RESUMEN
This paper describes the heroic efforts of Graeme Warrack, an oral surgeon, to save as many lives as possible during the battles around Arnhem in 1944. As the chief medical officer (CMO) of the medical section of the 1st British Airborne Division, he and his staff took care of many casualties, both on the battlefield and at the emergency hospital in Apeldoorn, north of Arnhem. He escaped from the hospital when all the patients were to be transported to prisoner of war (POW) camps in Germany, and was hidden by a Dutch family. Finally, with the help of the Dutch resistance movement, he was successfully ferried over the big rivers into liberated country.
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Servicio de Urgencia en Hospital , Cirujanos Oromaxilofaciales , Alemania , Personal de Salud , Historia del Siglo XX , Hospitales , HumanosRESUMEN
This study was performed to address the outcomes of patients treated with onlay grafts from the iliac crest to augment the deficient jaw. The results of 173 consecutive patients who underwent bone grafting prior to implant surgery are presented. The grafts were taken from the anterior iliac crest to repair alveolar bone deficiencies that were too large to be corrected using intraoral bone grafts. Three months postoperatively, 869 implants were placed into 190 onlay grafts (167 grafts in the maxilla, 23 in the mandible). The follow-up ranged from 3 months to 23 years post implantation. All patients received a fixed prosthesis. Parameters examined included healing of the donor site and bone grafts, implant survival, peri-implant condition, and donor site morbidity. The overall survival rate for all implants was calculated to be 95%±2.7% according to Kaplan-Meier analysis. The implant survival rate compares favourably with those reported in studies using intraoral and extraoral bone.
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Aumento de la Cresta Alveolar , Implantes Dentales , Trasplante Óseo , Implantación Dental Endoósea , Estudios de Seguimiento , Humanos , Ilion , Mandíbula , Maxilar , Estudios RetrospectivosRESUMEN
This review aimed to evaluate the level of evidence for bone augmentation preimplant surgery for atrophic jaws in studies which measure outcome. Medline, Embase, Cochrane library and online journal searches were performed with a defined search strategy and the abstracts screened against selection criteria. The resultant papers were sorted by study design using the Cochrane study design algorithm, analysed for clinical/statistical homogeneity and graded with the Oxford Centre of Evidence-based Medicine levels of evidence. The initial online Medline search yielded 1194 results and the Embase search yielded 490 results. Using the selection criteria, 10 studies were identified. Additionally, 5 articles were identified from bibliography and online searches, giving a total of 15 studies for grading. All 15 studies were graded as level 4 evidence. No meta-analysis of outcomes was possible with the low level of evidence and degree of heterogeneity found. The best grade of recommendation that can be made for a particular preimplant surgical bone augmentation procedure, from these level 4 studies, is Grade C. Benchmarking studies by assessing quality of evidence can be helpful to inform future study designs with respect to reporting study outcomes with a higher level of evidence.
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Aumento de la Cresta Alveolar , Implantes Dentales , Odontología Basada en la Evidencia/normas , Procedimientos Quirúrgicos Ortognáticos , Atrofia , Humanos , Maxilares/patología , Procedimientos Quirúrgicos Preprotésicos Orales , Resultado del TratamientoRESUMEN
The anterior maxillary osteoplasty restores adequate bone to the edentulous Class IV ridge prior to placement of endosseous implants. The aim of this retrospective study was to compare the long-term survival of implants placed into the particulate bone of an anterior alveolar osteoplasty to those placed into a 'block' onlay bone graft. Of 85 patients with Class IV 'knife-edge' alveolar ridges, 50 received interpositional particulate bone via an alveolar osteoplasty and 35 received an onlay cortico-cancellous graft. A total of 386 implants were placed as a secondary procedure and followed postoperatively (mean 6 years; 39 failures). There was improved cumulative survival of implants placed into the particulate bone of an osteoplasty compared to the block bone of an onlay graft. Implants supporting a fixed superstructure had a longer cumulative survival than those supporting a removable appliance. There was no statistical difference between implants placed into male and female bone, or between those in edentulous and partially dentate jaws. Within a partially dentate jaw there was a statistically significant increase in cumulative survival for implants within osteoplasty inlay bone compared to onlay bone grafts. Anterior osteoplasty is the surgical treatment of choice for augmentation of the resorbed Class IV alveolar ridge prior to placement of osseo-integrated implants.
