Reverse blood flow in cervicofacial veins after venous ligations: Potential implications in microsurgery.

INTRODUCTION: The consequences on the cervicofacial venous circulation of major cervicofacial vein ligations are poorly known. We aimed to highlight by using Doppler Ultrasound flow differences in the cervicofacial venous network in the case of unilateral or bilateral ligation of main venous collector trunks (external jugular vein [EJV] and internal jugular vein [IJV]) METHODS: A Doppler ultrasound was performed on 10 healthy volunteers, 8 patients with previous bilateral ligation of the EJV, 8 with a unilateral ligation of the EJV, and 8 with a unilateral ligation of the EJV and IJV, after modified radical neck dissection. The diameter, the flow direction and the peak systolic velocity (PSV) of the superficial temporal vein, the facial vein (FV) and the IJV were measured. RESULTS: Healthy patients had a similar right and left PSV for all the veins studied, with always antegrade flows. Patients with previous ligations had some significant right/left differences and retrograde flows. CONCLUSION: A redistribution of venous blood flow on the contralateral side of the face and neck seems to take place in the case of unilateral ligation of the EJV and/or IJV. Retrograde flows are sometimes observed in the case of previous ligation of the EJV and/or IJV and might compromise the success of venous microanastomoses.

Anatomic and histological study of the rabbit mandible as an experimental model for wound healing and surgical therapies.

The rabbit is one of the most widely used models for studying bone remodeling or dental implant osseointegration but very few data are available about the rabbit's mandible. The aim of this work was to describe the anatomy of the rabbit mandible and to estimate the available bone volume for experimental studies. First, with a dissection, the morphology of the mandible was described and the mental foramen, the position of the main salivary glands and muscular insertions were located. Then, by X-ray imaging, the position of the inferior alveolar canal, the dental root courses and volume and bone density were described. Finally, with frontal sections of the mandible body, the rabbit's dental and alveolar bone histological structure were assessed. Thus, the relevance of the rabbit mandible as an experimental model for wound healing or surgical therapies was discussed.

[Practice guidelines of the use of bisphosphonates in solid tumours with bone metastases and in multiple myeloma]. / Guide de recommandations d'utilisation des bisphosphonates dans les lésions osseuses malignes des tumeurs solides et du myélome multiple.

Bisphosphonates are indicated for the treatment of bone lesions in patients with solid tumours or multiple myeloma. Bisphosphonates have proven their effectiveness in reducing the number of bone complications (hypercalcemia, pain, disease-related fractures, spinal cord compression) and delaying their occurrence in patients with bone tumours; they have also been shown to reduce the need for bone surgery and palliative or pain-relieving radiotherapy in these patients. International recommendations for the treatment of bone lesions related to malignant solid tumours and multiple myeloma have been established. We have elaborated clinical practice guidelines on the use of bisphosphonates to assist treatment decision-making in bone oncology. The guide contains decision trees and tables with information to guide pre-treatment evaluation and patient follow-up, as well as indications and conditions of use of bisphosphonates. In 2007, the regional cancer network of Rhône-Alpes, ONCORA, formed a working group (GIP ONCORA) to elaborate the guideline. The final version was then discussed and adopted at a plenary session in July 2009, during a collaborative workshop on supportive care recommendations organized by ONCORA and the regional cancer network of Lorraine.

Dental implants and free fibula flap: 23 patients.

INTRODUCTION: Mandibular reconstruction with a microvascular free fibula flap (MFF) is an elegant solution to restore the anatomic arch, oral functions, and facial esthetics. But the thin cutaneous tissue, the thickness of subcutaneous tissues, the absence of a pelvilingual and vestibular groove, and the fragility of soft tissues complicate dental prosthetic stabilization. Implants may restore prosthetic functionality. A lot has been published on osteointegration with a MFF, but few studies have been aimed at the prosthetic aspect, final goal of any oral reconstruction. The aim of this retrospective study was to present the results of oral reconstruction with implant supported prostheses after mandibular reconstruction with a MFF. PATIENTS AND METHOD: Twenty-three patients underwent mandibular reconstruction: 17 men and six women with a mean age of 46 years (17-66). Fourteen patients (60.8%) underwent radiotherapy before reconstruction. Mandibular osteoradionecrosis was the indication for reconstruction in seven patients. Each patient was assessed by dentascan. Implants were placed under general anesthesia. Postoperative clinical and radiographic controls were made regularly. Transmucous abutments were placed after six postoperative months and the prosthetic phase was initiated one month later. The criteria for implant and prosthetic success were assessed. RESULTS: Seventy-five implants were placed, on average 3.2 per patient, with an 80% success rate. Three implants (4%) were not used for prosthesis placement. Ten permanent prostheses and 13 removable prostheses were placed. The mean delay before implant loading was 7.6 months (6-10) and the mean follow-up was 27.5 months (1-71). Occlusion was considered as "satisfactory" for 69.6% of patients. For 57% of patients, the quality of surrounding soft tissues was considered as "satisfactory". For 74% of patients, oral rehabilitation was "satisfactory". DISCUSSION: The implant supported prosthesis after MFF mandibular reconstruction, on an irradiated site or not, gives satisfactory results despite the thickness and mobility of soft tissues, and despite scar contracture and the absence of keratinization. Implant placement must be performed after a prosthetic planning. Using radiosurgical guides, despite their cost and difficult adaptation, would certainly improve the technique greatly.

