Rol del protesista en el equipo multidisciplinario para el manejo del paciente con cáncer de cabeza y cuello

La denominación de carcinomas de cabeza y cuello o tracto aerodigestivo superior, supone un agrupamiento de neoplasias que comparten elementos comunes como etiología, epidemiología, histología, evolución clínica, procedimientos diagnósticos, enfoques terapéuticos y medidas de seguimiento. El objetivo del presente trabajo es identificar la evidencia científica respecto al tratamiento multidisciplinario del paciente con cáncer de cabeza y cuello y el rol que desempeña el protesista. Para ello, se realizó una búsqueda de literatura disponible en las bases de datos electrónicas PubMed, Medline, Cochrane, Hinari y SciELO. Se encontró que el tratamiento de estas lesiones malignas requiere de un equipo conformado por diferentes especialistas, como otorrinolaringólogo, cirujano de cabeza y cuello, cirujano maxilofacial, odontólogo oncológico, protesista, psiquiatra y psicólogo, nutricionista y rehabilitador, para optimizar el tratamiento de estos pacientes mediante la decisión colectiva.

The designation of carcinomas of head and neck or high aero-digestive tract, supposes a grouping of neoplasia that share common elements like etiology, epidemiology, histology, clinical evolution, diagnostic procedures, therapeutic approaches and follow-up measures. The aim of this paper is to identify the scientific evidence regarding the multidisciplinary treatment of the patient with cancer of head and neck and the role played by the prosthodontist. To this end a literature search was conducted in the electronic databases PubMed, Medline, Cochrane, Hinari and SciELO. It was found that the treatment of these malignant lesions requires a team consisting of different specialists, such as otolaryngologist, head and neck surgeon, maxillofacial surgeon, oncologic dentist, prosthodontist, psychiatrist and psychologist, nutritionist and rehabilitator, to optimize the treatment of these patients through a collective decision.

Progress in application of propeller flap in reconstruction of soft tissue defect of oral and maxillofacial-head and neck / 中华显微外科杂志

Oral and maxillofacial-head and neck soft tissue defects affect the appearance of patients, as well as pronunciation, swallowing and other functions. Introduction of the propeller flap in 1991 has improved reconstruction procedures for oral and maxillofacial-head and neck soft tissue defects. A propeller flap has several advantages over traditional local flaps. It improves mobility, colour and texture matching for maxillofacial defect, surgical procedure, and individual satisfaction. Therefore, it can be used as a complement to the traditional flap by providing surgeons with more options. This paper reviews the classification, surgical procedures, and recent clinical applicatiosn and indications of the propeller flap.

Pediatric oral maxillofacial management and artificial intelligence / 临床耳鼻咽喉头颈外科杂志

With the enhancement of aesthetic awareness of children's oral maxillofacial development, multi-disciplinary doctors pay attention to children's oral maxillofacial management. Artificial intelligence (AI) technology has been gradually applied to all fields of children's oral maxillofacial management because of its outstanding advantages in medical screening and auxiliary decision-making. This article reviews the application of AI technology in the screening, diagnosis, treatment and follow-up of oral maxillofacial management in children.

Paired logistic regression analysis of influencing factors for vascular crisis after repair of oral and maxillofacial tumors with free tissue flaps / 口腔疾病防治

Objective @#To investigate the influencing factors of vascular crisis after oral and maxillofacial tumor free tissue flap transplantation. @*Methods @# A retrospective analysis was performed on all patients who underwent free tissue flap transplantation and developed vascular crisis in the surgical ward of head and neck cancer in a grade A specialized hospital. Forty-six possible influencing factors were collected using 1:1 matching according to surgeons, operation time, sex and age of patients from patients without vascular crisis from 2015-2020 in this ward during the same period. SPSS 26.0 statistical software was used for univariate and multivariate logistic regression analyses of the data.@*Results @#A total of 158 patients were enrolled, including 79 in the crisis group and 79 in the pairing group. Univariate analysis was performed for each variable. Paired logistic regression analysis showed that only postoperative blood potassium (P = 0.048, OR = 3.118, 95% CI: 1.008-9.641) and preoperative and postoperative red blood cell count differences (P = 0.004, OR = 4.53, 95% CI: 1.609-12.750) were statistically significant.@*Conclusion @#High blood potassium levels and red blood cell count differences before and after surgery were risk factors for vascular crisis.