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Aumento de la Cresta Alveolar/métodos , Alveoloplastia/métodos , Trasplante Óseo/métodos , Implantación Dental Endoósea , Fracaso de la Restauración Dental , Pérdida de Hueso Alveolar/rehabilitación , Femenino , Estudios de Seguimiento , Humanos , Incisivo , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Implantación Dental Endoósea/tendencias , Procedimientos Quirúrgicos Preprotésicos Orales/tendencias , Aumento de la Cresta Alveolar/métodos , Aumento de la Cresta Alveolar/tendencias , Trasplante Óseo , Implantes Dentales , Encía/trasplante , Humanos , Procedimientos Quirúrgicos Preprotésicos Orales/métodos , Colgajos QuirúrgicosAsunto(s)
Aumento de la Cresta Alveolar/métodos , Anodoncia/rehabilitación , Implantación Dental Endoósea/métodos , Prótesis Dental de Soporte Implantado , Maloclusión de Angle Clase III/cirugía , Adolescente , Anodoncia/complicaciones , Trasplante Óseo , Humanos , Masculino , Maloclusión de Angle Clase III/complicaciones , Osteotomía Le FortRESUMEN
BACKGROUND: Since the first version of the Liverpool Oral Rehabilitation Questionnaire (LORQ) was first published in 2004, the questionnaire has been modified to include more detail on chewing and appearance, and also details of denture, dental and implant status. AIM: The aim of this study is to report the ongoing development and validation of the LORQ version3. METHODS: A postal survey of the LORQv3 and OHIP-14 questionnaires was performed in April 2004 of 164 patients who had attended the oral rehabilitation clinic from February 2000. In addition The LORQv3 was administered to 349 patients attending six General Dental Practices, based in Liverpool, attending for routine care. RESULTS: Patients attending GDP scored appreciably better on most items in the LORQv3. The questionnaire discriminated between cancer and non-cancer oral rehabilitation patients in items such as swallowing, chewing, trismus, drooling and food clearance. There was no significant difference between rehabilitation groups for any of the seven OHIP-14 domains. The LORQv3 demonstrated good criterion validity when compared to the OHIP-14 with social items in the LORQv3 correlating well with items of the OHIP-14. Conversely various LORQv3 items did not have strong correlates within the OHIP-14 thus endorsing the additional items in the LORQv3.
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Atención Odontológica/psicología , Neoplasias de Cabeza y Cuello/rehabilitación , Rehabilitación Bucal/psicología , Evaluación de Necesidades/normas , Calidad de Vida , Encuestas y Cuestionarios/normas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Actitud Frente a la Salud , Estudios de Cohortes , Estudios Transversales , Deglución/fisiología , Implantes Dentales/psicología , Prótesis Dental/psicología , Estética Dental , Femenino , Humanos , Masculino , Masticación/fisiología , Persona de Mediana Edad , Satisfacción del Paciente , Trastornos del Habla/psicología , Xerostomía/psicologíaRESUMEN
Microvascular reconstructive techniques in head and neck surgery are well established, but we are now entering an era of modification exemplified by perforator and free style free flaps. We present a review of the database introduced into the unit in 1992 over a 10-year period, during which time 977 patients with malignant disease were operated on and 620 defects were reconstructed with free flaps. There were 358 radial forearm flaps, 78 composite radial forearm flaps, 84 iliac crest flaps, 43 fibular flaps, 24 from the scapula, 26 from the latissimus dorsi, 4 from the rectus abdominis, and 3 from the lateral arm. The main changes over this time have been the use of more bulky flaps for larger resections of the tongue and the preference for iliac crest flaps over those from the fibula and forearm for composite reconstructions. Improving reliability of tissue transfer remains an important aim, and further development of reliable objective methods of monitoring of flaps is required.
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Anastomosis Quirúrgica/tendencias , Neoplasias de Cabeza y Cuello/cirugía , Microcirugia/tendencias , Procedimientos de Cirugía Plástica/tendencias , Colgajos Quirúrgicos/irrigación sanguínea , Bases de Datos Factuales , Humanos , Mandíbula/cirugía , Maxilar/cirugía , Auditoría Médica , Paladar Blando/cirugía , Lengua/cirugía , Trasplante Autólogo/tendencias , Resultado del TratamientoAsunto(s)
Amnios/trasplante , Ciclofosfamida/administración & dosificación , Oftalmopatías/terapia , Inmunosupresores/administración & dosificación , Penfigoide Benigno de la Membrana Mucosa/terapia , Anciano , Enfermedad Crónica , Terapia Combinada , Ciclofosfamida/uso terapéutico , Oftalmopatías/tratamiento farmacológico , Oftalmopatías/cirugía , Femenino , Humanos , Inmunosupresores/uso terapéutico , Penfigoide Benigno de la Membrana Mucosa/tratamiento farmacológico , Penfigoide Benigno de la Membrana Mucosa/cirugíaRESUMEN
The purpose of this study was to investigate the use of oral rehabilitation in a group of patients who had primary resection of oral and oropharyngeal squamous cell carcinoma. Of 132 consecutive patients operated on for previously untreated disease between January 1995 and June 1997, 130 were recruited. The University of Washington Quality of Life questionnaire was completed on the day before operation at 6 and 12 months, and at last review. A larger similar dataset was used to predict survival. Twenty-eight patients (22%) were seen by the oral rehabilitation team. The median (IQR) time from operation to start of treatment was 12 months (6-21). The median (IQR) time from beginning to end of rehabilitation was 14 months (5-49). Patients with larger tumours (P=0.06) and patients who were edentulous with dentures in the maxilla (P=0.07) were most likely to be seen for oral rehabilitation.
