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1.

Objectives

The purpose of this study was to evaluate the prevalence of anatomical variations of the nasal cavity and ethmoid complex on cone-beam computed tomography (CBCT) images.

Methods

The CBCT images of 322 patients were evaluated retrospectively. The anatomical variations of the bilateral nasal cavity and ethmoidal complex were evaluated in four categories, namely nasal septum, turbinates, ethmoid air cells, and crista galli.

Results

The patients comprised 134 males (41.6 %) and 188 females (58.4 %), with an age range of 18–83 years. One or more nasal septum variations were observed in 76.7 % of patients, while variations in the turbinate and ethmoid cell categories were present in 89.4 and 62.1 % of patients, respectively. Overall, 5 % of patients showed pneumatized crista galli.

Conclusions

The detailed radiographic examination of the nasal cavity and ethmoid complex is possible and successful on the CBCT images.
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2.

Purpose

We report the results of the intralesional steroid injections for the management of central giant cell granuloma (CGCG) of the jaws.

Methods

Seven CGCGs were treated with intralesional injection of corticosteroids. To accomplish this, 3.5 mL of triamcinolone and 3.5 mL of 0.5 % marcaine with 1/200,000 epinephrine (total 7 mL) were mixed. An adequate amount of steroid was injected into different areas of the lesion. This procedure was repeated on a weekly basis for 6 weeks.

Results

Clinical and radiological examination showed complete resolution and ossification of the lesions in four patients. Partial recovery was achieved in two patients. One patient did not respond to the treatment and underwent surgical curettage.

Conclusions

We suggest that intralesional steroid injection is safe and effective for the treatment of CGCG, especially in non-aggressive lesions.
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3.

Purpose

To test the hypothesis that there is no immediate and long-term effects of maxillary distraction osteogenesis (DO) on nasal index among adult subjects with cleft lip and palate deformities.

Materials and Methods

Twelve adult subjects in the age range of 17–20 years with complete unilateral cleft lip and palate underwent advancement of maxilla by DO. The immediate and long-term effects of maxillary DO on nasal index were evaluated from extra-oral full face frontal photographs recorded prior to DO (T0), at the end of active DO (T1) and at least 2-years after the DO (T2). The ANOVA, Post Hoc test (Bonferroni) and Pearson correlation coefficients were used. The probability value (P value) 0.05 was considered as statistically significant.

Results

SNM angle and Ptm-M distance increased significantly by DO (P < 0.001). The nasal index increased significantly (P < 0.01) by 13.85 % from T0 value of 85.15 ± 4.49 to 99.02 ± 11.16 % at the end of active distraction (T1) and by 12.69 to 97.84 ± 9.14 % at the end of long-term follow-up (T2). The correlation between sagittal maxillary advancement and nasal index was statistically significant (P < 0.001). For each millimeter of maxillary advancement, the nasal index increased by 1.38 % and 1.8 % at the end of active distraction and long-term follow-up respectively.

Conclusion

The advancement of maxilla by distraction osteogenesis among subjects with cleft lip and palate deformities increased nasal index significantly.
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4.

Objective

We analyzed patients with advanced parotid malignancy requiring proximal facial nerve exposure undergoing mastoidectomy versus lateral temporal bone resection to determine differences in local and distant recurrence.

Study design

The study design is a case series with chart review.

Setting

The setting is in Tertiary care practice in Fort Worth, Texas from January1998 to January 2014.

Subjects and methods

The study included 120 patients with advanced parotid malignancy, 82 males between 19 and 87 years, and 38 females between 26 and 83 years. Patients with no overt bone involvement were treated with parotidectomy and mastoidectomy for exposure of the proximal facial nerve, and patients with clinically suspected (radiographic imaging or clinical fixation) bone involvement were treated with parotidectomy and lateral temporal bone resection. Follow up ranged from a minimum of 18 months to 11 years following surgery.

Results

Sixty patients were treated with mastoidectomy and 60 were treated with lateral temporal bone resection. In patients treated with mastoidectomy, 13 had local recurrence and 7 had distal recurrence. In patients treated with lateral temporal bone resection, 2 had local recurrence while 9 had distant recurrence. Statistical analysis revealed that patients treated with mastoidectomy developed local recurrence (p = 0.0022) more commonly than those treated with lateral temporal bone resection. There was no significant difference in distant recurrence between both groups (p = 0.5949).

