RESUMEN
This study compared fixation of simple mandibular angle fractures with a single miniplate either placed from a combined transbuccal and intra-oral approach, or intra-orally alone. 140 consecutive patients were randomly allocated to the two treatment groups. Complications were noted and compared. An email questionnaire to all the participating surgeons examined their personal preferences between the two methods. 20% of plates needed to be removed during the 3 month study period in the combined transbuccal/intra-oral group compared with 36% in the intra-oral alone group (pAsunto(s)
Placas Óseas
, Fijación Interna de Fracturas/métodos
, Fracturas Mandibulares/cirugía
, Adolescente
, Adulto
, Femenino
, Fijación Interna de Fracturas/instrumentación
, Humanos
, Masculino
, Persona de Mediana Edad
, Resultado del Tratamiento
, Adulto Joven
Asunto(s)
Diseño Asistido por Computadora , Tabique Nasal/cirugía , Prótesis e Implantes , Diseño de Prótesis , Tomografía Computarizada Espiral , Medios de Contraste , Gutapercha , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Enfermedades Nasales/cirugía , Elastómeros de Silicona , Tomografía Computarizada Espiral/métodosRESUMEN
It has previously been demonstrated that mitochondrial DNA (mtDNA) mutations within the ND2 gene of histologically normal parotid salivary gland tissue of smokers may be molecular biomarkers for smoking-induced mtDNA damage. Oral squamous cell carcinoma (SCC) is strongly related to cigarette smoking; therefore, we used PCR and direct sequencing to establish whether mtDNA mutations were also present in oral SCC which could be used as additional biomarkers for smoking-associated DNA damage. In addition to searching for mutations in the ND2 gene, the mitochondrial D-Loop was also analysed. Three mutation hotspots were observed in the D-Loop at nt 146, 152 and 186, two of which (nt 146 and 152) have also been implicated in oesophageal SCC, another smoking-related cancer. The mutation hotspot observed at nt 186 has not previously been reported in other tumours. Furthermore, we show that the mutations previously reported within the ND2 gene in normal parotid tissue of smokers were not evident in these samples, but that a mutation hotspot occurs at nucleotide 4917 in oral SCC. We also show that D-Loop mutations occur predominantly in male smokers and female non-smokers and that this association with gender is statistically significant (P = 0.003). We conclude that the mtDNA mutation hotspots found in this study, in particular nt 186, are potential biomarkers for oral SCC. However, owing to gender-specific differences in occurrence in smokers and non-smokers, and a lack of environmental smoking history, in general, it is difficult to associate these mutations with mtDNA damage induced by smoking. If the mutations observed in the subset of male patients are smoking induced, given our previous findings, mutation hotspots in the ND2 gene may be tissue specific suggesting the causative mutagens for mtDNA damage within these tissues are likely to be different.
Asunto(s)
Carcinoma de Células Escamosas/metabolismo , ADN Mitocondrial , Neoplasias de la Boca/genética , Neoplasias de la Boca/metabolismo , Mutación , Anciano , Animales , Daño del ADN , Análisis Mutacional de ADN , ADN Mitocondrial/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , FumarRESUMEN
Descending necrotising mediastinitis is a rare complication of odontogenic infection. The key to diagnosis is to maintain a high index of suspicion when antibiotics and adequate surgical drainage do not lead to resolution of symptoms. Open thoracic operation to drain mediastinal collections is potentially lethal and interventional radiological techniques are thought to reduce mortality. We report the use of interventional radiology in the diagnosis, monitoring and treatment of this condition and illustrate our experience with three case reports.
Asunto(s)
Infección Focal Dental/complicaciones , Mediastinitis/terapia , Radiología Intervencionista , Absceso/microbiología , Absceso/terapia , Adulto , Drenaje , Estudios de Seguimiento , Humanos , Angina de Ludwig/microbiología , Angina de Ludwig/terapia , Masculino , Mediastinitis/microbiología , Persona de Mediana Edad , Cuello/microbiología , Derrame Pleural/microbiología , Derrame Pleural/terapia , Radiografía Intervencional , Infecciones Estreptocócicas/terapia , Tomografía Computarizada por Rayos X , Ultrasonografía Intervencional , Estreptococos Viridans/aislamiento & purificaciónRESUMEN
We prospectively studied 49 patients with oral squamous cell carcinoma (SCC) who had their cervical regional lymph nodes examined by ultrasound (US), with or without fine needle aspiration cytology (FNAC), for the detection of metastatic spread. They were screened over a two-year period (1993-1995) by computed tomography (CT) and magnetic resonance imaging (MRI) or both to measure the primary tumour. US, with or without FNAC, was used to stage the neck. All tumours were biopsied preoperatively and the diagnosis of SCC conformed by histological examination. Management of the neck was based on US staging. Thirty-five patients had neck dissections and 14 were managed conservatively. Mean follow-up was 30 months (range 24-48). All patients were alive at one year, but one died at 14 months from recurrence of disease in the neck. There were 3 false negatives (6%). We find that US, with or without FNAC, is an accurate (86%), sensitive (92%) and specific (83%) technique for the preoperative assessment of lymph node metastases in patients with SCC.
