一期手术治疗腰椎间孔内外生长神经鞘瘤

目的：探讨腰椎间孔内外生长神经鞘瘤一期手术治疗效果。方法：回顾性分析我院自1999年3月至2010年4月收治的14例经磁共振及术后组织病理学检查明确诊断的腰椎间孔内外生长神经鞘瘤,施行一期手术切除的患者的临床资料。结果：14例腰椎间孔内外生长神经鞘瘤患者椎旁肿块长径6-14cm（平均9.2cm）。主要症状为椎旁肿块的胀痛、神经根性疼痛、感觉减退、肌力减退等。所有病例均行手术治疗,无严重并发症,11例随访1至5年,均正常工作。结论：磁共振检查对于腰椎间孔内外生长神经鞘瘤的诊治有重要价值,一期手术切除肿瘤是有效的治疗方法。     

Bisphosphonate-associated osteonecrosis: a long-term complication of bisphosphonate treatment

We present current knowledge of bisphosphonate-associated osteonecrosis, a new oral complication in oncology. It was first described in 2003, and hundreds of cases have been reported worldwide. The disorder affects patients with cancer on bisphosphonate treatment for multiple myeloma or bone metastasis from breast, prostate, or lung cancer. Bisphosphonate-associated osteonecrosis is characterised by the unexpected appearance of necrotic bone in the oral cavity. Osteonecrosis can develop spontaneously or after an invasive surgical procedure such as dental extraction. Patients might have severe pain or be asymptomatic. Symptoms can mimic routine dental problems such as decay or periodontal disease. Intravenous use of pamidronate and zoledronic acid is associated with most cases. Other risk factors include duration of bisphosphonate treatment (ie, 36 months and longer), old age in patients with multiple myeloma, and a history of recent dental extraction. We also discuss pathobiology, clinical features, management, and future directions for the disorder.     

Dent et irradiation : denture et conséquences sur la denture de la radiothérapie des cancers de la tête et du cou

Pre-irradiation dental care depends on teeth health, fields and dose of irradiation, compliance to fluorides, cessation of tobacco and psychosocial cofactors. Dental care aims at preventing complications and preserving the quality of life (eating, speech and aesthetics). Approximately 11% of patients do not require any pre-irradiation dental care. Dental complications vary from slight colorations of the teeth to major complication such as osteoradionecrosis. Osteoradionecrosis rates vary from 1 to 9%, and may be decreased by using a 21-day delay between extractions and irradiation, provided that it does not postpone cancer treatment, with a dose-dependent risk (<6% if <40 Gy; 14% between 40 et 60 Gy; ≥20% if >60 Gy). Osteoradionecrosis occurs spontaneously (35%), mostly involves the mandibula (85%).     

哑铃型椎管肿瘤的临床诊治分析

目的　探讨哑铃型椎管肿瘤的临床特征以及诊疗方法。方法　回顾性分析我院自１９９８至２００８年１０年间收治的２８例哑铃型椎管肿瘤患者的临床资料。结果　２８例哑铃型椎管肿瘤患者均经ＭＲＩ和术后组织病理学检查明确诊断,临床特征主要为椎管内压迫症状（根性疼痛、感觉异常、肌无力）和椎管外压迫症状（椎体周围发现包块）。所有病例均行Ⅰ期手术切除,无手术死亡,２３例获得随访,随访７个月～１０年,１８例恢复正常工作。结论　对椎管肿瘤患者应重视临床病史和体格检查;ＭＲＩ检查在哑铃型椎管内肿瘤的诊断和手术方式的选择上占重要地位;早期诊断、Ⅰ期手术完全切除肿瘤是优选有效的治疗方法。     

Fibula free flap reconstruction of the mandible in cancer patients: evaluation of a combined surgical and prosthodontic treatment concept