Características clínicas y evolutivas de pacientes rehabilitados con prótesis oculares / Clinical and evolutive characteristics of patients rehabilitated with ocular prosthesis

Introducción: La prótesis ocular es un medio artificial con fines funcional y estético, que posibilita la rehabilitación física, psíquica y social de pacientes con defectos en los ojos. Objetivo: Describir la evolución de los pacientes con prótesis ocular según signos de infección en las cavidades oculares rehabilitadas, factores de riesgos asociados, así como modificaciones en la forma de la cavidad y/o en la prótesis ocular. Métodos: Se realizó un estudio observacional, longitudinal y prospectivo de 74 pacientes aquejados por defectos oculares, que recibieron tratamiento protésico en el período de 2018 a 2019 en la Clínica de Rehabilitación Bucomaxilofacial de Santiago de Cuba, los cuales fueron evaluados a través de una encuesta y un examen clínico en tres momentos durante un año de evolución. Para establecer la asociación entre variables, se emplearon la prueba de la Χ2 de Pearson y la exacta de Fisher de acuerdo con el cumplimiento de supuestos. Resultados: De los 222 exámenes efectuados a las cavidades oculares rehabilitadas, 31 revelaron la presencia de secreciones en 23 pacientes, con recurrencia en 8 de ellos; dicho signo clínico se manifestó de manera similar a la hipercoloración de la conjuntiva en cuanto al momento del hallazgo y al grupo etario afectado, con mayores porcentajes al año de evolución y una incidencia superior en los pacientes de 60 y más años de edad. Asimismo, se constató una asociación estadísticamente significativa de las variables higiene diaria de la cavidad y de la prótesis con la existencia de secreciones, para un intervalo de confianza de 95 %. Conclusiones: Se demostró la ventaja del aseo semanal de la cavidad ocular y de la prótesis en sus portadores, pues con ello se disminuye la frecuencia de los signos inflamatorios e infecciosos de la mucosa, lo que debe observarse con mayor rigurosidad en los ancianos, quienes resultan ser los más afectados.

Introduction: Ocular prosthesis is an artificial means with functional and cosmetic ends that facilitates the physical, psychic and social rehabilitation of patients with eyes defects. Objective: To describe the evolution of patients with ocular prosthesis according to infection signs in the rehabilitated ocular cavities, associated risk factors, as well as modifications in the form of the cavity and/or in the ocular prosthesis Methods: An observational, longitudinal and prospective study of 74 patients suffering from eye defects that received prosthetist treatment from 2018 to 2019 in the oral maxillofacial Rehabilitation Clinic was carried out in Santiago de Cuba, who were evaluated through a survey and a clinical exam in three moments during a year of evolution. To establish the association between variables, the Pearson chi-square and Fisher exact tests were used with the fulfillment of suppositions. Results: Of the 222 exams made to the rehabilitated ocular cavities, 31 revealed the presence of secretions in 23 patients, with recurrence in 8 of them; this clinical sign became evident in a similar way to the hypercoloring of the conjunctiva as for the moment of the finding and the age group affected, with higher percentages at the year of evolution and a higher incidence in the patients of 60 years and over. Also, an association statistically significant of the daily hygiene of the cavity and prosthesis variables with the existence of secretions was verified, for a confidence interval of 95 %. Conclusions: The advantage of the ocular cavity and prosthesis weekly personal cleanliness was demonstrated, because with it the frequency of the inflammatory and infectious signs of the mucous is reduced, what should be strictly observed in elderly, who are the most affected.