[Osteonecrosis of the jaw and biphosphonates: imaging features]. / Ostéonécrose de la machoire sous biphosphonates: aspects radiologiques.

PURPOSE: 1) To review the pathophysiology of osteonecrosis of the jaw in patients receiving biphosphonates. 2) To review the imaging findings of osteonecrosis of the jaw and attempt to define pathognomonic imaging features. Materials and methods. Retrospective study of 15 patients with metastatic disease treated with biphosphonates. All available imaging studies including orthopantomograms, CT and bone scans were reviewed simultaneously by two radiologists (FO, DB). RESULTS: The most frequent imaging finding was osteolysis. Signs of biphosphonate impregnation were frequently observed: areas os osteosclerosis or heterogeneous demineralization due to abnormal bone remodeling. The outer cortex appeared duplicated in one case. Complications including fracture, sequestra, oroantral fistula and sinusitis may also occur. CONCLUSION: The imaging features of osteonecrosis remain fairly non-specific. Drug-related osteonecrosis of the jaw should nonetheless be suggested in the appropriate clinical setting in the presence of osteolysis associated with osteosclerosis. Imaging is helpful to assess the extent of the disease and detect complications for improved patient management.

[Dental implants and microvascular free fibula flap: 23 patients]. / Implants dentaires et lambeau de fibula microanastomosé : 23 patients.

INTRODUCTION: Mandibular reconstruction with a microvascular free fibula flap (MFF) is an elegant solution to restore the anatomic arch, oral functions and facial esthetics. But the thin cutaneous tissue, the thickness of subcutaneous tissues, the absence of a pelvilingual and vestibular groove, and the fragility of soft tissues complicated dental prosthetic retention. Implants may restore prosthetic functionality. There is considerable publication on osteo-integration with a microvascular free fibula flap, but few studies were aimed at the prosthetic aspect, finality of any oral reconstruction. The aim of this retrospective study was to present the results of oral reconstruction with implant supported prostheses after mandibular reconstruction with a microvascular free fibula flap. PATIENTS AND METHOD: Twenty-three patients underwent mandibular reconstruction: 17 men and six women with a mean age of 46 years (17-66). Fourteen patients (60.8%) underwent radiotherapy before reconstruction. Mandibular osteoradionecrosis was the indication for reconstruction in seven patients. Each patient was assessed by dentascan. Implants were placed under general anesthesia. Postoperative clinical and radiographic controls were made regularly. Transmucous abutments were placed after six postoperative months and the prosthetic phase was initiated one month later. The criteria for implant and prosthetic success were assessed. RESULTS: Seventy-five implants were placed, on average 3.2 per patient, with an 80% success rate. Three implants (4%) were not used for prosthesis. Ten permanent prostheses and 13 removable prostheses were placed. The mean delay before implant loading was 7.6 months (6-10) and the mean follow-up was 27.5 months (1-71). The occlusion was considered as "satisfactory" for 69.6% of patients. For 57% of patients, the quality of surrounding soft tissues was considered as "satisfactory". For 74% of patients oral reconstruction was "satisfactory". DISCUSSION: The implant supported prosthesis after MFF mandibular reconstruction, on an irradiated site or not, gives satisfactory results despite the thickness and mobility of soft tissues, and despite scar contracture and the absence of keratinization. Implant placement must be performed after a prosthetic planning. Using radio-surgical guides, despite their cost and difficult adaptation, would certainly bring important improvement to the technique.