The final goal of mandibular reconstruction following ablative surgery for oral cancer is often considered to be dental implant-supported oral rehabilitation, for which bone grafts should ideally be placed in a suitable position taking subsequent prosthetic restoration into account. The aim of this study was to evaluate the efficacy of a standardized treatment strategy for mandibular reconstruction according to the size of the bony defect and planned subsequent dental prosthetic rehabilitation. Data of 56 patients, who had undergone such a systematic mandibular fibula free flap reconstruction, were retrospectively analyzed. Early complications were observed in 41.5% of the patients but only in those who had been irradiated. Late complications were found in 38.2%. Dental implant survival rate was 92%, and dental prosthetic treatment has been completed in all classes of bony defects with an overall success rate of 42.9%. The main reasons for failure of the complete dental reconstruction were patients' poor cooperation (30.4%) and tumour recurrence (14.3%) followed by surgery-related factors (10.8%) such as implant failure and an unfavourable intermaxillary relationship between the maxilla and the mandible. A comparison of our results with the literature findings revealed no marked differences in the complication rates and implant survival rates. However, a systematic concept for the reconstructive treatment like the method presented here, plays an important role in the successful completion of dental reconstruction. The success rate could still be improved by some technical progress in implant and bone graft positioning.     

Evolution of bisphosphonate-related osteonecrosis of the jaw in patients with multiple myeloma and Waldenstrom's macroglobulinemia: a retrospective multicentric study

Bisphosphonates (BPs) are used intravenously to treat cancer-related conditions for the prevention of pathological fractures. Osteonecrosis of the jaw (BRONJ) is a rare complication reported in 4-15% of patients. We studied, retrospectively, 55 patients with multiple myeloma or Waldenstrom's macroglobulinemia followed up from different haematological departments who developed BRONJ. All patients were treated with BPs for bone lesions and/or fractures. The most common trigger for BRONJ was dental alveolar surgery. After a median observation of 26 months, no death caused by BRONJ complication was reported. In all, 51 patients were treated with antibiotic therapy, and in 6 patients, this was performed in association with surgical debridement of necrotic bone, in 16 with hyperbaric O(2) therapy/ozonotherapy and curettage and in 12 with sequestrectomy and O(2)/hyperbaric therapy. Complete response was observed in 20 cases, partial response in 21, unchanged in 9 and worsening in 3. The association of surgical treatment with antibiotic therapy seems to be more effective in eradicating the necrotic bone than antibiotic treatment alone. O(2) hyperbaric/ozonotherapy is a very effective treatment. The cumulative dosage of BPs is important for the evolution of BRONJ. Because the most common trigger for BRONJ was dental extractions, all patients, before BP treatment, must achieve an optimal periodontal health.     

Maxillofacial Infections of Odontogenic Origin: Epidemiological,Microbiological and Therapeutic Factors in an Indian Population

Odontogenic fascial space infections are commonly encountered by the oral and maxillofacial surgeon. A retrospective study of the epidemiological characteristics, microbiological analysis and treatment response to odontogenic infections treated in the oral and maxillofacial unit of a Dental school is presented. A retrospective analysis of case records of all odontogenic infections that reported to the oral and maxillofacial surgery unit in a Dental school over a period of 2 years was performed. Epidemiological data, microbiological profile and treatment responses were analysed. All data were subjected to statistical analysis using SPSS statistical package. Mann–Whitney U test, Kruskal–Wallis test and nonparametric tests were carried out. A total of 2,140 patients were included in this study. Mandibular third molars were the offending tooth in nearly 40 % of cases with 107 patients becoming symptomatic following a dental extraction procedure. All patients were treated with surgical incision and drainage, antibiotics and local wound care. More than 95 % cases needed intraoral incisions. Penicillin was the drug in most of the cases. The pterygomandibular space was the most commonly involved with 15 % reporting with multiple fascial space involvement. Microbiological analysis showed a predominance of aerobic gram positive organisms with Streptococcus sanguis most commonly isolated. Peptostreptococci and Propionibacterium were the common anaerobes isolated. More than 80 % of the strains isolated were sensitive to penicillin. The average length of stay was 6.3 days. Inadequate documentation with regards to referral patterns, antibiotic history was commonly observed in case records. Penicillin continues to remain the drug of choice for a vast majority of maxillofacial infections of odontogenic origin. A delay in reporting can lead to worsening of symptoms with consequent increase in surgical morbidity and costs of treatment. Preventive dental care remains the best option available to mitigate the consequences of poor oral hygiene. Poor awareness among patient population for regular dental reviews and oral hygiene maintenance emphasises the need for sensitisation and education programs.     

