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European Respiratory Review : An... Dec 2021Treatment of obstructive sleep apnoea (OSA) in adults is evolving, as new therapies have been explored and introduced in clinical practice, while other approaches have... (Review)
Review
Treatment of obstructive sleep apnoea (OSA) in adults is evolving, as new therapies have been explored and introduced in clinical practice, while other approaches have been refined or reconsidered. In this European Respiratory Society (ERS) guideline on non-continuous positive airway pressure (CPAP) therapies for OSA, we present recommendations determined by a systematic review of the literature. It is an update of the 2011 ERS statement on non-CPAP therapies, advanced into a clinical guideline. A multidisciplinary group of experts, including pulmonary, surgical, dentistry and ear-nose-throat specialists, methodologists and patient representatives considered the most relevant clinical questions (for both clinicians and patients) relating to the management of OSA. Eight key clinical questions were generated and a systematic review was conducted to identify published randomised clinical trials that answered these questions. We used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the quality of the evidence and the strength of recommendations. The resulting guideline addresses gastric bypass surgery, custom-made dual-block mandibular advancement devices, hypoglossal nerve stimulation, myofunctional therapy, maxillo-mandibular osteotomy, carbonic anhydrase inhibitors and positional therapy. These recommendations can be used to benchmark quality of care for people with OSA across Europe and to improve outcomes.
Topics: Adult; Continuous Positive Airway Pressure; Humans; Mandibular Advancement; Occlusal Splints; Respiratory System; Sleep Apnea, Obstructive
PubMed: 34853097
DOI: 10.1183/16000617.0200-2021 -
JNMA; Journal of the Nepal Medical... Jul 2022Ameloblastomas of jaws are benign odontogenic tumors of epithelial origin with four clinical variants: solid multicystic type, unicystic type, desmoplastic type, and...
UNLABELLED
Ameloblastomas of jaws are benign odontogenic tumors of epithelial origin with four clinical variants: solid multicystic type, unicystic type, desmoplastic type, and extraosseous type. The incidence rate of ameloblastoma is 0.92 per million person-years. Unicystic ameloblastoma refers to those cystic lesions that show clinical and radiologic characteristics of an odontogenic cyst but shows a typical ameloblastomatous epithelium lining part of the cyst cavity, with or without luminal and/or mural tumor proliferation on histological examination. Here is a unique case of unicystic ameloblastoma involving the mandible in a 70-year-old patient. The case was managed by segmental mandibulectomy and flap repair. Unicystic ameloblastoma accounts for only 13% of all known cases in scientific literature. Considering the rarity of the lesion, the purpose of presenting this report on a clinical case is to emphasize the importance of radiological evaluation and histopathological examination for the diagnosis of ameloblastoma.
KEYWORDS
ameloblastoma; odontogenic cysts; odontogenic tumors; segmental mandibulectomy.
Topics: Humans; Aged; Ameloblastoma; Mandible; Odontogenic Tumors; Odontogenic Cysts; Jaw
PubMed: 36705195
DOI: 10.31729/jnma.7566 -
Biomedical Journal 2014The surgery-first approach in orthognathic surgery has recently created a broader interest in completely eliminating time-consuming preoperative orthodontic treatment.... (Review)
Review
The surgery-first approach in orthognathic surgery has recently created a broader interest in completely eliminating time-consuming preoperative orthodontic treatment. Available evidence on the surgery-first approach should be appraised to support its use in orthognathic surgery. A MEDLINE search using the keywords "surgery first" and "orthognathic surgery" was conducted to select studies using the surgery-first approach. We also manually searched the reference list of the selected keywords to include articles not selected by the MEDLINE search. The search identified 18 articles related to the surgery-first approach. There was no randomized controlled clinical trial. Four papers were excluded as the content was only personal opinion or basic scientific research. Three studies were retrospective cohort studies in nature. The other 11 studies were case reports. For skeletal Class III surgical correction, the final long-term outcomes for maxillofacial and dental relationship were not significantly different between the surgery-first approach and the orthodontics-first approach in transverse (e.g., intercanine or intermolar width) dimension, vertical (e.g., anterior open bite, lower anterior facial height) dimension, and sagittal (e.g., anterior-posterior position of pogonion and lower incisors) dimension. Total treatment duration was substantially shorter in cases of surgery-first approach use. In conclusion, most published studies related to the surgery-first approach were mainly on orthognathic correction of skeletal Class III malocclusion. Both the surgery-first approach and orthodontics-first approach had similar long-term outcomes in dentofacial relationship. However, the surgery-first approach had shorter treatment time.
