ABSTRACT
BACKGROUND: Distraction osteogenesis has been used for reconstruction of bone and soft-tissue defects. The authors present their clinical experience in the reconstruction of mandibular segmental defects by means of internal distraction osteogenesis. METHODS: Ten patients with mandibular defects ranging from 30 to 80 mm in length were treated in the authors' department. Internal distraction devices with transcutaneous activators were placed immediately after complete resection of the affected bone. Distraction was initiated 10 days after surgery at a rate of 0.5 mm/day. The consolidation period ranged from 12 to 22 weeks. Finally, the distractor device was removed. In two patients, an additional iliac crest bone graft was needed to complete bone union. RESULTS: Follow-up ranged from 4 to 47 months after surgery. Partial cutaneous and intraoral exposure was observed in two patients. At the end of the follow-up period, successful distraction osteogenesis was achieved in eight patients. Six patients were alive and free of disease, whereas two patients showed local relapse and required new resective surgery. Complete intraoral exposure with failure of the distraction process was observed in one patient, whereas another patient did not complete distraction because of metastatic disease diagnosed 4 months after surgery. CONCLUSIONS: Good clinical results for reconstruction of mandibular and soft-tissue postablative defects are reported with the use of this technique. The use of semiburied devices provides better aesthetics and acceptable quality of life to the patients. Larger series are required to popularize the use of this procedure.
Subject(s)
Mandibular Neoplasms/surgery , Osteogenesis, Distraction/methods , Plastic Surgery Procedures/methods , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Mandibular Neoplasms/diagnostic imaging , Middle Aged , Radiography , Time Factors , Treatment OutcomeABSTRACT
La aparición de melanomas primarios de la mucosa oral esinfrecuente. La agresividad de esta entidad y la ausencia deprotocolos de tratamiento estandarizado, hacen que el pronósticosea infausto. Se han relacionado la dificultad de la resecciónquirúrgica con márgenes libres, la tendencia elevada a la invasiónen profundidad y las metástasis hematógenas tempranas,como consideraciones que justifican un peor pronóstico enrelación al melanoma cutáneo. Sin embargo, no existen seriesclínicas grandes, y las series de casos clínicos constituyen lafuente principal de información en el momento actual. Ante laausencia de modalidades de tratamiento que aumenten substancialmentela supervivencia a largo plazo, sugerimos el empleode cirugía de resección con márgenes amplios y el diagnósticoprecoz mediante la biopsia de lesiones pigmentadas melánicassospechosas. En el presente trabajo presentamos 2 nuevos casosde melanoma primario de mucosa oral, con un seguimiento de72 y 12 meses respectivamente, y realizamos una revisión dela literatura en relación con esta rara neoplasia
The appearance of primary melanomas of the oral mucosa isuncommon. The aggressiveness of this entity and the absenceof any standardized treatment protocol make the prognostic unfortunate.The difficulty to obtain free surgical margins, the elevatedtendency to invade in depth and the early haematogenousmetastasis have been referred as features which may explain itsbad prognosis, even in comparison with cutaneous melanoma.However, no large clinical series exist and actually, clinical casesare the main source of information. Due to the absence ofany treatment modality which may substantially increase longtermsurvival, we suggest the use of resective surgery with widemargins and early diagnosis by means of biopsy for suspiciousmelanotic-pigmented lesions. In this work we present 2 newcases of primary melanoma of the oral mucosa, with a follow-upperiod of 72 and 12 months respectively, and we make a reviewof the literature in relation with this rare entity
Subject(s)
Adult , Humans , Melanoma/epidemiology , Melanoma/surgery , Mouth Neoplasms/diagnosis , Melanoma/diagnosis , Neoplasm Invasiveness , Nicotiana , Diagnosis, DifferentialABSTRACT
The appearance of primary melanomas of the oral mucosa is uncommon. The aggressiveness of this entity and the absence of any standardized treatment protocol make the prognostic unfortunate. The difficulty to obtain free surgical margins, the elevated tendency to invade in depth and the early haematogenous metastasis have been referred as features which may explain its bad prognosis, even in comparison with cutaneous melanoma. However, no large clinical series exist and actually, clinical cases are the main source of information. Due to the absence of any treatment modality which may substantially increase long-term survival, we suggest the use of resective surgery with wide margins and early diagnosis by means of biopsy for suspicious melanotic-pigmented lesions. In this work we present 2 new cases of primary melanoma of the oral mucosa, with a follow-up period of 72 and 12 months respectively, and we make a review of the literature in relation with this rare entity.