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Carcinoma de Células Escamosas/rehabilitación , Neoplasias de la Boca/rehabilitación , Neoplasias Orofaríngeas/rehabilitación , Calidad de Vida , Anciano , Implantes Dentales , Dentadura Completa , Femenino , Estudios de Seguimiento , Humanos , Tablas de Vida , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/cirugía , Neoplasias Orofaríngeas/cirugía , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Análisis de SupervivenciaRESUMEN
The surgical and prosthodontic rehabilitation of the edentulous patient aims to restore oral function and facial form. Planning treatment requires an understanding of the effect of progressive jaw atrophy, and the concomitant effect on the soft tissues of the face. This study examined 179 Caucasians at different stages of jaw atrophy according to the Cawood and Howell classification; various standard anthropological measurements of the face, according to Farkas, were also taken. We have demonstrated that changes in the soft tissues are related to the degree of underlying jaw atrophy. This has important implications when planning surgical and prosthodontic rehabilitation of the edentulous patient. Early stages of jaw atrophy (Class II, III & IV) result in the collapse of the circumoral musculature causing a narrowing of the mouth, loss of lip support, inversion of the lips and contraction of the cheeks. Late changes of jaw atrophy (Class V & VI) result in changes in vertical facial proportion causing a decrease in lower facial height and an increase in chin prominence. These late skeletal changes accentuate the earlier soft tissue facial effects.
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Pérdida de Hueso Alveolar/patología , Cara/anatomía & histología , Arcada Edéntula/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Pérdida de Hueso Alveolar/etiología , Cefalometría , Progresión de la Enfermedad , Músculos Faciales/fisiopatología , Femenino , Humanos , Arcada Edéntula/complicaciones , Masculino , Persona de Mediana EdadRESUMEN
There are several validated health-related quality of life (HRQOL) questionnaires designed to record patient-derived outcomes in head and neck cancer. None deals specifically with oral rehabilitation. The aim of this study was to pilot a new questionnaire, the Liverpool Oral Rehabilitation Questionnaire (LORQ). The questionnaire consists of 25 items about oral function and denture satisfaction. A four-point Likert scale is used. Sixty-one consecutive patients attending oral rehabilitation clinics completed the LORQ in combination with the University of Washington Head and Neck questionnaire version 3 (UW-QOL) and European Organisation for Research and Treatment of Cancer H and N quality of life questionnaire (EORTC H and N 35). Forty-two patients received questionnaires at baseline, whereas the rest were provided with the questionnaires at various stages of oral rehabilitation. For each item on the questionnaire, a full range of possible responses were given by patients. Kappa coefficients of agreement for test-retest data indicated moderate to very good agreement between repeat questionnaires. There were significant correlations (P < 0.001) between items in the LORQ and those in the UW-QOL and EORTC HN questionnaires. The LORQ also identified differences in responses between non-cancer and cancer groups of patients undergoing oral rehabilitation. This study of the LORQ is encouraging, although data on its responsiveness over time and to intervention is awaited.