55 cases of perioperative mortality in oral maxillofacial head and neck cancer patients: a retrospective analysis / 口腔疾病防治

Objective@#To analyze the characteristics of perioperative mortality (POM) in oral maxillofacial head and neck cancer patients.@*Methods@#A retrospective study was adapted for head and neck cancer patients who were treated and had POM in the department of oral maxillofacial & head and neck oncology in Shanghai Ninth People′s Hospital from Jan 1999 to Dec 2019. Demographic information, disease characteristic and clinical records were collected. The factors of POM were classified into surgical complication, medical complication, mixed complication (surgical and medical) and personal complication. SPSS 17.0 software was used to analyze the cause composition for POM under different condition.@*Results @# 55 patients were included: 39 were male, and 16 were female. A total of 12 patients had a smoking history. Furthermore, 28 patients had general comorbidities. 20 underwent preoperative radiotherapy and 9 received preoperative chemotherapy. Squamous cell carcinoma was the most frequent pathological diagnosis in 37 patients. A total of 9 patients had tumors in the maxilla and skull base. In addtition, 4 patients had POM preoperatively, 1 patient had POM within the operation, and 50 patients had POM postoperatively. The leading causes of death were as follows: rupture of the carotid artery was the most frequent (8), and the surgical complication of pulmonary infection was the main medical complication (6). Pulmonary infection and hemorrhage were regarded as the main mixed complication (4). Two patients had POM due to personal complications. The higher the American Society of Anesthesiologists (ASA) score, the higher the proportion of medical factors in POM (P=0.039).@*Conclusion@#The composition of POM in oral maxillofacial- head and neck cancer (OMHNC) patients was complicated. Carotid artery rupture was the most common and fatal surgical complication, especially for those who underwent preoperative radiotherapy. Pulmonary infection was the most frequent medical complication, and those who had a higher ASA grade tended to have more complication.

Estudo epidemiológico de pacientes portadores de infecção do complexo bucomaxilofacial tratados no Hospital Universitário de Maringá: estudo retrospectivo ao longo de 8 anos / Epidemiological study of patients with oral maxillofacial infection treated at Universitary Hospital of Maringá: retrospective study about 8 years

Infecções agudas bucomaxilofaciais podem ser condições clínicas graves e de ocorrência comum, caracterizadas pela disseminação do processo infeccioso a tecidos adjacentes e espaços faciais da região de cabeça e pescoço, podendo resultar em várias complicações, até mesmo em óbito, embora seja raro. Objetivo: realizar uma análise epidemiológica de infecções maxilofaciais, relacionando os dados ao tratamento instituído e à sua efetividade, bem como analisar dados referentes a idade, sexo, principais dentes envolvidos e tempo total de internação. Sujeito e método: foram analisados retrospectivamente 240 prontuários de pacientes admitidos no Hospital Universitário de Maringá com infecção odontogênica, atendidos pela equipe de Cirurgia e Traumatologia Bucomaxilofacial no período de janeiro de 2009 a janeiro de 2017. Resultados: a média de idade dos pacientes foi de 38 anos, com 57 mulheres e 54 homens. A média de temperatura de admissão foi 38,5°C. A região mais acometida foi o ramo posterior da mandíbula, tendo uma média de duração de infecção e hospitalização de 6,1 dias. A principal conduta foi drenagem e antibioticoterapia, sendo que cerca de 13 pacientes não precisaram desse tipo de intervenção, e um paciente evoluiu a óbito. Conclusão: com base nestes resultados e na literatura, infecções odontogênicas merecem atenção, pois podem ser fatais e requerem internação rápida e tratamento adequado. Esse, portanto, é um assunto de grande importância para o cirurgião- -dentista, que exerce papel fundamental na prevenção e no tratamento. A resolução precoce ainda é a forma mais adequada para evitar complicações mais graves. (AU)

Acute Oral maxillofacial infections can be serious and relatively common clinical conditions, characterized by the spread of the infectious process to adjacent tissues and facial spaces of the head and neck region, which can result in several complications and lead to even death, although it is rare. Objective: the objective of this study was to perform an epidemiological analysis of maxillofacial infections and relate their data to the treatment instituted and the effectiveness of the same, as well as to analyze data regarding the age, sex, main teeth involved and total time of hospitalization. Subjects and method: in order to carry out study, 240 medical recordswere analyzed retrospectivelyat the University Hospital of Maringá of the patients with odontogenic infection attended by the Oral Maxillofacial Surgeon in the period of January 2009 to January 2017. Results: as a result, mean age was 38 years, with 57 women and 54 men and mean intake temperature was 38.5 °. The most affected region was the posterior branch of the mandible, with a mean duration of infection and hospitalization of 6.1 days. The main conduct was drainage and antibiotic therapy, and about 13 patients did not need this intervention and only 1 died. Conclusion: Based on these results and in literature, attention should be paid to odontogenic infections, which can be fatal and require proper treatment. This is a subject of great importance for the dentist, who plays a key role in prevention and proper treatment, its early resolution is still the most appropriate way to avoid serious complications. (AU)