Intraperitoneal radioactive phosphate in early ovarian carcinoma: an analysis of complications

Intraperitoneal radioactive chromic phosphate was administered to 69 patients with Stage I and II ovarian carcinoma who had undergone comprehensive surgical staging. Intestinal obstruction requiring surgical intervention occurred in four patients and was the most severe complication. Abdominal pain was the most common post-therapy complaint. Attention to time and technique of drug administration could minimize complications.     

Postoperative morbidity of lymph node excision for cutaneous melanoma-sentinel lymphonodectomy versus complete regional lymph node dissection

For patients with melanoma metastasis to a sentinel lymph node, subsequent complete regional lymph node dissection (CLND) is currently regarded to be the surgical standard. This approach, however, has not been confirmed by controlled studies, so that surgical morbidity is of primary importance. Using clinical examination and a questionnaire, we determined morbidity in 315 patients with axillary or inguinal lymph node excision on whom 275 sentinel lymphonodectomies (SLNEs) and 90 CLNDs were performed. The overall incidence of at least one complication following SLNE was 13.8%. The short-term complication rate was 11.3% (allergic reaction to blue dye 0%, wound breakdown 0%, haematoma 2.5%, wound infection 3.6%, seroma 6.9%). The incidence of long-term complications was 4.1% (persistent tattoo 0.4%, functional deficit 0.4%, nerve dysfunction/pain 0.7% or swelling 2.5%). All complications were mild. Significantly, the complication rate was not higher for patients aged 70 years or older. After CLND, the overall complication rate was significantly higher (65.5%, P<0.000001). The incidence of short-term complications was 50% (haematoma 0%, wound breakdown 6.7%, wound infection 24.7% or seroma 34.8%). The incidence of long-term complications was also 50% (nerve dysfunction/pain 8.9%, functional deficit 16.8%, swelling 37.1%). Overall, inguinal lymph node excision was burdened by a higher complication rate (P=0.015). Age and sex did not influence postoperative morbidity. No deaths linked to either procedure were noted. Complication rates after SLNE are low and most complications are minor and short-lasting. In contrast, CLND has been demonstrated to be a major and potentially morbid surgical procedure. This highlights the importance of testing the therapeutic value that CLND adds to the sentinel lymph node procedure.     

Dent et irradiation : prévention et traitement des complications dentaires de la radiothérapie y compris l’ostéoradionécrose

Pre-irradiation dental care depends on teeth health, fields and dose of irradiation, compliance to fluorides, cessation of tobacco and psychosocial cofactors. Dental care aims at preventing complications and preserving the quality of life (eating, speech, and aesthetics). The role of hyperbaric oxygenotherapy for the prevention of osteoradionecrosis after teeth removal on the mandibula in areas receiving 50 Gy or more is still controversial. Medical treatments may be sufficient for early stages of osteoradionecrosis (antibiotics, pain killers, non-steroidal anti-inflammatory drugs as well as clodronate, vitamin E, pentoxifyllin). However, reconstructive surgery should not be delayed in advanced stages of osteoradionecrosis. New irradiation techniques are changing dose distributions and therefore require close collaboration between odonto-stomatologists and radiation oncologists to define the best dental care.     

Primary intraosseous carcinoma of the mandible--a case report and review of the literature.

BACKGROUND: Squamous cell carcinoma arising within bone is a rare lesion and is only seen essentially in the jaw bones. METHODS: A case of primary intraosseous carcinoma arising in the mandible is reported in a 60-year-old female patient. Twenty-eight cases of primary intraosseous carcinoma published in the literature, till date, are reviewed. RESULTS: The mean age of the patients at the time of diagnosis was 53 years and the male: female ratio was 2.2:1. The posterior mandible was the predominant site. Fourteen of 28 patients presented with routine dental disorders, while eight patients complained of swelling, four of severe pain and three had sensory disturbances. The incidence of lymphadenopathy was 10 (34.481%) out of the 29 cases reviewed here. Wide surgical excision is accepted as the treatment of choice. CONCLUSION: The most common presenting symptom of these tumours is swelling and persistent pain in the jaw. Hence, in making a diagnosis one is likely to consider benign dental conditions. The importance of considering intraosseous carcinoma as a possibility in all cases of persistent pain and swelling in the jaw is emphasized so that suitable treatment can be instituted early.     