Conclusions

Patients with advanced parotid malignancy should be treated aggressively with parotidectomy and lateral temporal bone resection regardless of bone involvement due to increased risk of local recurrence in those treated with mastoidectomy alone.

Level of evidence

Level of evidence is a 4 case series.
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5.

Objective

Dermoid and epidermoid cysts are rare cysts of the head and neck region, which should be considered in differential diagnosis of sublingual mass, constituting 0.01 % of all oral cavity cysts. There are suspected theories regarding the basis of the pathology.

Case Report

30-year-old male referred to our clinic with a chief complaint of sublingual mass which had been present for many years but the lesion enlarged over the past 3 years. MRI examination revealed a giant cystic mass which was 3.6 × 3.9 mm in diameter and medially located at sublingual region.

Treatment and Prognosis

Intraoral approach was preferred for surgery and no recurrence or complaints were detected during follow-up period.

Conclusion

When a cystic mass is detected on the floor of oral cavity, we must consider dermoid cysts for differential diagnosis. Surgery is the only treatment. If possible, intraoral approach should be preferred because of its perfect cosmetic results.
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6.

Background

We present a case report of a professional diver who sustained a fracture of the left orbital medial wall as well as floor exceeding 50% with orbital fat herniation blocking the maxillary sinus ostium. This may result in a closed cavity within the maxillary sinus that could potentially result in barotraumas during future diving. The aim of his surgery consists of repairing the orbital fracture and to aerating the sinus at the same sitting.

Method

A transconjunctival approach was used combined with endoscopic sinus surgery approach to the maxillary sinus. The orbital floor fracture was repaired with a titanium plate. A wide middle meatal antrostomy was performed. A size eight Foley’s catheter was inserted into the maxillary sinus and the balloon inflated to elevate and support the displaced inferior orbital floor bone fragment. The balloon was left in situ for 4 weeks to support the mobile inferior orbital fragment till adequate bone healing and stability.

Results

Patient recovered well. At 3 months post-operatively, the maxillary antrostomy remained patent, and a hyperbaric oxygen challenge test was performed with success. A repeat orbital CT scan 1 day after hyperbaric challenge showed no signs of air leakage, and the bony inferior orbital floor fracture has healed completely with the titanium plate in situ.

Conclusion

This is the first case report of repair of orbital floor fracture with simultaneous aeration of the maxillary sinus in a professional diver using a combined approach. The patient was able to resume his occupation as a professional diver following surgery.
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7.

Background

Certain preoperative anatomical features may lead the surgeon to choose one particular incision pattern in preference to another. No one technique of cleft lip repair consistently produces ideal aesthetic and functional results.

Objectives

This study was conducted to compare the outcomes attained using two different designs of skin incision used for surgical correction of unilateral cleft lip.

Materials and Methods

Modified Millard’s incision and Delaire’s functional method techniques were performed and evaluated on 18 patients who received primary unilateral cleft lip repair. Soft-tissue measurements of the lip and nose were recorded preoperatively. Analysis was based on postoperative assessment of the white roll, vermilion border, scar, Cupid’s bow, lip length, and nostril symmetry and appearance of the alar dome and base. Chi-square and Fisher exact test, Student t test (two tailed, independent) and Student t test (two tailed, dependent) were used for statistical analysis of study parameters at 5 % level of significance.

Results

Preconceptions that one particular technique was better suited to certain preoperative cleft anatomical forms were not proven statistically. The outcome of our surgical methods was good and suggested quantitative changes with progressive diminution of asymmetry of the cleft and non cleft sides.

Conclusion

Lip length improvement was better in case of modified Millard’s incision. The Delaire’s functional method of cleft lip repair results in improved nasal symmetry due to correction of the abnormal insertions of the underlying musculature.
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8.

Objectives

The aims of this study were to determine the quality of life of periodontally compromised patients after implant treatment (primary aim) and their satisfaction with the restoration and treatment approach (secondary aim).