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Neoplasias de Cabeza y Cuello/rehabilitación , Enfermedades Mandibulares/rehabilitación , Neoplasias Orofaríngeas/rehabilitación , Calidad de Vida , Encuestas y Cuestionarios/normas , Atrofia , Femenino , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Masculino , Mandíbula/patología , Enfermedades Mandibulares/patología , Persona de Mediana Edad , Neoplasias de la Boca/rehabilitación , Neoplasias de la Boca/cirugía , Neoplasias Orofaríngeas/cirugía , Proyectos Piloto , Reproducibilidad de los ResultadosRESUMEN
The vascularized iliac crest graft with internal oblique muscle as a method of reconstruction after maxillectomy has been used routinely at the Regional Maxillofacial Unit in Liverpool since 1993. Twenty-four consecutive operations have now been done and this paper reports an audit of our experience. An analysis of case-notes was made retrospectively after checking theatre diaries and records. A detailed inspection of the case-notes was undertaken to ascertain the presenting diagnosis, the complications and the outcome in terms of recurrence and disease survival. The type of defect was recorded, as was whether it had been possible to rehabilitate the patient both dentally and facially. At the time of this study 9 patients (38%) had died of their disease leaving 15 surviving. In 13 cases full dental and facial rehabilitation had been achieved or patients were waiting for an implant-retained prosthesis. Donor site problems important enough to be recorded in the notes were minimal, one case of abdominal wall weakness was noted, which required no intervention. The vascularized iliac crest graft with internal oblique muscle offers a complete solution for reconstruction after maxillectomy, providing there has been no sacrifice of the overlying facial skin and oral sphincter. There is sufficient height and depth of bone to maintain a facial profile and the muscle epithelializes to provide an ideal oral and nasal lining. This flap provides a base to enable full dental and facial prosthetic rehabilitation with either implant-retained or conventional prostheses.
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Músculos Abdominales/trasplante , Trasplante Óseo/métodos , Maxilar/cirugía , Neoplasias Maxilares/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trasplante Óseo/patología , Niño , Implantes Dentales , Prótesis Dental de Soporte Implantado , Dentadura Completa Superior , Dentadura Parcial , Cara/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Neoplasias Maxilares/rehabilitación , Auditoría Médica , Persona de Mediana Edad , Rehabilitación Bucal , Recurrencia Local de Neoplasia/patología , Complicaciones Posoperatorias , Procedimientos de Cirugía Plástica , Estudios Retrospectivos , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/patología , Tasa de Supervivencia , Resultado del Tratamiento , Trombosis de la Vena/etiologíaRESUMEN
Ablative surgery of the oral tissues may result in significant facial deformity, poor oral function, and psychologic detriment. Immediate surgical reconstruction with vascularized free flaps has become increasingly popular, but the oral rehabilitation of these patients with conventional dental prostheses is usually unsuccessful. The results and clinical experiences of treating a group of 17 patients with ablative surgery, immediate reconstruction with free flaps, and restoration with mandibular implant-retained prostheses are presented after follow-up periods of 6 months to 7 years. Most patients expressed a high degree of satisfaction with their prostheses. General principles and guidelines for the provision of this effective treatment modality are discussed.
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Prótesis Dental de Soporte Implantado , Mandíbula/cirugía , Rehabilitación Bucal , Colgajos Quirúrgicos , Adolescente , Adulto , Anciano , Niño , Protocolos Clínicos , Pilares Dentales , Implantación Dental Endoósea , Implantes Dentales , Diseño de Prótesis Dental , Femenino , Estudios de Seguimiento , Humanos , Masculino , Neoplasias Mandibulares/fisiopatología , Neoplasias Mandibulares/psicología , Neoplasias Mandibulares/cirugía , Persona de Mediana Edad , Neoplasias de la Boca/fisiopatología , Neoplasias de la Boca/psicología , Neoplasias de la Boca/cirugía , Satisfacción del PacienteRESUMEN
Pre-implant surgery was carried out in 20 patients with advanced atrophy of the edentulous maxilla, using autogenous bone grafts. Endosseous implants were placed after the initial healing period and these were used to retain removable overdentures. Patients were observed for up to 5 years with 15 of the 105 implants placed being lost and two remaining as sleepers. The resulting implant success rate was 84%. Three patients had to return to conventional dentures while the remaining 17 expressed a high degree of satisfaction with their implant retained prostheses. Pre-implant surgery successfully extends the scope for implant therapy by providing sufficient bone for implant placement. The survival rate of implants in these cases appears promising up to 3 years, although further data is required to confirm the effectiveness of this treatment in the long term. Implant retained overdentures are able to successfully restore both oral function and facial form. The rehabilitation of the atrophic, edentulous maxilla remains difficult and complex, even when using pre-implant surgery and implant retained prostheses.
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Pérdida de Hueso Alveolar/cirugía , Implantación Dental Endoósea/métodos , Prótesis Dental de Soporte Implantado , Prótesis de Recubrimiento , Enfermedades Maxilares/cirugía , Procedimientos Quirúrgicos Preprotésicos Orales/métodos , Adulto , Anciano , Aumento de la Cresta Alveolar , Trasplante Óseo , Femenino , Humanos , Masculino , Seno Maxilar/cirugía , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Current management of oral cancer following tumour resection includes reconstruction of the surgical defect with free vascularized flaps and rehabilitation of orofacial form and function with the aid of endosteal implants. The choice of flap for reconstruction influences the use of implants, and further hard- and soft-tissue surgery is frequently required to enhance the success of oral rehabilitation.