Long‐term management issues in restless legs syndrome

Restless legs syndrome is a neurologic movement and sleep disorder with lifelong symptoms causing considerable morbidity. Several short‐term and some long‐term open‐label and double‐blind clinical trials have demonstrated the efficacy and safety of dopaminergic treatment in restless legs syndrome. Long‐term treatment, however, is associated with the emergence of vexing long‐term side effects that pose a challenge for physicians. These long‐term complications can be broadly categorized as disease‐related (impact on sleep and acute exacerbation of restless legs syndrome symptoms), and medication issues (augmentation, sleep attacks, impulse control disorders, addiction and dependence, site reaction, occasionally sleep apnea, fibrotic complications, and weight gain). © 2011 Movement Disorder Society     

Review of high‐risk features of cutaneous squamous cell carcinoma and discrepancies between the American Joint Committee on Cancer and NCCN Clinical Practice Guidelines In Oncology

Cutaneous squamous cell carcinoma (SCC) is a malignancy that arises from epidermal keratinocytes. Although the majority of cutaneous SCC cases are easily treated without further complication, some behave more aggressively and carry a poor prognosis. These “high‐risk” cutaneous SCCs commonly originate in the head and neck and have an increased tendency toward recurrence, local invasion, and distant metastasis. Factors for high‐risk cutaneous SCC include large size (>2 cm), a deeply invasive lesion (>2 mm), incomplete excision, high‐grade/desmoplastic lesions, perineural invasion (PNI), lymphovascular invasion, immunosuppression, and high‐risk anatomic locations. Both the National Comprehensive Cancer Network^® (NCCN^®) and the American Joint Committee on Cancer (AJCC) identify several of these high‐risk features of cutaneous SCC. The purpose of this article was to review the high‐risk features included in these guidelines, as well as their notable discrepancies and omissions. We also provide a brief overview of current prophylactic measures, surgical options, and adjuvant therapies for high‐risk cutaneous SCC. © 2016 Wiley Periodicals, Inc. Head Neck 39: 578–594, 2017     

Tooth‐to‐Implant Connection: A Systematic Review of the Literature and a Case Report Utilizing a New Connection Design

Background: In the treatment of partially edentulous patients, implants have often been connected to natural teeth. Numerous studies have reported significant complications and problems, while others have demonstrated favorable outcomes. Purpose: The purpose of this article was to systematically review the literature regarding the splinting of implants and teeth. The difference in the biomechanical behavior between osseointegrated implants and teeth and the efficacy of the different modes of connection that have been employed are explored. Materials and Methods: A MEDLINE search between 1966 and October 2006 was performed to retrieve relevant articles. A further manual search from the bibliographies of the former articles was performed to include as many references as possible. Prospective and retrospective clinical studies, as well as laboratory and computer‐generated research, were included. Results: A pronounced difference in the biomechanics of teeth and implants has been revealed in theoretical models. This disparity has also been supported by the majority of the experimental work published. As a result, principal complications, such as intrusion of teeth and higher risk of overload and greater marginal bone loss around the implants have been reported. Among the several types of connections utilized, the rigid connection showed fewer complications but unfortunately did not eliminate them. Conclusion: Totally implant‐supported prostheses should be the treatment of choice. However, there are cases where combining teeth and implants is inevitable. The authors propose a rationale design of connecting implants and teeth. This design minimizes the biologic and technical complications.     

Combination Lower Lip Prosthesis Retained by an Intraoral Component

Patients who have had a partial or full surgical resection of the maxillary or mandibular lip experience difficulties with articulation of speech, swallowing, and salivary control. This is further complicated by significant alterations in facial esthetics and lowered self‐esteem. This clinical treatment will describe the fabrication of a two‐piece tooth‐retained maxillofacial prosthesis. An intraoral retentive portion and an extraoral section restoring lip anatomy were attached by retentive elements. This prosthesis restored the patient's esthetics, oral function, and self‐esteem.