Prevention of complications and consequences of parotidectomy in cases of benign tumors

The method of surgical treatment of parotid gland tumours has been developed, to prevent Lucie Frey's syndrome, restore facial contours by suturing the volumetric allotransplant. A new cosmetic surgical access to the parotid gland is used. The results of treatment of 10 patients were analyzed. Healing was observed in 100% of cases. No one of the patients has developed Lucie Frey's syndrome.     

Design of a scale for measuring post-surgical complications in third molar surgery

The aim of this study was to design a scale for measuring the extent and severity of post-surgical complications in third molar surgery. A multi-stage study using a quantitative methodology and qualitative interview strategy was employed. The degree of importance of signs and symptoms in the evaluation of post-surgical complications was initially observed using a self-report questionnaire administered to maxillofacial surgeons and surgical residents at the International Conference of Oral and Maxillofacial Surgeons in 2011. Then, using exploratory factor analysis, the items and components of the scale were established, with internal consistency determined using Cronbach's alpha. Finally, a group of experts performed a face validity analysis and provided conceptual definitions for the items and components. Thirty-six signs and symptoms were evaluated by 100 respondents, with the most relevant being ‘suppuration’ and ‘abscess’. Factor analysis of the results identified three factors, defined as ‘secondary complication’, ‘soft tissue infection’, and ‘osseous involvement’ (Cronbach's alpha > 0.7). Finally, a preliminary scale was designed comprised of these three components and 10 items. In this way, a preliminary scale for measuring post-surgical complications was designed to standardize the semiological concepts of post-surgical assessment. This scale will be assessed in a future investigation.     

Preventing and resolving complications with osseointegrated implants

Zarb36 has stated: "The technique of osseointegration is supported by compelling evidence of clinical longevity. It is an outgrowth of good science, painstakingly investigated, and meticulously executed. The success of edentulous patient treatment augers well for a diversified application of the technique." Along with scientific advancement and diversification of applied technologies are equally diverse challenges. A variety of potential complications, using osseointegrated implants, have been discussed. The objectives of this discussion is the development of concepts to prevent complications through careful treatment planning and meticulous execution of surgical and prosthetic treatment techniques. The six major categories of potential complications include: (1) esthetic, (2) phonetic, (3) functional, (4) biologic, (5) mechanical, and (6) ergonomic. The most frequently observed difficulty with any implant prosthesis relates to esthetics in the maxillary anterior and is followed then equally by phonetic, functional, biologic, and mechanical. Ergonomic complications should be minimal with continued improvement in instrumentation and clinical techniques. Complications are but a challenge to our professional knowledge and ingenuity. Ultimately they benefit both patient and profession alike.     

负压引流预防腮腺术后并发症的系统评价

目的:用系统评价方法评价负压引流在预防腮腺术后并发症方面的疗效及安全性。方法:计算机检索PubMed、Cochrane图书馆临床随机对照试验库、荷兰医学文摘、欧洲灰色文献数据库、中国生物医学文献数据库、维普数据库、万方数据库,检索时限为建库截至2013年3月10日;同时手工检索19种中文口腔医学杂志,搜集负压引流与开放式引流预防腮腺术后并发症的临床随机对照试验。2位评价者独立使用Cochrane 协作网推荐的标准对纳入文献进行偏倚风险评价并提取数据,采用Revman5.2软件进行meta分析。结果:最终纳入10项研究,偏倚风险评价显示均为中等偏倚风险。Meta分析结果显示,与开放式引流相比,负压引流能明显减少腮腺术后并发症(涎瘘/积液、血肿)的发生,提高临床综合疗效及患者的生活质量(P<0.05)。结论: 负压引流在预防腮腺术后并发症发生方面有一定的疗效和安全性,但还需要更多高质量的临床随机对照试验支持。     

Oral post-surgical complications following the administration of bisphosphonates given for osteopenia related to malignancy

BACKGROUND: This case report seeks to illustrate the clinical consequences of the administration of bisphosphonate therapy to prevent osteopenia secondary to malignancy in one patient. METHODS: A 69-year-old white female with a history of breast cancer with metastasis presented with pain in the upper left quadrant and periodontal pocketing of at least 6 mm in each of the four quadrants of the oral cavity. One week following surgery on the lower right region, lingual bone exposure was noted, and several attempts at achieving healing over the course of 15 months proved unsuccessful. RESULTS: Upon referral to a surgeon at the Louisiana State University Medical Center, New Orleans, Louisiana, a potential causative factor was finally identified. The drug zoledronic acid, a bisphosphonate given for prevention of osteoclastic activity of bone metastasis, secondary to breast cancer, was identified as the possible cause of inhibition of healing, most likely from regional vascular insufficiency. The drug was immediately discontinued. The patient is healing very slowly with the aid of hyperbaric therapy; she has been unable to achieve smoking cessation, which is deterring thorough healing of the exposed bony area on the lower right lingual side. CONCLUSIONS: Physicians and dentists alike must become increasingly aware of impaired oral healing following the use of bisphosphonates given for malignancy-related osteopenia. A dental exam should be performed before bisphosphonate therapy, as recommended for radiation therapy related to malignancy.     