Asunto(s)
Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patología , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/patología , Neoplasias de la Boca/diagnóstico por imagen , Neoplasias de la Boca/patología , Ultrasonografía Intervencional , Biopsia con Aguja/instrumentación , Biopsia con Aguja/métodos , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Estudios de Seguimiento , Humanos , Metástasis Linfática , Neoplasias de la Boca/radioterapia , Neoplasias de la Boca/cirugía , Cuello , Disección del Cuello , Recurrencia Local de Neoplasia/epidemiología , Estadificación de Neoplasias , Radioterapia Adyuvante , Sensibilidad y Especificidad , Resultado del Tratamiento , Ultrasonografía Intervencional/instrumentación , Ultrasonografía Intervencional/métodosRESUMEN
A case report of an extradural haematoma (EDH) after temporomandibular joint arthroscopy is presented. The possible cause of this unusual occurrence is discussed.
Asunto(s)
Artroscopía/efectos adversos , Hematoma Epidural Craneal/etiología , Trastornos de la Articulación Temporomandibular/cirugía , Adulto , Femenino , Hematoma Epidural Craneal/diagnóstico por imagen , Humanos , Tomografía Computarizada por Rayos XRESUMEN
It has been suggested that early intensive medical treatment will improve the outcome for trauma patients with severe injuries. A Helicopter Emergency Medical Service (HEMS) based in an urban area was inaugurated by The Royal London Hospital. Specially trained medical and paramedical personnel flew with the helicopter to accident scenes. On return to the hospital, multi-disciplinary teams, including maxillofacial, were called to manage the patients. Operations from its own helipad commenced from the end of August 1990. A retrospective study of 192 patients transferred by HEMS to the Royal London Hospital during 16 months was undertaken. 18% (34) patients had facial injuries recognised at primary and secondary surveys according to Advanced Trauma Life Support (ATLS) protocols. The problems of early management are described and routine techniques for the control of haemorrhage from the maxillofacial area were developed.
Asunto(s)
Aeronaves , Servicios Médicos de Urgencia , Traumatismos Maxilofaciales/terapia , Traumatismo Múltiple/terapia , Transporte de Pacientes , Adolescente , Adulto , Anciano , Servicios Médicos de Urgencia/estadística & datos numéricos , Epistaxis/prevención & control , Femenino , Hemorragia/prevención & control , Humanos , Puntaje de Gravedad del Traumatismo , Londres/epidemiología , Masculino , Traumatismos Maxilofaciales/diagnóstico , Traumatismos Maxilofaciales/fisiopatología , Traumatismos Maxilofaciales/cirugía , Persona de Mediana Edad , Traumatismo Múltiple/diagnóstico , Traumatismo Múltiple/fisiopatología , Traumatismo Múltiple/cirugía , Respiración/fisiología , Estudios Retrospectivos , Tasa de Supervivencia , Traqueostomía , Índices de Gravedad del TraumaRESUMEN
A case report of a metastasising basal cell carcinoma is presented. The primary lesion was situated on the right upper lip with metastasis to soft tissue on the buccal aspect of the right molar region of the mandible. The literature regarding this unusual occurrence is reviewed.
Asunto(s)
Carcinoma Basocelular/secundario , Neoplasias Gingivales/secundario , Neoplasias de los Labios , Neoplasias Mandibulares/secundario , Carcinoma Basocelular/patología , Neoplasias Gingivales/patología , Humanos , Neoplasias de los Labios/patología , Masculino , Neoplasias Mandibulares/patología , Persona de Mediana EdadRESUMEN
A case of adenoid cystic carcinoma of the tongue is reported. It was unusual in that its initial presentation was that of a twelfth cranial nerve palsy of unknown origin. A brief review of the literature of this uncommon condition is presented.