Material and methods

In this study, 61 adult subjects were evaluated following non-surgical periodontal treatment, under regular maintenance and implant therapy with a fixed restoration. Oral health-related quality of life (OHQoL) was assessed using the German short form of the Oral Health Impact Profile (OHIP-G14). Patient satisfaction with the restoration and treatment procedure was investigated applying a self-designed questionnaire focusing on social-psychological aspects. Statistical analysis of the collected data was performed using Kruskal-Wallis and Man-Whitney U test for the relationship between OHIP score and number of implants, patient age and level of education.

Results

The average OHIP-G14 score of the examined study population was 2.78 (SD ±4.2), while the item pain had the biggest influence on the number of points. No statistical significance was detected between the relationship of OHIP-G14 score and the number of placed implants (p = 0.98). Furthermore, there was no statistically significant correlation between OHIP-G14 score and patient age (p = 0.67) or for level of education (p = 0.39). The questionnaire focusing on patient satisfaction showed a high level of contentment in this study population. All patients declared that they would repeat the treatment and most (98.4 %) would recommend it to their friends. Furthermore, a high level of satisfaction with aesthetics, stability, cleanability and speech comprehension was reported.

Conclusion

The examined study population showed a quality of life after implant therapy comparable to pre-existing reference values of a healthy non-restored population. There was no statistical significance between OHIP-G 14 score and the number of implants, patients’ age and education level. Analysis of the satisfaction with the realized implant therapy provided consistently positive results.

Clinical relevance

When restoring periodontally compromised patients, implant treatment should be considered to achieve potentially higher oral health-related quality of life compared to for example removable dentures. This needs to be investigated in randomized controlled clinical trials.
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9.

Purpose

The main aim of our study was to assess and evaluate the efficacy, long standing outcome and infection of porous polyethylene implants in treatment of orbital floor fractures.

Patient and methods

Twelve patients with fractures of orbital floor were included in the study. The cause of fracture was road traffic accident, self fall and cow hit respectively. They also complained of enophthalmos (n = 9), diplopia (n = 3), restricted eye movement (n = 2), impairment of infraorbital nerve (n = 3) and dystopia (n = 6). All the fractures were reconstructed with thin porous polyethylene sheets.

Results

No implants were extruded and there were no signs of inflammatory reactions against porous polyethylene implant. In all nine patients with pre-op enophthalmos it was corrected post-operatively with p value = 0.000 and was statistically significant; diplopia in one patient was corrected; persistence of double vision was noted in two patients. Restricted eye movement was corrected in all patients, dystopia was corrected in four patients and in two patients have persisting dystopia. Paresthesia persisted in all three patients.

Conclusion

Our experience was that reconstruction of orbital floor fracture using porous polyethylene implant is reliable, safe and effective and may be used for reconstruction of the orbital floor fracture with no donor site morbidity.
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10.

Purpose

Bulimia is a common cause of sialadenosis. This paper presents a case of bilateral parotid sialadenosis associated with long-standing bulimia, and reviews the relevant literature and current treatment options.

Methods and Results

A 32-year-old woman had severe bilateral parotid sialomegaly for the last 6 years, which had occurred secondary to bulimia nervosa, which she had since 14 years. Treatment with pilocarpine was unsuccessful, so she underwent bilateral conservative parotidectomy. This procedure not only improved the aesthetic appearance of the patient but also improved her social and work life and overall quality of life.

Conclusions

Sialomegaly secondary to bulimia results in a major alteration of the aesthetics of a patient’s face. Conservative measures are not enough in many cases, and parotidectomy may be the only viable option, as it can also significantly improve adherence to psychiatric treatment for bulimia, in addition to correcting the facial aesthetics.
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11.

Purpose

Whistle deformities are frequent sequelae after surgical correction of cleft lip, trauma, or tumor excision. The aim of this study was to examine the role of autologous free fat grafting in the reconstruction of whistle deformity.

Patients

Fifteen patients with whistle deformity were enrolled in this pilot study. The mean follow-up period was 19 months. Liposuction was done followed by the replantation of an average of 2.2 ml autologous fat per patient (range 0.7–4 ml). An overcorrection was performed in all patients.

Results

All the patients showed improvements in whistle deformity. The mean resorption rate was 53% (range 30–80%). Three patients (20%) were not satisfied with the postoperative result. Six complications were assessed (4× feeling of pressure [27%], one hematoma [7%], one recurrent pain [7%]), but a major complication did not occur.