Preventing and treating the oral complications of cancer therapy

Approximately 1.25 million Americans are diagnosed with cancer for the first time each year. Forty percent (500,000) of these individuals develop oral complications to their cancer therapy. The three modalities of cancer therapy (surgical, pharmacologic, or radiotherapy), employed individually or, more often, in combination, may result in a variety of general and/or treatment-specific oral complications. In many cases, these oral complications lead to dose reductions, delays, or termination of cancer treatment, which reduce the chances of remission or cure. This paper reviews the basic concepts of pretreatment oral care, treatment of oral complications during cancer therapy, and the need for continuing posttreatment oral care.     

腮腺多形性腺瘤区域性切除术与浅叶切除术的比较研究

目的 比较腮腺多形性腺瘤区域性切除术与浅叶切除术两种术式的术后复发率及并发症发生情况,为临床合理选择术式提供依据.方法 总结1998年1月～2004年6月间收治的腮腺多形性腺瘤61例,其中24例采用腮腺区域性切除术,37例行腮腺浅叶切除术,随访时间3～9年.结果 采用腮腺区域性切除手术的病例术后面瘫、Frey综合征、涎瘘的发生率均低于腮腺浅叶切除术,而肿瘤的复发率无明显差异.结论 区域性切除术手术创伤小,并发症少,还可以保存腮腺一定的功能,可作为腮腺多形性腺瘤临床治疗的首选术式.     

改良的腮腺切除术

目的 介绍一种改良的腮腺切除术。方法 该改良术式的要点为：①采用隐蔽的面部除皱切口，避免了常规术式的耳前和颈部切口；②在SMAS筋膜下翻瓣，减少了术后Frey综合征的发生；③采有总干法解剖面神经，减少了面神经周围支损伤的机率；④暴露面神经总干后，根据肿瘤的位置，选择性解剖面神经颈面干而行腮腺部分切除术，保护腮腺的部分功能；⑤采用蒂在上方的胸锁乳突肌肌瓣填塞腮腺切除后的凹陷区，避免了常规术式后的面部畸形。结果 采用该术式对12例患者行腮腺切除术，所有手术均顺利完成，术后随访3－12个月，患者面部疤痕不明显，外形恢复良好，面神经损伤均完全恢复，且无1例出现Frey综合征。结论 改良的腮腺切除术克服了传统术式的缺陷，值得进一步、推广和普及。     

Metronidazole (Flagyl) and Arnica Montana in the prevention of post-surgical complications, a comparative placebo controlled clinical trial

A double blind trial, was designed, in which 118 patients undergoing the removal of impacted wisdom teeth were randomly divided into the following groups; 41 patients received Metronidazole, 39 patients received Arnica Montana, 38 patients received the placebo. Metronidazole was more effective in pain control than Arnica (p less than 0.001) and placebo (p less than 0.01). It prevented swelling better than Arnica (p less than 0.01) and placebo (p less than 0.05) and was more effective in promoting healing than Arnica (p less than 0.01) and placebo (p greater than 0.02). Arnica Montana appeared to give rise to greater pain than placebo (p less than 0.05) and caused more swelling than the placebo (p less than 0.01).     

两种腮腺手术切口的临床观察

目的 比较两种腮腺手术切口。方法 选取40例需行腮腺手术的患者。随机分成甲乙两组，甲组20例患者采用传统的“S”形手术切口，乙组20例患者采用改良的腮腺手术切口。结果 两组患者中，肿瘤大小及术后暂时性面瘫相比较，无统计学差异（P〉0．05），手术时间、术中出血量及术后面部瘢痕满意度相比较，存在明显统计学差异（P〈0．005）。结论 两种手术切口，均能充分暴露并完整切除腮腺及肿瘤，但改良的腮腺手术切口。术后患者有较满意的面部外形，提高了患者的生存质量，较传统手术切口有其优越性。     

美容切口在腮腺肿瘤外科中的应用

目的 评价腮腺美容切口在腮腺肿瘤切除术中应用的临床价值.方法 收集28例腮腺肿瘤患者,采用由面部除皱切口改良而来的腮腺美容切口入路,进行保留面神经和耳大神经的腮腺切除术,并联合颈清拐杖式切口手术入路,治疗腮腺恶性肿瘤.随访观察该切口的美观程度以及临床疗效.结果 所有患者均达临床Ⅰ期愈合,无涎瘘发生.1例患者术后出现暂时面瘫,2个月后恢复.所有患者术后均出现不同程度的耳垂麻木,除3例患者耳大神经损伤外,其余患者耳垂麻木于术后2个月恢复.患者对该切口的美观程度十分满意.结论 腮腺美容切口入路隐蔽,美容效果好,腮腺任何部位的肿瘤都可以采用此术式.     