Comparison of Space Infections in Oral Maxillofacial Region between Patients with and without Diabetes / 昆明医科大学学报

Objective To compare the clinical features of space infections in the oral maxillofacial region between patients with diabetes mellitus and patients without diabetes.Methods A retrospective study was conducted on 61 patients diagnosed with space infections in the oral maxillofacial region and receiving treatment at the department of oral and The 4nd Affiliated Hospital of Kunming Medical University between 2013 and 2016.The patients were divided into 2 groups:diabetic group (n =28) and non-diabetic group (n =33).The study variables were demography,etiology,clinical and laboratory examinations (bacteriology,admission blood glucose level,admission white blood cell count and percent of neutrophil on admission).The outcome was compared.The length of hospital stay and complications were also compared.Statistical analyses of the results between groups were performed using the t test and chi square test.Results For oral and maxillofacial space infection,there was no statistically significant difference in gender between the diabetic group and (28 cases) and non diabetes group (33 cases) (x 2 test,P=0.5929);while there were statistically significant differences between two groups in age (t test,P＜0.001) and in the number of infection space (t test,P＜0.001);there was no significant difference between the two groups in the sources of infection (x 2,P＞0.05);The main source of infection was odontogenic,followed by adenogenous.There were statistically significant differences between two groups in blood glucose concentration at admission (t test,P＜0.001) and in the hospitalization time and complications (t test and x 2 test P＜0.05),while no statistically significant differences in the white blood cells count and neutrophil count (t test,P＞0.05).Compared with the non diabetic group,for patients in the diabetic group,the age of onset was older,the involvd gaps were more,the blood glucose concentration was higher on admission,the length of stay was longer,complications were more likely to occur,and the consequences were more serious.Conclusion Compared with non diabetes group,space infection in oral and maxillofacial region is more serious and the hospital stay is longer and has more complications in diabetic patients which should be paid higher attention to.

Application of vascularized anterolateral thigh perforator flap harvested with free-style approach in oral and maxillofacial reconstruction / 中华显微外科杂志

Objective To assess the harvest method and application value of free-style anterolateral thigh perforator flap (ALTPF) in oral-maxillofacial reconstruction.Methods Fifty-three patients who suffered from oral and maxillofacial tumor underwent simultaneous reconstruction using free-style ALTPFs after radical resection from August,2013 to May,2014.Perforators of the ALTPF region were marked through hand-held Doppler probe preoperatively.Flaps were designed centered on perforators according to the defect size of the accepting site.Incisions were first made at the inner border of the designed flap.Perforators were exposed above the fascia lata femoris and then dissected retrogradely through the vastus lateralis muscle to harvest a vascular pedicle with desired caliber and length.Flap thinning was applied under microscope in some cases to compromise the need of the accepting site.Results All 53 flaps survived after transplantation while skin exfoliation occurred in 5 cases due to flap thinning.Four cases sustained partial necrosis and was cured by trimming and dressing changes.Five to 14 months' post-operative followup showed satisfactory accepting-site morphology with good speech function and swallowing recovery.All donor sites were closed primarily without skin-grafting,leaving no donor-site complications including incision disruption,scar hyperplasia and muscle strength degeneration of the lower limb.Conclusion Multiple perforators have been accu rately located preoperatively in free-style harvest approach of ALTPFs,thus optimal effects can be reached with decreased donor-site morbidity and improved aesthetic outcome to the uttermost,which accords with the refined,personalized and minimal invasive development concept of modem reconstructive surgery.

