was examined using a comparison of pre- and post-surgical respiratory parameters. 21 patients with both maxillary hypoplasia and mandibular excess underwent Le Fort I osteotomy and advancement together with bilateral sagittal split osteotomy (BSSO) setback. Respiratory parameters, ECG and position of the body were monitored before surgery and postoperatively after the fixation removal (mean 8.5 months). Average Le Fort I advancement was 4.44 mm, BSSO setback was 4.96 mm. Generally, the orthognathic procedure worsened breathing function during sleep, as reflected in significant increase of index of flow limitations and decrease in oxygen saturation. The posterior airways space decreased to 75% of its original volume, the distance between mandibular plane and hyoid bone increased to 133%. The results indicate that bimaxillary surgery for class III malocclusion increased upper airway resistance. A young person would probably be able to balance such a decline in respiratory function using different adaptive mechanisms, but the potential impact of orthognathic surgery on the upper airways should be incorporated in a treatment plan.
Asunto(s)
Obstrucción de las Vías Aéreas/etiología , Maloclusión de Angle Clase III/cirugía , Mandíbula/cirugía , Procedimientos Quirúrgicos Ortognáticos/efectos adversos , Osteotomía Le Fort/efectos adversos , Apnea Obstructiva del Sueño/etiología , Adulto , Remodelación de las Vías Aéreas (Respiratorias) , Resistencia de las Vías Respiratorias , Cefalometría , Femenino , Humanos , Masculino , Osteotomía/efectos adversos , Polisomnografía , Ventilación Pulmonar , Adulto JovenRESUMEN
The most of patients need dental care during their time of life. It can be situation to detect bleeding disorder in patients who have been suggested apparently healthy to this time. In patients with known bleeding tendency it can be situation in which good interdisciplinary coordination is necessary. In the most cases patients with anticoagulation treatment are involved between those with haemostasis problems. Nevertheless, they do not need therapy interruption in the most of cases, only the knowing actual therapeutic level of INR and appropriate stomatologist's erudition. Another situation is in patients with severe haemostatic bleeding disorder. They don't need only special procedure in dental extractions but also lifelong dental care. One can establish patients, in whom it is not possible only outpatient treatment but in whom a few days hospitalization is necessary. Above all they are patients with haemophilia and inhibitor, those with multiple or surgery extractions and persons with multiple haemostasis impairment.
Asunto(s)
Trastornos de la Coagulación Sanguínea , Procedimientos Quirúrgicos Orales , Trastornos de la Coagulación Sanguínea/diagnóstico , Trastornos de la Coagulación Sanguínea/tratamiento farmacológico , HumanosRESUMEN
Stability of bilateral sagittal split osteotomy (BSSO) is an important goal for every surgeon. In the article factors influencing stability of the surgery result are reviewed. Special emphasis is given to different types of fixation of bone fragments. Their advantages and disadvantages in clinical use are discussed. Relapse after BSSO is usually classified as early and long-term relapse. Early relapse is usually caused by movements at the osteotomy site or temporomandibular joint sag and should be called surgical displacement. Long term relapse happens due to the progressive temporomandibular joint condylar resorption, which causes a lost of condylar and mandibular ramus height. Four different types of fixation were described in orthognatic surgery: rigid intermaxillary fixation, osteosuture, osteosynthesis and fixation with biodegradable materials.
Asunto(s)
Mandíbula/cirugía , Osteotomía , Prognatismo/cirugía , Retrognatismo/cirugía , Humanos , Procedimientos Quirúrgicos Orales/métodos , Osteotomía/métodosRESUMEN
In 37 oncological patients where extensive resections of the face, maxilla, mandible or calva were necessary, microsurgical reconstructions were used in 27 cases as primary operations at the time of resection, and in 10 cases delayed or secondary operations were made. 49 flaps were used. In five cases two flaps were used in a single stage reconstruction, i.e. one flap for reconstruction of the mandible or buccal and on the other for facial side of the face. During operations a multidisciplinary approach of the surgical team comprising a maxillofacial surgeon, ENT and plastic surgeon is preferred.