Review

We also present a review of the literature with different techniques that were described in the last 20 years.

Conclusion

Autologous free fat graftings for reconstruction of whistle deformity represent a reliable method with a low complication rate. However, the resorption rate is unpredictable. If necessary, several autologous fat transplantations should be conducted at an interval of at least 6 months.
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12.

Objectives

Asymmetries of the jaw and orthodontic abnormalities are suspected as long-term consequences of positional cranial deformity. But only few data exist on this issue. As plagiocephaly is a common problem in infancy, potential functional impairments should be investigated to initiate appropriate measures if necessary. The aim of our study was to compare the orthodontic situation in primary dentition of children with positional plagiocephaly and children without cranial deformities.

Material and methods

Fifty children treated by helmet therapy for plagiocephaly and 50 non-affected children (age 1.98–5.69 years) were examined in a cross-sectional study. Orthodontic parameters of all dimensions were assessed and analyzed.

Results

Children of the plagiocephalic group showed more often orthodontic alterations compared to the others. Especially the frequencies of a class II malocclusion (36 vs. 14 %), an edge-to edge bite (28 vs. 12 %), and deviations of the midline (38 vs. 16 %) were conspicuous. However, none of the differences was significant (p > 0.003). Of all observed mandibular asymmetries, 69 % appeared as a shift to the contralateral side of the former flattened occipital region.

Conclusion

Positional head deformity might be associated in some cases with a higher prevalence of occlusal abnormalities in primary dentition.

Clinical relevance

Positional plagiocephaly interfaces medicine and dentistry. As it is a common disorder, this etiology has to be considered in the prevention and therapy of malocclusion.
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13.

Objective

With respect to the unknown aetiology of molar incisor hypomineralisation (MIH), it is unclear whether this phenomenon was overlooked in the last century as a result of a high number of caries in children or if this developmental disorder was not present until then. Therefore, this study determined the presence of MIH in historical dentitions and teeth.

Materials and methods

Dental remains from late medieval (n = 191, twelfth–sixteenth century, Regensburg, Germany), post-medieval (n = 33, sixteenth–eighteenth century, Passau, Germany) and modern age archaeological skeletal series (n = 99, nineteenth–twentieth century, Altdorf, Germany) were examined for MIH. In addition, linear enamel hypoplasia (LEH), diffuse opacities, hypoplasia and Turner’s teeth were documented.

Results

MIH-related demarcated opacities or enamel breakdowns were found in only 15 (0.4 %) of the 3891 examined permanent teeth. Ten cases (3.1 %) from a total of 323 dentitions were classified as having MIH. In contrast, 98 individuals (30.3 %) showed LEH. Other enamel disorders were recorded in 64 individuals (19.8 %).

Conclusion

With respect to the low number of affected dentitions and teeth, MIH most likely did not exist or was at least rarely present in the investigated archaeological case series.

Clinical relevance

This study supports the hypothesis that MIH may be linked to contemporary living conditions or other health-related factors.
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14.

Purpose

To determine the quantity of dexamethasone plasma concentration achieved following intrapterygomandibular space injection of dexamethasone when co-administered with inferior alveolar nerve block correlating with the clinical effects in the postoperative phase.

Objective

A preliminary prospective study to evaluate the dexamethasone plasma concentration achieved following intrapterygomandibular space injection of dexamethasone with 2% lignocaine inferior alveolar nerve block to achieve hemi-mandibular anesthesia for minor oral surgical procedures and derive clinical correlations.

Background

Dexamethasone is a glucocorticoid, chiefly used for the management of postsurgical sequelae like trismus and swelling in maxillofacial surgical practice. Conventionally, parenteral dexamethasone is administered via intravenous or intramuscular route. Intrapterygomandibular space injection is a novel route of steroid delivery described in literature. For minor oral surgical procedures in maxillofacial surgical practice requiring inferior alveolar nerve block, dexamethasone can be administered along with local anesthetic through a single injection as a mixture (twin mix).