Proceedings: Dental care for the cancer patient

In the dental treatment and maintenance of cancer patients the dentist is often confronted with particularly and peculiarly accented situations which require knowledge of disease and therapy-related problems. Surgery, radiotherapy, chemotherapy, and basic disease may present a constellation of conditions which require for their control the efforts of the entire health profession team. Dental care of the irradiated head and neck cancer patient requires close follow-up and meticulous oral hygiene. There are definite indications for preirradiation extractions, basic rules for maintenance during and after irradiation, and certain precepts for post-irradiation extractions. Chemotherapy has introduced new considerations in the dental treatment of cancer patients. As most anti-tumor drugs cause thrombocytopenia, this effect on hemostasis is of great concern when contemplating oral surgery. During the acute phase of hematologic disorders dental maintenance must be limited to atraumatic procedures to control periodontal and pulp involvement. Good oral hygiene plays an important part in the dental maintenance of all patients. Dentists must take an active part in the therapy and rehabilitation of cancer patients.     

Avascular Necrosis of Bone: A Complication of Aggressive Therapy for Acute Lymphoblastic Leukemia

The purpose of the present paper was to report cases of avascular necrosis of bone (AVNB) arising as a complication of chemotherapy for acute lymphoblastic leukemia (ALL). X-rays and ^99mtechnicium-MDP bone scans were performed on patients with symptoms of bone pain, whereby five patients out of 850 patients were detected to have avascular necrosis of the femoral head. All had received aggressive chemotherapy with steroids. Two patients were still on therapy for the primary disease. In these patients further chemotherapy was continued without steroids. The median period from diagnosis of ALL to development of AVNB was 29 months. Three patients underwent corrective surgical procedures. To conclude, the data suggest that patients receiving combination chemotherapy, especially those with high cumulative doses, run a risk of developing AVNB. Awareness of this complication is important in order to have an early diagnosis so as to limit disability.     

Adaptation of dental home care--report number 2: Attempt at a new system of dental home care

In the first report we revealed some problems in visiting dental treatment, and concluded that a new dental care system should be constructed for the solution of those problems. Therefore, we started a new system which included dental treatment under hospitalization in our dental hospital. For home patients this system aims at treating, managing smoothly and providing better dental treatment, due to the choice of hospitalization, outpatient care, or home visits in the medical process. In the period from March, 1993, when our dental hospital was established, until December, 1998 treatment was given 1,527 times with 420 patients under this system, and 127 of these patients chose dental treatment under hospitalization. Dental treatment under hospitalization is the management method not found in usual dental treatment, but it is indispensable to our system. When we decide hospitalization, we must make an overall estimate of the patient's general condition, contents of treatment, eating function and nutritional condition, background, and the wishes of the patient and family. In principle, visiting dental treatment is intended for a patient who has finished dental treatment. When treatment is necessary, it should be limited to simple treatment, first aid and maintenance. The oral care of many home patients under the present circumstances is not practiced sufficiently, and cooperation of medical and welfare workers is required to improve such conditions.     

Decreased occurrence of osteonecrosis of the jaw after implementation of dental preventive measures in solid tumour patients with bone metastases treated with bisphosphonates. The experience of the National Cancer Institute of Milan

Background: Screening of the oral cavity and dental care wassuggested as mandatory preventive measures of osteonecrosisof the jaw (ONJ) in patients receiving bisphosphonates (BPs).We investigated the occurrence of ONJ before and after implementationof dental preventive measures when starting BP therapy. Patients and methods: Since April 2005, 154 consecutive patientstreated with BPs (POST-Group) have undergone a baseline mouthassessment (dental visit ± orthopantomography of thejaws) to detect potential dental conditions and dental careif required. A retrospective review was also conducted of allconsecutive cancer patients with bone metastases (PRE-Group)and treated for the first time with BPs from January 1999 toApril 2005 in our clinic without receiving any preventive measure.Incidence proportion and incidence rate (IR) were used to estimatethe incidence of ONJ. Results: Among the study population (966 patients; male/female= 179/787), 73% had breast cancer. 25% of patients were givenzoledronic acid (ZOL), 62% pamidronate (PAM), 8% PAM followedby ZOL and 5% clodronate. ONJ was observed in 28 patients (2.9%);we observed a reduction in the incidence of ONJ from 3.2% to1.3%, when comparing—pre and post-implementation of preventivemeasures programme. Considering the patients exposed to ZOL,the performance of a dental examination and the applicationof preventive measures led to a sustained reduction in ONJ IR(7.8% in the PRE-Group versus 1.7% in the POST-Group; P = 0.016),with an IR ratio of 0.30 (95% confidence interval 0.03–1.26). Conclusions: ONJ is a manageable and preventable condition.Our data confirm that the application of preventive measurescan significantly reduce the incidence of ONJ in cancer patientsreceiving BPs therapy. Dental exams combined to the identificationof patients at risk in cooperation with the Dental Team canimprove outcomes and increase the number of ONJ-free patients. Key words: bisphosphonates, bone metastases, dental preventive measures, dental team, ONJ, osteonecrosis of the jaw, osteoporosis Received for publication February 15, 2008. Revision received June 17, 2008. Accepted for publication June 23, 2008.     

