RESUMEN
Therapeutic irradiation of the neck is frequently used to treat patients with head and neck carcinoma. The irradiation, however, has been implicated as the cause of cervical carotid artery atherosclerotic lesions and subsequent stroke. Panoramic radiography previously shown capable of demonstrating isolated lesions was used to assess their development over time. Individuals with a pre-irradiation radiograph free of atheromas were enrolled for study. The prevalence rate of atheroma formation on post-irradiation (bilateral portals at >/=45 Gy) radiographs obtained at an interval of >/=36 months was determined. A control group of non-irradiated patients having similar risk factors for head and neck carcinoma and atherosclerosis and having an initial radiograph free of atheroma formation were likewise enrolled for study. The prevalence rate of atheroma formation on a second radiograph obtained from these individuals at an interval of >/=36 months was determined. The study population consisted of 17 patients, with a mean age of 56.5 (range 21.5-77.8) years who received a mean therapeutic irradiation dose of 53.2 Gy (range 45-71) to each side of their neck. The prevalence rate of atheromas manifested on the post-irradiation radiographs was 53%. These radiographs were obtained, on average, 69.7 (range 37-133) months after completion of radiation therapy. The prevalence rate of atheromas manifested on the second radiograph of patients in the control group was 5.9%. These radiographs were obtained, on average, 53.5 (range 52-55) months after the first. The difference in prevalence rates was statistically significant (p=0.0003). Individuals who have received therapeutic irradiation to the neck are more likely to develop carotid artery atheromas after treatment than are risk-matched control patients who have not been irradiated. These lesions can be detected by panoramic radiography.
Asunto(s)
Arteriosclerosis/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/etiología , Neoplasias de Cabeza y Cuello/radioterapia , Traumatismos por Radiación/diagnóstico por imagen , Radiografía Panorámica/métodos , Adulto , Anciano , Anciano de 80 o más Años , Arteriosclerosis/etiología , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuello , Prevalencia , Traumatismos por Radiación/etiología , Radioterapia/efectos adversos , Factores de RiesgoRESUMEN
Large, complex bony defects can be a vexing problem for the reconstructive surgeon, especially when standard donor sites are not available or do not provide sufficient tissue. Using the concept of flap prefabrication, we demonstrated in a single patient that (1) iliac crest bone chips and bone morphogenic protein in an alloplastic mandibular tray can ossify in a heterotopic location and (2) neovascularization sufficient to support a large, custom-designed bone graft occurs within a convenient "carrier" flap. Ultimately, the fields of angiogenesis and osteogenesis research could significantly contribute to the ability of the plastic surgeon to construct the "ideal" composite prefabricated flap for complicated reconstruction.
Asunto(s)
Labio/cirugía , Mandíbula/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Ameloblastoma/cirugía , Femenino , Humanos , Neoplasias Mandibulares/cirugía , Persona de Mediana Edad , Recurrencia Local de NeoplasiaRESUMEN
PURPOSE: A clinical study of 23 craniofacial implants placed in 8 irradiated and nonirradiated orbital detects was conducted over a 7-year period. MATERIAL AND METHODS: Implant-retained orbital prostheses were fabricated, implant success rate was determined, and the soft tissue responses were recorded at 6-month intervals. As a result of patient death, no data were gathered on three implants. A five-point scale was used to record the health of the peri-implant soft tissues and the patients were followed from 9 to 72 months. The unit of measure was a visit/site that was assigned for each instance an implant site was evaluated. Evaluations were conducted at 6-month intervals, and for the study period, there were 80 visit/sites. RESULTS: The study revealed that 42.5% (34/80) of the visit/sites demonstrated an absence of inflammation; 23.7% (19/80) of visit/sites demonstrated slight redness; 13.8% (11/80) demonstrated peri-implant red and moist tissues; 6.2% (5/80) demonstrated granulation tissue associated with the implants; and 13.8% (11/80) infection of the peri-implant soft tissues was noted. Implant success rate was 35% (7/20); implant success rate in the nonradiated patients was 37.5% (3/8) and the success rate for radiated patients was 33.3% (4/12). Implants placed in the orbital region demonstrated a high failure rate. Most implant failures occurred late as opposed to early in the study period. CONCLUSION: Orbital implants should be placed in patients who understand that long-term success rates may be low and require meticulous hygiene maintenance.
Asunto(s)
Implantación de Prótesis Maxilofacial , Órbita , Oseointegración , Adulto , Anciano , Irradiación Craneana , Femenino , Tejido de Granulación , Humanos , Magnetismo , Masculino , Prótesis Maxilofacial , Implantación de Prótesis Maxilofacial/efectos adversos , Persona de Mediana Edad , Estudios Prospectivos , Diseño de Prótesis/instrumentación , Falla de Prótesis , Infecciones Relacionadas con Prótesis/etiología , Resultado del TratamientoRESUMEN
Coronary artery disease is common in the general population. Dentists must be prepared to treat patients with coronary artery disease in the safest possible manner. This article reviews the dental management of such patients. Specific attention is devoted to medical history, treatment planning, treatment modifications and appropriate measures to be taken in the event of an emergency.
Asunto(s)
Enfermedad Coronaria , Atención Dental para Enfermos Crónicos/métodos , Adulto , Anciano , Anestesia Dental/métodos , Anestesia Local/métodos , Angina de Pecho , Angina Inestable , Urgencias Médicas , Femenino , Humanos , Masculino , Anamnesis , Persona de Mediana Edad , Infarto del Miocardio , Planificación de Atención al Paciente , Estrés Fisiológico/prevención & controlRESUMEN
Panic disorder is a psychiatric disease without obvious cause. It is accompanied by signs of terror, such as chest pain, palpitation, and shortness of breath. One of every 75 Americans is afflicted. Onset occurs most commonly during adolescence. Some infants and children exhibit anxiety-like responses, such as retreat and avoidance, and behavioral restraint when faced with unfamiliar people, objects, and events. Panel disorder has a special relevance for dentistry, because it is frequently associated with mitral valve prolapse. Furthermore, medications used to treat the disorder are associated with detrimental changes in the oral cavity and adverse interactions with dental therapeutic agents. The authors discuss the podromal characteristics of children at risk for panic disorder and the characteristics of the malady recognized by the American Psychiatric Association. Associated medical problems are also presented and discussed. A survey of ninth graders found as many as 12 percent had spontaneous panic attacks. Approximately 20 percent of all adults with the disorder report its onset before age ten. Etiology, medical and dental management are discussed.
Asunto(s)
Atención Dental para la Persona con Discapacidad , Trastorno de Pánico , Adolescente , Anestesia Dental , Niño , Humanos , Trastorno de Pánico/diagnóstico , Trastorno de Pánico/tratamiento farmacológico , Trastorno de Pánico/etiología , Factores de RiesgoRESUMEN
Schizophrenia is a psychiatric disorder in which thought disturbances and aberrant behavior lessen an individual's ability to care for him or herself and to effectively work and communicate with others. The disorder affects 1 percent of the United States population. Onset of the florid psychotic symptoms most commonly occurs during adolescence or young adulthood, but most of these youngsters exhibit unusual behavior and peculiar thinking during childhood. Medications used in managing the disorder have numerous systemic and orofacial adverse side effects that must be recognized by dentists. Dental treatment strategies for the identification and management of these side effects are described as is a method to improve compliance with oral hygiene techniques.