RESUMEN
An 83-year-old man reported recent temporomandibular joint complaints and a swelling near his ear. The swelling moved whileopening the mouth. Additional imaging showed an osseous deviation of the right condyle with extension into the masticator space. In addition, several lytic and expansive bone lesions were visible in the skeleton, which initially suggested multiple myeloma. However, blood tests pointed in the direction of prostate cancer that had been treated twenty years earlier. There appeared to be extensive osseous metastatic recurrent prostate carcinoma with a metastasis in the right condyle of the mandible. The patient was treated with palliative systemic therapy.
Asunto(s)
Cóndilo Mandibular , Neoplasias de la Próstata , Anciano de 80 o más Años , Humanos , Masculino , Mandíbula , Cóndilo Mandibular/patología , Recurrencia Local de Neoplasia/patología , Articulación Temporomandibular , Trastornos de la Articulación Temporomandibular , Neoplasias de la Próstata/patología , Cuidados PaliativosRESUMEN
OBJECTIVE: The objective of this study was to evaluate the biological performance of osteoinductive microstructured tricalcium phosphate (MSTCP) particles in maxillary sinus floor augmentation surgery in sheep. MATERIAL AND METHODS: Sinus floor augmentation was performed in eight Swifter sheep. In each animal, the maxillary sinus floor was unilaterally augmented with MSTCP particles. Computed tomography (CT) imaging and histological analyses were performed after 12 weeks of implantation. RESULTS: Maxillofacial CT, histology, histomorphometrical analysis and sequential polychrome fluorescent labeling indicated that MSTCP particles provided a scaffold for cell ingrowth and bone formation. After a 12-week implantation period, the sinuses grafted with MSTCP showed an increased bone height of 6 mm and a mean total bone volume of 43%, with significant degradation of MSTCP particles. CONCLUSION: MSTCP particles represent a suitable bone substitute material for maxillary sinus floor augmentation surgery.
Asunto(s)
Materiales Biocompatibles/farmacología , Sustitutos de Huesos/farmacología , Fosfatos de Calcio/farmacología , Elevación del Piso del Seno Maxilar/métodos , Animales , Femenino , Maxilar/diagnóstico por imagen , Maxilar/cirugía , Osteogénesis , Oveja Doméstica , Coloración y Etiquetado , Estadísticas no Paramétricas , Andamios del Tejido , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: No studies are available that provide predictive parameters regarding the expected amount of resorption after maxillary sinus augmentation surgery using autologous bone grafts. Therefore, the aim of this study was to determine parameters influencing the outcome of the bone graft resorption process. MATERIAL AND METHODS: In 20 patients, three-dimensional analysis of alveolar ridge dimensions and bone graft volume change in the atrophic posterior maxilla was performed by Cone-Beam Computerized Tomography imaging. Ridge dimensions were assessed before maxillary sinus augmentation surgery. Bone graft volumes were compared after maxillary sinus floor augmentation surgery and a graft healing interval of several months. To analyze the relation between bone volume changes with the independent variables, patients' gender, age, alveolar crest height and width, and graft healing time interval, a multi-level extension of linear regression was applied. RESULTS: A residual bone height of 6.0 mm (SD = 3.6 mm) and 6.2 mm (SD = 3.6 mm) was found at the left and right sides, respectively. Moreover, alveolar bone widths of 6.5 mm (SD = 2.2 mm) and 7.0 mm (SD = 2.3 mm) at the premolars, and 8.8 mm (SD = 2.2 mm) and 8.9 mm (SD = 2.5 mm) at the molars regions were found at the left and right site, respectively. Bone graft volume decreased by 25.0% (SD = 21.0%) after 4.7 months (SD = 2.7, median = 4.0 months) of healing time. The variables "age" (P = 0.009) and mean alveolar crest "bone height" (P = 0.043), showed a significant influence on bone graft resorption. A decrease of 1.0% (SE = 0.3%) of bone graft resorption was found for each year the patient grew older, and an increase in bone graft resorption of 1.8% (SE = 0.8%) was found for each mm of original bone height before sinus floor augmentation. CONCLUSIONS: Graft resorption occurs when using autologous bone grafts for maxillary sinus augmentation. Alveolar crest bone height and patient age have a significant effect on graft resorption, with increased resorption for higher alveolar crest bone height and decreased resorption for older patients. Consequently, patient characteristics that affect the process of bone graft resorption should be given full consideration, when performing sinus augmentation surgery.