Methods

Prospective double-blind randomized clinical trial was designed to evaluative plasma concentration of dexamethasone achieved following injection of a freshly prepared mixture of 1.8 ml of 2% lignocaine with adrenaline (1:200000) and 1 ml (4 mg) dexamethasone [2.8 ml solution of twin mix] in the pterygomandibular space. The 30 candidates included for the trial were randomly split into three study groups (ten each)—(1) control group (C); (2) intramuscular group (IM); (3) intraspace group (IS).

Results

The mean plasma dexamethasone concentration at 30 min postinjection in group IM was 226.41?±?48.67 ng/ml and for IS group it was 209.67?±?88.13 ng/ml. Post hoc (Bonferroni-Holm test) intergroup comparison for plasma dexamethasone concentration (IM and IS) was found statistically insignificant (P?=?0.605).

Conclusion

Intraspace route of drug administration can be utilized to deliver dexamethasonized local anesthetics safely with predictable clinical effects in the patients requiring mandibular minor oral surgery under local anesthesia.
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15.

Objective

Micro-neurosurgical repair is considered in permanent nerve damage but the outcome is unpredictable. We examined if histopathologic parameters of traumatic neuromas have a prognostic value for recovery in relation to lingual nerve micro-neurosurgery.

Materials and methods

Retrospective case study on neurosensory recovery after micro-neurosurgery. Outcome variables were as follows: pain perception, two-point discrimination, and sum score of perception, before and 12 months after micro-neurosurgery. Predictive histopathology variables included size, nerve tissue, and inflammation. Statistics are as follows: logistic and correlation analyses (P < 0.05).

Results

Sixty-five patients with lingual nerve damage were included in the study. Improved two-point discrimination was associated with small size of resected tissue (P = 0.0275). No normal appearing distal nerve tissue was associated with improved sum score of perception (P = 0.0185), higher final sum score of perception value (P = 0.0475) and final pain perception (P = 0.0324). Foreign body reaction was associated with no final pain perception (P = 0.0492).

Conclusions

Small size, absence of distal nerve tissue, and no foreign body reaction were associated with improvement of the neurosensory functions.

Clinical relevance

Histological parameters of the traumatic neuromas in routine preparation appeared to have some prognostic value for neurosensory functions as improvement of the neurosensory functions was associated with small size of resected tissue, no distal normal appearing nerve tissue, and no foreign body reaction.
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16.

Objectives

This study reports the radiographic analysis of a split-mouth, single-blinded, randomised controlled clinical trial which was designed to compare the efficacy of simplified papilla preservation flap (SPPF) with or without guided tissue regeneration (GTR) in patients with aggressive periodontitis (AgP).

Methods

Eighteen AgP patients who had similar bilateral intrabony defects were treated. In all patients, the defects presented with radiographic evidence of an intrabony defect ≥3 and ≥5 mm of periodontal pocket depths (PPD). The surgical procedures included access for root instrumentation using SPPF alone (control) or, after debridement, a placement of resorbable GTR membrane (test). The standardised radiographic assessments were carried out at pre-surgical baseline and at 6 and 12 month post-surgery. Radiographic linear measurements and subtraction radiography were used as the method of analysis.

Results

Both treatments showed significant improvements in linear radiographic bone fill and defect resolution at 6 and 12 months, compared to baseline. The 12-month subtraction radiography at the GTR sites showed a significant improvement compared to the 6-month outcomes.

Conclusions

Both therapies were effective in the treatment of intrabony defects in AgP patients although no significant differences between them could be demonstrated. The finding that the bone fill and resolution of the defect at the GTR sites were significantly higher at 12 months than at 6 months after treatment indicates that bone regeneration is still an ongoing process at 6 months post-surgery.

Clinical relevance

Radiographic assessment of periodontal regeneration should be carried out at 12 months post-surgery in order to evaluate the complete healing of the bony defect.
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17.

Aims

The aim of this study was to evaluate cephalometrically the stability of hard tissues and soft tissue changes of advancement genioplasty 2 years after surgery.

Methods

A prospective study was conducted which comprised of 25 patients, who underwent advancement genioplasty alone with no other orthognathic surgical procedures. Immediate pre-operative, 6 months postoperative, and 2 years postoperative lateral cephalograms were compiled and assessed.

