[Distant metastases of malignant tumors of head and neck]. / Metastazele la distanta ale tumorilor maligne ale capului si gâtului.

The charts of 176 previously untreated patients with head and neck squamous cell carcinoma who completed treatment during 2006 in Oro-Maxillo-Facial Clinic, UMF "Carol Davila" Bucharest were reviewed. These patients had no evidence of distant metastases when initially evaluated. The overall incidence of distant metastases was 27.84%, varying from 10.52% for buccal mucosa to 63.63% for tongue and floor of the mouth (p < 0.05). 80% of the metastases were detected within two years after treatment. The rate also increased with the T and N classification; however, the N stage had greater influence on the rate of metastases than the T stage.

Identical Mutation in SH3BP2 Gene Causes Clinical Phenotypes with Different Severity in Mother and Daughter - Case Report.

Cherubism is a particular form of fibrous dysplasia of the jaws. Familial occurrence was reported in most cases. The condition is a rare hereditary disorder with autosomal dominant inheritance, with complete penetrance in males and incomplete penetrance in females and variable expressivity. It is known to be caused by mutations in the gene encoding SH3-domain binding protein 2, SH3BP2 gene. Major diagnostic criteria are cherubic facial appearance, painless hard enlargement of the jaws, and frequently associated dental abnormalities. The aim of the study was to analyze clinical and genetic features of cherubism in a family with 3 daughters in which the youngest one was affected. Clinical and radiographic examinations, hematological and biochemical evaluations and biopsy were performed. Molecular genetic analysis consisted of PCR amplification and direct sequencing of selected exons of the SH3BP2 gene. Cherubism was suspected based on clinical and radiographic examinations of the 9-year-old daughter. She presented asymmetrical enlargement of the mandible, speech and swallowing problems and dental abnormalities on the lower jaw. There was no history of similar clinical findings in any of the daughters or the parents of the affected girl. Abnormal results were obtained by genetic analysis. A c.1244G>A mutation was identified in exon 9 of the SH3BP2 gene in the asymptomatic mother and her affected daughter. The identified mutation in the SH3BP2 gene is probably disease-causing. The asymptomatic mother transmitted the gene mutation to her affected daughter. Our results confirm the reduced penetrance and variable expression of the gene mutation.

[Correlations between the occlusal plane angle and the risk of relapse after surgical orthodontic treatment of Angle Class III anomalies]. / Corelatii intre orientarea planului de ocluzie si riscul de recidiva in tratamentul chirurgical al anomaliilor dento-maxilare de clasa a III-a.

An important criterion in the diagnostic and therapeutic assessment of severe true mandibular prognathia (characterized by excessive growth of the mandible and hiperdivergent facial growth pattern) is the orientation of the occlusal plane compared with the facial benchmark represented by the Frankfurt horizontal line. This is because orthognatic surgery in this pathology (sagittal bilateral osteotomy) envisages not only the shortening of the mandible, but also the counterclockwise rotation of the mandible to restore facial and dento-alveolar harmony in the three planes (sagittal, transverse, vertical). The aim of the study is the analysis of the evolution of the maxillo-mandibular complex in relation to the occlusal plane after orthognatic surgery (sagittal osteotomy of the mandible and bilateral Le Fort I of the maxilla), in a group of 15 patients with a mean age 22+3 years diagnosed with skeletal class III malocclusion, hiperdivergent facial pattern, initial average value of the occlusal plane angle 130+0.60. t test applied for comparative statistical analysis for the linear and angular parameters considered in four therapeutic stages (initial presurgical, post surgical, one year post surgical) show statistically significant changes in parameters related to the mandibular length and rotation, without significant variations one year after the surgical phase.

[Computed tomography investigation of temporomandibular joint in surgery of dento-maxillary anomalies]. / Metoda de evaluare tomografica a articulatiei temporo-mandibulare in chirurgia anomaliilor dento-maxilare scheletale severe.

The aim of this study was to evaluate changes in the temporomandibular joint morphology, regarding the relation between mandibular condyle and fossa, after bilateral sagittal split osteotomy in Angle class III dentomaxillary anomalies. Preserving the preoperative position of the condyle during sagittal split osteotomy is considered important to obtain skeletal and occlusal stability. Cone-beam computed tomography of 20 class III patients with mandibular prognathism were assessed before and 6 weeks after operation to evaluate changes of the condylar position. We propose a protocol for head posture and computed tomography investigation, which makes possible the comparison between cone-beam computed tomography (CBCT) in different moments at the same patient. There are no significant changes after bilateral sagittal split osteotomy regarding joint relations.

[Clinical and therapeutical considerations regarding odontogenic acute mediastinitis]. / Consideratii clinico-terapeutice în mediastinitele acute de cauza dentara.