Morbilidad por defectos bucomaxilofaciales en las provincias orientales durante el período 2000-2013 / Morbidity due to oral maxillofacial defects in the eastern provinces during the period 2000-2013

Se realizó un estudio descriptivo y retrospectivo de 2441 pacientes, atendidos en el Servicio de Prótesis Bucomaxilofacial de Santiago de Cuba, desde el 2000 hasta el 2013, con vistas a caracterizar la morbilidad por defectos bucomaxilofaciales en los afectados. Hubo un promedio de 200 ingresos y 159 altas anuales de pacientes atendidos. La mayoría de los casos (63,8 %) pertenecieron a la provincia antes citada. Prevalecieron el sexo masculino (63,0 %), el grupo etario de 60 años y más (33,7 %), el nivel escolar primario (32,6 %), los defectos oculares (80,3 %) y el trauma (53,8 %). En los afectados de 0-19 años predominaron los defectos congénitos, en los de 40-59 los traumas, en personas de más de 60 años los oncológicos y por otras causas. Los defectos oculares se produjeron por traumas en 59,0 %, los nasales por causas oncológicas en 100,0 %, los craneales y auriculares por traumas en 78,6 y 76,5 %, respectivamente.

A descriptive and retrospective study of 2441 patients, assisted in the Service of Oral and Maxillofacial Prosthesis in Santiago de Cuba was carried out from the 2000 to 2013, aimed at characterizing the morbidity due to oral and maxillofacial defects in those affected. There was an average of 200 admissions and 159 annual discharges of assisted patients. Most of the cases (63.8%) belonged to the above mentioned province. Male sex (63.0%), the age group 60 years and over (33.7%), the primary school level (32.6%), the ocular defects (80.3%) and trauma (53.8%) prevailed. In the affected age group 0-19 years, the congenital defects prevailed, in the 40-59 years traumas prevailed, in patients over 60 years the oncological causes and others prevailed. Ocular defects were caused by traumas in 59.0%, the nasal defects were caused by oncological causes in 100.0%, the cranial and ears defects were due to traumas in 78.6 and 76.5%, respectively.

Transcatheter embolization for high blood flow vascular malformations of oral maxillofacial region / 介入放射学杂志

Objective To explore the treatment and efficiency of high blood flow vascular malformations of oral maxillofacial region with super-selective arterial embolization. Methods 18 cases underwent angiography of the head and neck before treatment and then followed by super-selective catheterization with microcatheter to embolize the feeding vessels of the vascular malformations with PVA. 8 cases underwent surgical excision within 72 hours after the embolization and the other 10 cases passed through the arterial radical emboliztion treatment. Results Technical success ratio reached 100% with no complications causing skin necrosis or incorrect arterial embolization else where in the skull. All 8 cases undergone preoperative embolization showed obviously less bleeding, easier removal of the mass and reduction of operation time. 10 cases with radical arterial embolization manifested reduction of swelling and improvement of organ function within 1 to 24 months after the procedure. 5 patients were cured with only once operation, 4 cases with twice operation and 1 with the thrice. Conclusions Aterial embolization is a safe and effective method in the treatment of high blood flow vascular malformations of oral maxillofacial region.

Damage control surgery for polytraumatism with severe oral maxillo-facial trauma: A report of 32 cases / 医学研究生学报

Objective:To explore the effect of damage control surgery on polytraumatism with severe oral maxillo-facial trauma.Methods: We retrospectively analyzed 32 cases of polytraumatism with severe oral maxillo-facial trauma treated by damage control surgery.Results: The principles of damage control surgery were successfully applied to the treatment.Of the 32 cases,31 survived,with their polytraumatism sequentially managed,and only 1 died.Conclusion: Damage control surgery helps to raise the success rate in the treatment of polytraumatism with severe oral maxillo-facial trauma.

Comparison of postoperative patient-controlled intravenous analgesia effects between lornoxicam and tramadol on patients undergoing of oral maxillofacial surgery / 重庆医科大学学报

0.05),There were 2 cases of nausea and one case of vomit in Lornoxicam group,as compared with 8 cases of nausea and 4 cases of vomit in Tramadol group.The number of nausea is 2 vs 8(P