A rational approach to prevent recurrences after definitive treatment of oral cancers by surgery

Oral Cancer is a major problem not only in the Indian Subcontinent, but also in large areas of South and South East Asia where tobacco habits (chewing and smoking) are prevalent.     

MRI examination of the TMJ after surgical treatment of condylar fractures

The position of discs in 20 adult patients whose unilateral condylar fractures were treated by open reduction was investigated by means of magnetic resonance imaging. In four (20%) of the 20 cases, the disc was anteriorly displaced in both the closed mouth and open mouth positions. Three of the four cases had a high condylar neck fracture with dislocation and one had a high condylar neck fracture with displacement. The results of this study showed that repositioning the dislocated condyle did not always lead to anatomical restoration of the joint structures.     

Transplantation and implantation procedures after surgical treatment of ameloblastoma

Attention is called to the fact that in cases of large ameloblastomas systematic, careful treatment is essential. This implies proper reconstruction of the jaw and restoration of the occlusion after adequate extirpation of the tumor. A case involving a large mandibular ameloblastoma is reported. It was successfully treated, step by step, by tumor extirpation, jaw reconstruction with rib transplants and installation of titanium implants (Biotes) in the rib transplants, anterior vestibuloplasty with skin graft, and, finally, an overdenture. Carefully planned coordination of well-documented surgical and prosthetic procedures has achieved a functionally and esthetically successful result.     

Functional outcome after surgical treatment of orbital floor fractures

In the present article, the authors want to present the results of a retrospectively evaluated consecutive series of patients with surgically treated isolated orbital floor fractures (OFF; "blow-out fractures") concerning the functional outcome after OFF and give detailed recommendations based on the clinical and radiological findings. A series of 60 patients with isolated OFF over a 5-year period needing surgically repair at the same institution were evaluated. Patient data were analysed in terms of preoperative and postoperative clinical parameters and radiological findings. The analysed parameters were type of fracture, diplopia, gaze restriction, enophthalmos, materials used for repair, surgical approach and timing of the surgical intervention. Burst type fractures were more often found than punched-out fractures. The most frequently used surgical approach was a preseptal transconjunctival approach. An overall decrease of gaze restriction (93%), diplopia (89%) and enophthalmos (86%) was observed. According to the fracture size, we used Ethisorb patches in smaller fractures and resorbable or titanium meshes or autologous bone in larger fractures in most cases. Patients who underwent surgery more than 7 days after the trauma showed better results with regard to an improvement of diplopia and motility disturbances than patients who were treated immediately. In indicated cases, the surgical repair of OFF leads to very good results if the anatomical and functional properties of the orbit and its contents are respected. The applied strategy and means presented in our study proved of value and can therefore be recommended.     

Reconstruction after surgical treatment of head and neck cancer: surgical and prosthetic possibilities

Soft and hard tissue defects in the head and neck region after benign or malignant tumour resection, can be reconstructed by surgical techniques, such as tissue transplantation, and/or prostheses. The aim of reconstruction is to restore the original esthetics and functions of the bone and soft tissues that have been resected. The introduction of free vascularized osteomyocutaneous fibula and iliac crest flaps improved the surgical possibilities of reconstructing the mandible and the maxilla. With respect to oral rehabilitation, a reconstruction of the mandible and the maxilla should be carried out in such a way that it provides an adequate base for inserting endosseous implants, which will retain a removable or fixed prosthesis This requires good interdisciplinary planning, in which the plan for prosthetic treatment determines, in part, the choice of reconstruction method.     

Mandibular kinematics after orthognathic surgical treatment a pilot study

We recorded three-dimensional mandibular movements, while the mouth was being opened and closed, using an optoelectronic motion analyser in 14 patients (5 skeletal Class II, 9 skeletal Class III) who were being assessed 7-49 months after orthognathic operations, and in 44 healthy subjects. All 14 patients had satisfactory healing on clinical examination, and function had been restored. Mandibular movement was divided into its rotational and translational components. On maximum mouth opening, the patients had significantly less total displacement of the mandibular interincisor point (p=0.05), and more mandibular movement that was explained by pure condylar rotation (p=0.006), than control subjects. There was no significant relation between maximum mouth opening and percentage rotation. While mandibular motion was well restored clinically by orthognathic surgery, the kinematics of the joint were modified. Larger studies and longitudinal investigations are necessary to appreciate the clinical relevance of the variations in condylar rotational and translational components.     

Late loco-regional recurrences after radical resection for mandibular ameloblastoma

5 cases of mandibular ameloblastoma are described with multiple recurrences after a long period of time. 4 of them were primarily treated by radical resection. 1 was initially treated by enucleation and extensive resection was performed only after its recurrence. The invasive growth of the recurrent tumor into the soft tissues and the cranial base, necessitating extensive ablative and reconstructive surgery, reflects the potential aggressiveness of this tumor. It is therefore recommended, to plan an adequate resection in cases of multicystic ameloblastoma, which includes a margin of at least 1 cm, of apparently non-invaded bone. If the tumor has eroded through the cortical bone and invaded into the soft tissues, wider margins are necessary to eliminate possible tumor extensions that are left behind. Adequate follow-up on a regular basis should enable the clinician to detect early recurrence so as to avoid major surgery.     