肿瘤根治术后眶缺损畸形的整复

肿瘤术后眶的重建是一个复杂的工程。成功的眶重建对患者的生活方式和心理产生良好的影响。颅面外科、显微外科技术和生物材料等的发展，使得整复眶缺损畸形成为可能。手术内容包括：骨性眶的重建、眶内容的充填、结膜囊的成形和眼睑的再造等。作者仅就近年来有关肿瘤根治术后眶缺损畸形整复的进展作一综述。     

Comparison of postoperative complications and facial nerve recovery rates after conventional and partial superficial parotidectomy of benign parotid tumours: a prospective study

The aim of this study was to compare postoperative complications and facial nerve (FN) recovery rates between conventional superficial parotidectomy (CSP) and partial superficial parotidectomy (PSP) as surgical treatment for benign parotid tumours. A prospective study was conducted on 55 consecutive patients who underwent either CSP (n = 35) or PSP (n = 20) for benign parotid tumours. The primary outcomes were FN injury, FN recovery rates, and Frey syndrome. Secondary outcomes were operative time, hospital stay, sialocele, haematoma, and auricular numbness. The degree of FN injury was evaluated at 1 week, 1, 3, 6, and 12 months postoperative using the House–Brackmann grading system. Frey syndrome was assessed using a subjective clinical questionnaire and objective Minor starch–iodine test. No patient in either group experienced permanent FN paralysis. There was a significantly higher incidence of temporary FN weakness in the CSP group (P = 0.007). The respective FN recovery rates at 1, 3, 6, and 12 months were 60%, 88.6%, 94.3%, and 100% in the CSP group and 90%, 95%, 100%, and 100% in the PSP group. No significant difference was observed between the groups regarding the incidence of Frey syndrome, sialocele, and haematoma. The operative time and hospital stay were both shorter in the PSP group. Although the PSP is a more conservative procedure with significantly reduced FN injury, operative time, and hospital stay compared to CSP, the CSP procedure shows a comparable FN recovery rate to the PSP.     

Study on the occurrence of microorganisms on the post-surgical maxillary prostheses with obturators and in the post-surgical cavities of maxilla

The bacterial environment of the mouth cavity may be subjected to change under influence of various factors, such as surgical removal of neoplasm tumors and in consequence the wearing of post-surgical prostheses with obturators. The purpose of the paper was to study the conceivable differences in occurrence of particular types of microorganisms found on the margin of post-surgical cavities and on the prosthetic obturators. The performed microbiologic examinations revealed that more pathologic bacterial flora was found on the obturators than in the post-surgical cavities. The authors conclude that the post-surgical patients should pay more attention to the very accurate hygiene of their prostheses and the mouth cavity as well.     

V形切口在腮腺区肿物切除术中的应用

目的 探讨V形切口在腮腺区肿物切除术中的临床效果,评价其可行性及优越性.方法 回顾分析2008年5月至2011年1月在中山大学孙逸仙纪念医院口腔科就诊的32例腮腺肿物患者,采用V形切口切除肿物及部分或全部腺体,观察患者术后并发症.结果 采用V形切口切除腮腺肿物及部分或全部腺体的手术时间为0.5～1.5 h,术中出血约1...     

内镜辅助下腮腺切除术14例报道

目的：探讨内镜辅助下进行腮腺手术切除的临床效果。方法：对2004年10月-2006年9月就诊的15例腮腺肿物住院患者采用无注气内镜辅助下腮腺切除手术。通过耳垂后下方皮纹小切口，在颈深筋膜浅层，采用高频超声刀切割分离，远端借助监视器锐性分离，暴露腮腺浅叶。内镜下解剖面神经主干及分支，超声刀切除腮腺，伤口负压引流。结果：耳垂后下方切口长4．0—5．4cm，平均4．8cm。手术麻醉时间平均115min。腮腺浅叶切除3例，部分腮腺浅叶切除11例。术后病理诊断为多形性腺瘤8例，Warthin瘤4例，淋巴上皮病1例，淋巴结反应性增生1例。随诊6～31个月，平均14个月。面神经轻度麻痹5例，均在6个月内恢复正常。结论：内镜辅助下腮腺切除手术适用于腮腺浅叶良性肿瘤的切除，切口小且隐蔽，手术创伤小，有利于患者的恢复。