Role of Dental Institutions in Tobacco Cessation in India: Current Status and Future Prospects

Tobacco abuse is a major preventable cause of premature death and disease, including various cancers. TheGlobal Adult Tobacco Survey India (GATS) 2009-10 revealed that more than one-third of adults use tobacco inone form or the other. Nearly two in five smokers and smokeless tobacco users made attempts to quit the habitin the past 12 months. Tobacco dependence is a chronic condition characterized by susceptibility of relapseover years. It can be well handled by sustained professional support from health care providers mainly throughbehavioral counseling and pharmacotherapy. Dental professionals can play a pivotal role in diagnosing andeffectively managing tobacco dependence. Dental Institutions have rapidly grown in last two decades across thecountry and so has the curriculum been adapted to improve student competencies to accommodate changingdisease patterns and technological advances, but not in regard to tobacco cessation. Untapped dental manpowerlike undergraduates, dental hygienists and other paramedical staff need effective training to be more penetrative.The present review paper explores the potential role of dental training institutions and recommends variousapproaches to counter public health jeopardy of tobacco related diseases.     

Bisphosphonatassoziierte Nekrosen der Kiefer

Bisphosphonates are widely used in the treatment of various benign and malignant diseases of the bone. Avascular necroses of the jaw bones are a new, typical complication of such therapy with increasing incidence, mostly occurring after dental (e.g., teeth extractions) or accidental (e.g., tender spot caused by dental prosthesis) lesions of the oral mucosa. Bisphosphonate-related necrosis of the jaws appears with clinical symptoms of persistently exposed avital bony areas in both the maxilla and mandible and can be differentiated from any other disease of the facial skeleton (e.g., osteoradionecrosis). Therapy of such necroses is exclusively surgical and is frequently combined with considerable loss of quality of life and unsatisfactory prognosis at present. As preventive measures, individual risk assessment, patient information and instruction, close dental/oral and maxillofacial monitoring, and interdisciplinary cooperation are necessary.     

Prosthetic treatment and rehabilitation: Use in patients with cancer of the head and neck

Dental management of the patient with cancer, especially when the disease process involves the head and neck region, should be an integral part of the patient's overall treatment plan. By utilizing the team approach and detailed advance planning, stressing both immediate treatment to control the patient's disease and short- and long-term rehabilitation, the best possible treatment for each patient can be formulated with a minimum of posttreatment complications.If an institution is to make the commitment to treat patients with cancer, a comprehensive dental support program with a maxillofacial prosthodontist is a necessity. As the benefits of a dental department are recognized, the utilization of this service increases and the overall treatment and rehabilitation of the patient with cancer is improved.     

Dental and bone abnormalities in patients with familial polyposis coli

Dental and bone abnormalities of the maxilla and mandible are present in approximately 80% of patients with familial polyposis coli. The dental abnormalities include impacted teeth (other than third molars), supernumerary teeth, congenitally missing teeth, fused roots of first and second molars, and unusually long and tapered roots of posterior teeth. The bone lesions consist mostly of osteomas, either isolated or in clusters, in the maxilla and mandible or of exostoses with lateral and/or lingual extensions. Since dental and bone abnormalities are already present early in life there is a strong suggestion that they may be used as diagnostic features in the recognition of familial polyposis coli.