Pain and morbidity after non-surgical and surgical treatment of peri-implantitis

Objective: Not much information exists on post-treatment pain related to peri-implantitis. The purpose of this study was to evaluate intensity and quality of pain after non-surgical and surgical treatment of peri-implantitis.

Material and methods: A total of 30 patients with a diagnosis of peri-implantitis were included in the study. The patients registered pain using a VAS scale after non-surgical and surgical treatment of peri-implantitis. The data were registered for one week after each treatment. The patients also recorded quality of pain and if analgesics were taken. Factors included in the study were number of implants, severity of peri-implantitis (millimetre bone loss at most severely affected implant), implant localization, smoking and gender.

Results: Statistically significant difference in intensity of pain was found between day zero and day one for both non-surgical and surgical treatment of peri-implantitis (p?Conclusion: Levels of pain are found to be low to moderate for most patients after treatment of peri-implantitis. The pain was most pronounced on the first two days post-treatment. Throbbing/soreness and numbness were the most frequently reported quality of pain.     

髁突骨折手术治疗并发症及原因分析

目的：探讨髁突骨折手术治疗并发症及其预防。方法：对第四军医大学口腔医学院1985～2000年间收治的髁突骨折采取手术治疗的病例进行随访,统计各种并发症,分析其原因。结果：随访到的58例髁突骨折患者中,74．10%出现开口时偏斜,39．66%出现开口时关节弹响,27．57%出现咀嚼时关节区疼痛。结论：髁突骨折手术治疗后,可发生一定并发症,应予注意和预防。     

Three-dimensional changes of scleral show after surgical treatment of endocrine orbitopathy

Purpose

Surgery in endocrine orbitopathy should address exophthalmos and adjunct stigmata such as increased lid aperture and scleral show. Secondary to decompression, rehabilitative surgical treatment such as blepharoplasty is routinely used to achieve this goal. Until now, however, there has been no investigation to measure the effect of decompression surgery on scleral show and lid aperture 3-dimensionally.

Formation of interdental soft tissue defects after surgical treatment of periodontitis

This study monitored the development and repair of interdental soft tissue defects following surgical treatment of periodontitis in 21 patients. Open flap curettage was performed at 100 interdental areas with follow-up examinations 1, 3, and 6 months later. Interdental gingival contours were assessed both clinically and indirectly with silicone elastomer impressions from which stone models were obtained; defect depths were then calculated using the Reflex Microscope. Two types of defect were identified at the 1-month follow-up: 13 interdental clefts (mean depth, 1.8 mm); and 30 craters, (mean depth, 1.6 mm). Although clefts tended to persist, craters showed a strong tendency to repair. Thus, at the 6-month follow-up, the depths of clefts and craters were 1.3 mm and 0.7 mm respectively. The development of soft tissue defects did not appear to be related to the use of a periodontal dressing nor did the existence of an underlying bone defect appear to be of etiological importance. Pre-operative probing depths, however, were positively associated with the occurrence of soft tissue craters (P = 0.02). Pre-operatively, the overall mean probing depth and frequency of bleeding on probing were 5.3 mm and 100% respectively. At 6 months, these values were reduced to 2.0 mm and 22%. When clefts, craters, and interdental areas with no soft tissue defect were compared, no significant differences in probing depth reduction or frequency of bleeding were observed at any time point.(ABSTRACT TRUNCATED AT 250 WORDS)     

Problems reported by patients before and after prosthodontic treatment

PURPOSE: This study sought to investigate problems reported by patients before and after prosthodontic treatment. MATERIALS AND METHODS: Patient-reported problems were studied using the item list contained in the German version of the Oral Health Impact Profile in a convenience sample of 107 prosthodontic patients before (T0), 1 month after (T1), and 6 to 12 months after treatment (T2). "Frequently reported" problems were defined as impacts experienced fairly often or very often. The prevalence of frequently reported problems was compared among treatment groups and across appointments. RESULTS: At baseline, the most prevalent frequently reported problems were "difficulty chewing" (31%), "take longer to complete a meal" (28%), "food catching" (26%), "uncomfortable to eat" (24%), and "unable to eat (because of dentures)" (23%). At T2, the most prevalent frequently reported problems were "sore spots" (5%), "painful gums" (4%), "discomfort (because of dentures)" (3%), and "sore jaw" (2%). The number of reported problems decreased from 18.0 (T0) to 7.5 (T1), and further to 4.5 (T2). The decrease was the fastest in fixed partial denture wearers and the slowest in removable partial denture wearers. Some problems emerged during or after prosthodontic treatment. The kind of pre- and posttreatment problems differed substantially. CONCLUSION: The number of problems decreased substantially after prosthodontic treatment. Fixed partial dentures more effectively influenced the problems reported before treatment than did removable partial or complete dentures.