Journal of Stomatology Oral and Maxillofacial Surgery最新文献

Background: Infantile hemangiomas (IH) represent the most prevalent vascular tumors in infants, often necessitating prompt medical intervention due to their potential for rapid growth and complications. This retrospective study aims to evaluate the efficacy of propranolol combined with Pingyangmycin in the treatment of IH and to investigate its correlation with vascular endothelial growth factor (VEGF) levels.

Methods: A prospective, observational study was conducted over 12 months, enrolling 120 IH patients. Patients received a combination therapy of propranolol and pingyangmycin for 3 to 6 months. Hemangioma Activity Score (HAS) and serum VEGF levels were assessed at baseline, 30th day, and 90th day post-treatment.

Results: A total of 120 patients diagnosed with IH, including 68 males and 52 females with a mean age of 1.2 years, were enrolled in this study. The HAS at baseline was 8.5 ± 1.7, which significantly decreased to 4.2 ± 1.0 by Day 30 and further reduced to 2.1 ± 0.8 by Day 90 (P < 0.001 for both comparisons). Serum VEGF levels also showed a significant reduction from a baseline of 235.6 ± 42.1 pg/mL to 180.3 ± 34.7 pg/mL at Day 30 and to 122.8 ± 28.9 pg/mL at Day 90 (P = 0.02 and P = 0.01, respectively). The correlation analysis revealed a positive correlation between VEGF levels and HAS scores at all time points, with Pearson correlation coefficients ranging from -0.82 to -0.89 (P < 0.001). Adverse events were mild and transient, occurring in 15 % of patients, with the most common being mild hypoglycemia (8 %), transient bronchospasm (5 %), and gastrointestinal discomfort (2 %). All adverse events resolved with symptomatic treatment, and no patient discontinued therapy due to adverse reactions.

Conclusion: Propranolol treatment for infants with proliferative hemangiomas is significantly effective with minor adverse effects. The mechanism of action may be associated with the downregulation of serum VEGF levels.

Introduction: The prognosis of metastatic ameloblastoma (METAM), now defined as a benign tumor, and malignant odontogenic tumors (MOT) is poorly studied in the literature. The aim of this study was to determine the prognosis and factors influencing the survival of these patients.

Material and methods: Using the SEER database, we retrieved clinical data of patients with malignant tumors of dental origin between 1975 and 2020. They include 3 histological groups: metastatic ameloblastoma (METAM), malignant odontogenic tumors (MOT, including odontogenic carcinoma, odontogenic sarcoma, primary intraosseous carcinoma, and ameloblastic carcinoma) and ameloblastic fibrosarcoma (AFS).

Results: On 251 patients, we observed no significant difference in disease-specific survival (DSS) between the three histological groups, with 5-year DSS of 77.4 % (59.9 - 100), 84.0 % (78.7 - 89.7) and 71.1 % (50.7 - 99.7) for METAM, MOT and AFS respectively (p = 0.460). In the MOT group, using a multivariate analysis, surgical treatment appeared to be a protective factor for DSS (HR = 0.483 [0.243 - 0.960], p = 0.038) after taking into account the potential confounding factors mentioned above. No variable significantly influenced DSS in the METAM and AFS group in univariate analysis.

Discussion: We found no difference in specific survival between the three histological groups. Although metastatic ameloblastoma was reclassified as a benign tumor by the WHO in 2017, the vital risk for patients remains consequent, and statistically similar to malignant odontogenic tumors.

Introduction: The "All-on-four" technique addresses this by placing two vertical implants in the anterior region and two posterior implants angled up to 45°. This study evaluates stress distribution on bone, implants, abutments, gingiva, and prostheses based on posterior implant angulation, using both standard and angled neck implants. Additionally, angled neck implants were used alongside standard implants.

Methods: To evaluate the biomechanical stress and displacement behavior of implants placed at 15°, 30°, 45°, and 30° neck-angled in the interforaminal region of using the All-on-four technique, under a 200 N masticatory force on bone, implant, abutment, and prosthesis, using the FEA method with a nonlinear solver.

Results: The stress values measured in the neck region of the angled implant and abutment placed in the distal region were highest in model IV (305 and 420 MPa), followed model III (282 and 359 MPa), model II (192 and 337 MPa) and lowest in model I (177 and 225 MPa), respectively. The mean elemental von Mises stress in the mandibular bone region where the implant was placed was highest in model I (56 MPa) and lowest in model III (40.4 MPa).