Results

The mean surgical advancement planned was around 8 mm. Six months post-surgery, the relapse rate was 15% of the surgical advancement which was considerably reduced in the following 18 months to 7%. The ratio of soft tissue to bony advancement at pogonion was 0.9:1. There are significant alterations in the soft tissue profile in terms of decrease in the soft tissue thickness, facial convexity angle, deepened mentolabial sulcus and minimal increase in the lower lip height.

Conclusion

Advancement genioplasty was considered as a relatively stable procedure, if adequate muscular pedicle and internal rigid fixation were maintained. The present study was of 2 years, and we can expect further changes in the hard and soft tissues, which are clinically irrelevant.
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18.

Purpose

There is no consensus on how to successfully treat medication-related osteonecrosis of the jaws (MRONJ). We report here on the application of piezoelectric bone surgery to treat MRONJ in combination with antibiotherapy and on its possible benefit.

Materiel and methods

A cohort of 18 consecutive patients has been treated for MRONJ; they involved 20 sites, 15 in the mandible, and five in the maxilla. Surgical removal of the necrotic areas and debridement was performed with a powerful piezoelectric surgery device (max 90 W) in combination with antibiotherapy.

Results

All patients healed and obtained a complete soft tissue closure within 1 month. No recurrence of the symptoms was observed during the present follow-up (10–54 months).

Conclusion

We hypothesize that healing of all treated sites might have resulted from the synergic effect of bone ablation, biofilm alteration, and antibiotic administration. Biofilm alteration might have permitted a better access of antibiotics to the involved germs. These encouraging results warrant further studies on the use of ultrasonic surgery to treat MRONJ patients in order to confirm or refute the hypothesized effect.
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19.

Objectives

To compare the fit of all-ceramic crowns fabricated from conventional silicone impressions with the fit of all-ceramic crowns fabricated from intraoral digital impressions.

Methods

Thirty patients with 30 posterior teeth with a prosthetic demand were selected. Zirconia-based ceramic crowns were made using an intraoral digital impression system (Ultrafast Optical Sectioning technology) (digital group, D) and 2-step silicone impression technique (conventional group, C).To replicate the interface between the crown and the preparation, each crown was cemented on its corresponding clinical preparation using ultra-flow silicone. Each crown was embedded in resin to stabilize the registered interface. Specimens were sectioned in buccolingual orientation, and internal misfit was measured at different areas using stereomicroscopy (×40).Data was analysed using Student’s t test and Mann-Whitney test (α = 0.05).

Results

No statistically significant differences were found (P > 0.05) between two groups. The mean internal misfit and mean marginal misfit were 170.9 μm (SD = 119.4)/106.6 μm (SD = 69.6) for group D and 185.4 μm (SD = 112.1)/119.9 μm (SD = 59.9) for group C.

Conclusion

Ceramic crowns fabricated using an intraoral scanner are comparable to elastomer conventional impressions in terms of their marginal and internal fits. The mean marginal fit in both groups was within the limits of clinical acceptability.

Clinical significance

Impressions based on Ultrafast Optical Sectioning technology can be used for manufacturing ceramic crowns in a normal workflow, with the same results as silicone conventional impressions.
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20.

Purpose

The treatment of lip carcinomas needs tumor surgical resection with safety margins respect. The aim of this study was to report the oncologic and aesthetic/functional outcomes of a retrospective monocentric case series of 39 patients treated for cutaneous lip cancer.

Methods

This retrospective study assessed 56 patients who were treated for a lip carcinoma between 2008 and 2012 and included 39 patients with cutaneous lip basal cell carcinoma or squamous cell carcinoma. Clinical, surgical and pathological data were reviewed, and patients were interviewed for follow-up data. A comparison was made between the marked surgical margins and the margins observed under microscopy after histologic process.

Results

The most frequent tumor type was basal cell carcinoma in 69.2 %. The measured surgical margins were superior to the histological margins in 24 cases (61.5 %) and were inferior in 13 cases (33.3 %). Overall survival and recurrence-free survival rates at 1 year were 97.5 and 95 % respectively.

Conclusion

Differences between the surgical margins and the final histologic margins were the main finding of this retrospective study. These differences were attributed to surgical practices and modification during the histological process. Nevertheless, we did not observe a higher rate of recurrence or death in our study than in literature.
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