RESUMO
Rotational drift of mandibular third molar teeth is a challenge for clinicians to predict and manage. Evidence on the incidence and degree of rotation is sparse. As the factors influencing rotation are not defined, prediction is impossible. A series of four cases with lower third molar rotation are presented and discussed. Significant rotation can alter the degree of difficulty for an extraction. A lack of well-documented cases has hindered investigation of this phenomenon. Further research is required to identify the aetiology, incidence and increase in risk factors caused by such rotational drift.
Assuntos
Dente Serotino/fisiopatologia , Migração de Dente/fisiopatologia , Dente Impactado/patologia , Adolescente , Adulto , Humanos , Dente Serotino/diagnóstico por imagem , Radiografia , Migração de Dente/diagnóstico por imagem , Dente Impactado/diagnóstico por imagem , Adulto JovemRESUMO
This paper reviews all 17 cases of facial bone osteoradionecrosis (ORN) which were treated in Adelaide, South Australia, in a nine-year period (1987 1996). This was 1.2% of all cases of head and neck cancer treated with radiotherapy (RT). Fourteen cases received treatment following the Marx principles of staging and the protocols of hyperbaric oxygen plus or minus surgery. The three exclusions were two patients who died of recurrent cancer before treatment was complete and one who declined treatment. The eleven cases of mandibular ORN occurred within a few years of the initial RT treatment. All except one occurred after surgical trauma, with dental extractions being the factor in nine cases. All responded to HBO, with or without surgery depending on stage. The three cases of temporal bone ORN were all of late spontaneous onset. All were stage I and all responded to HBO alone. This study shows that the incidence of ORN in Adelaide is low, probably through use of conservative doses of RT and good preventative protocols. The treatment with HBO plus or minus surgery was effective.
Assuntos
Oxigenoterapia Hiperbárica , Doenças Mandibulares/terapia , Osteorradionecrose/terapia , Osso Temporal/efeitos da radiação , Idoso , Carcinoma de Células Escamosas/radioterapia , Irradiação Craniana/efeitos adversos , Feminino , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Masculino , Mandíbula/patologia , Mandíbula/efeitos da radiação , Doenças Mandibulares/etiologia , Doenças Mandibulares/patologia , Pessoa de Meia-Idade , Osteorradionecrose/etiologia , Osteorradionecrose/patologia , Estudos Retrospectivos , Austrália do SulRESUMO
Patients who have had their jaws irradiated as part of management of head and neck malignancy are at risk of osteoradionecrosis (ORN) following tooth extraction. Thirty-seven patients with a history of irradiation to the jaws were managed during a four year period. Twenty-nine patients received hyperbaric oxygen therapy (HBO) consisting of 20 treatments before surgery and ten treatments after. Only one (4 per cent) developed ORN. Seven patients who did not have HBO and one who did (15 per cent) developed ORN. The need for prophylactic treatment with HBO is discussed. It is recommended that prophylactic HBO is used prior to surgery for irradiated facial bones.