Conclusion: As the angle of insertion of the implant into the bone increases, the biomechanical stress value on the implant and abutment also increases. Among the models, the lowest von Mises stress values on the implant and abutment were measured in model I and model II. Models with low stress values can be recommended for patients with clinical conditions and biomechanical risk factors.

Objective: This study aimed to evaluate the survival outcomes of surgically treated oral squamous cell carcinoma (OSCC) patients with or without adjuvant therapies and factors predicting treatment outcomes from the largest head and neck cancer center in Northern Thailand.

Methods: Two hundred and sixty OSCC patients curatively treated between 2017 and 2021 were retrospectively recruited into the study to analyze the clinicopathological characteristics and oncological outcomes and compare them with historical data. A multivariate Cox proportional hazards model analysis was performed to evaluate factors affecting survival outcomes.

Results: Males were slightly predominant (58.1 %). The most common subsite was an oral tongue (48.5 %), followed by an alveolar ridge (18.5 %). Advanced stages (III-IV) presented most at 88.5 %. The majority of the patients (52.3 %) received surgery and chemoradiotherapy, followed by surgery and radiotherapy (36.9 %), and surgery alone (10.8 %). The five-year overall survival (OS), disease-specific survival, and disease-free survival were 28.8 %, 44.0 %, and 46.3 %, respectively. Age > 45, ECOG performance status 2, and positive surgical margin status were found to be independent predictors for decreased OS (aHR 1.74, 95 % CI 1.01-3.00, aHR 2.64, 95 % CI 1.22-5.68, and aHR 1.76, 95 % CI 1.18-2.63, respectively).

Conclusions: Survival outcomes of OSCC in the study remain poor compared to other studies. The high prevalence of locally advanced stage presentation and inadequate surgical margin are the main problems. Public awareness, cancer screening programs, and intraoperative specimen-driven evaluation might help obtain adequate surgical margins and improve survival outcomes.

Introduction: Despite being less common in recent years, recurrent pleomorphic adenoma still poses a surgical challenge, especially after improper surgery.

Methods: We retrospectively recruited all patients with recurrent pleomorphic adenoma and Carcinoma ex pleomorphic adenoma from February 2007 to April 2024 who were operated upon in a tertiary cancer center. Epidemiological, radiological, and pathological data, risk factors, details of surgical treatment, and surgical/oncological outcomes were analyzed.

Results: 35 patients with recurrent pleomorphic adenoma were recruited, 19 were women (54.3 %) with the parotid gland being the most affected site in 74.3 % followed by the submandibular gland in 20 %. Only 11 patients (31.4 %) underwent surgery for the primary tumor in our center, and of interest that 48.6 % of the total cohort underwent simple enucleation for their primary tumors. The interval between resection and recurrence was shortened with frequent recurrences. Again, 71.4 % of facial nerve injuries had a history of simple enucleation for their primaries. 3 cases of Carcinoma ex pleomorphic adenoma were reported, representing 1.4 % of the patients with parotid pleomorphic adenoma in the study period, and was associated with young age and long-standing recurrence.

Conclusions: Surgery is the cornerstone treatment for both primary and recurrent pleomorphic adenoma. Inadequate primary surgery, long-standing lesions, multiplicity, and fragmentation may be associated with facial nerve injury. Reconstructive flaps may be needed to cover the large resultant defects. Surgery for pleomorphic adenoma should be done by adequately trained surgeons. Radiation as an adjuvant treatment needs to be used frequently, especially through a multidisciplinary approach. Carcinoma ex pleomorphic adenoma, being rare, is demanding in its management with a poor prognosis.

Objective: The aim of this study is to evaluate the nasolacrimal canal dimensionally and volumetrically after treatment in patients who underwent rapid maxillary expansion.

Materials and methods: A total of 19 patients (12 females, 7 males) with maxillary transverse deficiency, who underwent rapid maxillary expansion were included in the study. Cone beam computed tomography images were analyzed to measure the volume, anteroposterior diameter, transverse diameter, length, and angle of the nasolacrimal duct before and after treatment.

Results: The average age of the patients was 13.8 ± 1.69 years. Statistically significant increases in the volume, anteroposterior diameter, transverse diameter, length, and angle of the nasolacrimal canal were observed after treatment for both the right and left sides. No significant difference was found nasolacrimal canal dimensionally and volumetrically except angle on the left and right side of male and female patients. No significant differences were found in the changes between male and female patients.

Conclusion: Rapid maxillary expansion resulted in significant dimensional and volumetric increases in the nasolacrimal canal. Although no prior studies have linked maxillary transverse deficiency to nasolacrimal canal obstruction, the findings suggest that RME may be a viable treatment for nasolacrimal canal obstruction under appropriate conditions.