[Relationship between coronary artery disease and periodontal disease. What the cardiologist must know]. / Relations entre les pathologies cardiovasculaires et buccodentaires. Ce que le cardiologue doit connaître.

In this review, we will present the recent works, which shows a link between arterial lesions, particularly in coronary arteries, and periodontal disease. The pathways are those of chronic infection, and several studies have revealed a relationship between arterial lesions and buccal bacteraemia. Though the mechanism that links them is still unclear, the first hypotheses suggest that the presence of the bacteria in the bloodstream triggers a direct reaction (bacteria on the target organ), and/or an indirect immune reaction. This immune response could be induced by an increase in the secretion of pro-inflammatory cytokines (IL1, IL6, TNF), which are also involved in atherogenesis. Indeed, these cytokines have been found in higher concentrations in patients with periodontal disease, whereas reduced levels have been found in patients who have had deep gum pockets thoroughly cleaned. Cardiologists need to have access to such information not only because of the similarity of the populations, but also because of the therapeutic consequences. The future development of simple dental scores will provide an important tool for epidemiological studies of primary and secondary prevention.

[Dental implants in irradiated areas: a series of 33 patients]. / Implants dentaires en territoire irradié: série de 33 patients.

INTRODUCTION: Prosthetic rehabilitation, particularly in radiated areas, can be particularly difficult in patients with partial or total edentation following treatment for orofacial cancer. We report a series of patients who underwent a protocol of implantation in radiated bone with evaluation of the prosthetic rehabilitation. MATERIAL AND METHOD: Thirty-three patients given radiotherapy for an orofacial cancer were implanted, followed by a dental prosthesis. The three phases of the protocol were a preoperative clinical and radiological analysis, a surgical phase under general anaesthesia and a postoperative clinical and radiological follow-up. RESULTS: Fifteen patients were treated for an oral cavity tumor, ten for a pharyngeal lesion, six for a laryngeal tumor and two for a maxillary cancer. The average dose of radiotherapy was 60.5 Gy. Sixty-eight implants were positioned, 91.9% in the anterior mandible. The delay between radiotherapy and implantation was 54 months. The delay between implantation and loading was seven months. The average follow-up was 31.9 months. No peri-implantitis was observed. DISCUSSION: Implantation in irradiated bone is possible if a strict protocol is used; a good rate of success and improved quality of life will favour development of this technique. Criteria for dental implant placement include local and general conditions, the psychological situation and technical possibilities. Sufficient delay after radiotherapy is necessary to verify healing and the good prognosis of the cancer. The vascular supply can be preserved by implantation under general anesthesia. All patients were satisfied with the functional and esthetic results.

Long-term effects of chemotherapy on dental status in children treated for nephroblastoma.

Dental abnormalities among children treated at a young age for Wilms tumor are reported. The authors retrospectively reviewed the dental records and panoramic radiographs of 27 children treated for nephroblastoma between 1994 and 1998. They evaluated the frequency of apparent microdontia, excessive caries, root stunting, hypodontia, and enamel hypoplasia and compared this group to a control group of 78 children. Seventy percent of the children developed dental abnormalities, comprising root stunting (44%), enamel hypoplasia (22%), microdontia (18%), and hypodontia (7%). Results of control subjects were significantly different regarding dental abnormalities, especially microdontia and taurodontia. These results indicate that chemotherapy in children may lead to troubles affecting teeth growing at the time of treatment. Information and prospective dental care are needed, and further investigations are required.

[Postradiation dental extractions]. / Extractions dentaires en territoire irradié

INTRODUCTION: Healing may fail after postradiation dental extractions, with a risk of followed osteoradionecrosis, and its dramatic prognosis. We propose a protocol for postradiation extractions. MATERIAL AND METHODS: From January 2000 to December 2001, 107 patients underwent 287 dental extractions after radiation therapy: 80.5% in mandibular jaw, average radiation dose 61.6 Gy, average time between radiation and extraction 6 years. Extractions were performed under general anesthesia, diazanalgesia or local anesthesia, and extraction wounds were sutured after insertion of a collagenic sealant impregnated with gentamicin. General antibiotic prophylaxy was given. RESULTS: Healing failed in only two cases. The first case involved early-stage osteoradionecrosis and the second a tumoral localization. The rate of post-extraction osteoradionecrosis was thus 0.35%. DISCUSSION: A strict protocol associating non-traumatic surgery and an alveolar sealant can considerably decrease the risk of osteoradionecrosis after dental extraction in radiated bone.