Odontogenic acute mediastinitis is an polymicrobial infections caused in most cases by gram negative and anaerobic germs. The odontogenic origin of the cases in this study was based on anamnestic inquiry of the patients, which reveales a dental treatment 7-15 days before the diagnosis of acute mediastinitis was established. Clinical features are often nonspecific at the debut of this affection; septic shock could appear suddenly associated with multiple systems and organs failure. This is the explication why, some of these patients presented septic shock when are diagnosed. In this situations, when acute mediastinitis is suspected, based on clinical and imaging findings, it must be confirmed by surgical exploration and perioperative bacteriological evaluations. Positive diagnosis is based on clinical features associated with labs and imaging studies. Surgery plays an important role in therapy of acute mediastinitis: debridement and drainage of mediastinum with subsequently lavage of it, using antiseptic solutions. Broad spectrum antibiotherapy should be administrated immediately, before antibiogram is ready.

[Inferior hemiarthroplasty of the temporo-mandibular joint with articulated condylar prosthesis type Stryker]. / Hemiartroplastia inferioara a articulatiei temporo-mandibulare cu proteza de condil articular articulata tip Stryker.

The optimal reconstruction of the mandible and of the temporo-mandibular joint after mandibular hemi-resection with disarticulation is still controversial in literature. This paperwork presents our experience on four cases in the reconstruction of the mandible together with the inferior arthroplasty of the temporo-mandibular joint, after the resection of extended benign tumors of the mandible, based on fibular free vascularized grafts having attached a Stryker titanium condylar prosthesis reconstructing the inferior segment of the temporo-mandibular joint. Our results for the this technique were excellent, with a functional rehabilitation very close to normal. After reviewing the various techniques and their arguments in literature, with accent on the TMJ reconstruction, we consider this method to be optimal for the reconstruction of mandibular defects in patients with neoplastic conditions.

[Giant parotid pleomorphic adenoma--presentation of a case and review of the literature]. / Adenom pleomorf parotidian gigant--prezentare de caz si recenzia datelor din literatura de specialitate.

This is a case presentation of a 51-year-old patient, with a giant parotid tumor on the right side (18 x 11 cm on the longer, cranio-caudal axis, 950 g), with an extremely slow evolution, since 1978. There are no clinical signs of malignancy within the tumor. A total parotidectomy with conservation of the facial nerve and a cervico-facial plasty were performed. The pathological result indicated a pleomorphic adenoma with central malignant foci. Such cases are rare in the literature, approximately 12 similar cases.

Systematic review of randomized controlled trials of atypical antipsychotics and selective serotonin reuptake inhibitors for behavioural problems associated with pervasive developmental disorders.

A systematic review of randomized controlled trials of the use of atypical antipsychotics and selective serotonin reuptake inhibitors in the treatment of behavioural problems associated with pervasive developmental disorders is reported. A search through both published and unpublished literature, including contacting drug companies and known experts in the field was undertaken. Six trials met the criteria for inclusion in the review. They largely suffer from methodological weaknesses; only two trials had satisfactory methodological quality. The heterogeneity in outcome measurements prevented from conducting a meta-analysis. There is yet no coherent body of data concerning the effects of these medications across all sub-classifications of pervasive developmental disorders, across all age categories, and concerning their medium- and long-term effects, and their effects on quality of life. Atypical antipsychotics and selective serotonin reuptake inhibitors may be of benefit for behavioural problems associated with pervasive developmental disorders. Risperidone has been the best studied among these medications. Atypical antipsychotics appear to have a low risk of extrapyramidal symptoms during short-term treatment. The reviewed trials cannot provide data on the use of selective serotonin reuptake inhibitors in the treatment of children with pervasive developmental disorders. No firm conclusions for clinical practice can be drawn. Larger, well-conducted randomized controlled trials with long-term follow-up are needed.

[The reconstruction of the oral and maxillofacial defects with free vascularized flaps and microsurgical anastomoses]. / Plastia reconstructiva a defectelor oro-maxilo-faciale prin lambouri liber vascularizate si anastomozate microchirurgical.

The reconstruction of the oral and maxillofacial defects is difficult, because of the high specialisation of the tissues. In cancer resection, the post-operatory defects are quite important, because of the oncological principle of assuring free margins. The free flap is a modem and nowadays very used method in oral and maxillofacial reconstruction, after the removal of the malignant tumors with this localisation. These flaps are indicated for large defects, when the reconstruction with local or regional flaps is not possible. The wide variety of the raised tissues allows better results, making them the flaps of choice for large defects of the lip and cheek. The main advantages are related to the tri-dimensional extension of the free margins, assuring the quality of life and allowing early initiation of the radiotherapy in oncological patients.