Topics: Humans; Malocclusion, Angle Class III; Mandibular Osteotomy; Orthodontics, Corrective; Orthognathic Surgery; Orthognathic Surgical Procedures; Treatment Outcome
PubMed: 25116713
DOI: 10.4103/2319-4170.126863 -
The American Journal of Case Reports Jul 2015Ameloblastic carcinoma secondary type is an extremely rare and aggressive odontogenic neoplasm that exhibits histological features of malignancy in primary and...
BACKGROUND
Ameloblastic carcinoma secondary type is an extremely rare and aggressive odontogenic neoplasm that exhibits histological features of malignancy in primary and metastatic sites. It arises through carcinomatous de-differentiation of a pre-existing ameloblastoma or odontogenic cyst, typically following repeated treatments and recurrences of the benign precursor neoplasm. Identification of an ameloblastic carcinoma, secondary type presenting with histologic features of malignant transformation from an earlier untreated benign lesion remains a rarity. Herein, we report 1 such case.
CASE REPORT
A 66-year-old man was referred for management of a newly diagnosed ameloblastic carcinoma. He underwent radical surgical intervention comprising hemimandibulectomy, supraomohyoid neck dissection, and free-flap reconstruction. Final histologic analysis demonstrated features suggestive of carcinomatous de-differentiation for a consensus diagnosis of ameloblastic carcinoma, secondary type (de-differentiated) intraosseous.
CONCLUSIONS
Ameloblastic carcinoma, secondary type represents a rare and challenging histologic diagnosis. Radical surgical resection with adequate hard and soft tissue margins is essential for curative management of localized disease.
Topics: Aged; Ameloblastoma; Biopsy; Diagnosis, Differential; Humans; Lymphatic Metastasis; Male; Mandibular Neoplasms; Mandibular Osteotomy; Neck Dissection; Radiography, Panoramic
PubMed: 26126621
DOI: 10.12659/AJCR.893918 -
Journal of Indian Prosthodontic Society 2020The loss of mandibular continuity leads to difficulty in swallowing, problems in mastication, altered mandibular movement, impaired speech articulation, and cosmetic...
The loss of mandibular continuity leads to difficulty in swallowing, problems in mastication, altered mandibular movement, impaired speech articulation, and cosmetic disfigurement. Rehabilitation of such patients becomes more challenging in the case of complete edentulous maxillary and mandibular arches due to a lack of support and anchorage. This case report describes prosthetic rehabilitation of completely edentulous arches with segmental mandibulectomy. Hence, the anchorage was provided with the help of osseointegrated implants in both the maxillary and mandibular arches. Deviation of the mandible toward the unresected side during mastication and other functions was corrected using a palatal ramp. An attempt was made for prosthetic rehabilitation of mandibulectomy defect which required a multidisciplinary approach and which fulfilled the patient's requirement of mastication.
PubMed: 33223703
DOI: 10.4103/jips.jips_311_19 -
International Archives of... Oct 2023Oral cavity squamous cell carcinoma (OCSCC) is the most common malignancy in the oral cavity. Two types of mandibular resections have been described: the segmental... (Review)
Review
Oral cavity squamous cell carcinoma (OCSCC) is the most common malignancy in the oral cavity. Two types of mandibular resections have been described: the segmental mandibulectomy and the marginal mandibulectomy. Both may have a different impact over the quality of life, oncological prognosis, and functional or aesthetic result. The aim of this study was to systematically explore the literature to determine the survival outcomes and disease control rates in patients who underwent segmental or marginal mandibulectomy for OCSCC with histological evidence of cortical and medullary bone invasion. This review involved a systematic search of the electronic databases MEDLINE/PUBMED, Google Scholar, Ovid Medline, Embase, and Scopus including articles from 1985 to 2019. Fifteen articles were included for qualitative analysis and 11 articles were considered for meta-analysis calculations. All of them correspond to retrospective cohort studies. This systematic review reveals the low-level evidence regarding the impact over local control or survival according to the type of mandibulectomy. Our results need to be considered with precaution according to the limited evidence available. We just found difference regarding the 5-year disease-free survival, and a tendency in favor of segmental mandibulectomy was confirmed when medullary invasion was evident.
PubMed: 37876698
DOI: 10.1055/s-0042-1750764 -
Scientific Reports May 2019This is the first study to investigate the impact of a second fibula flap or a soft tissue flap combined with bridging plate for a repeated segmental mandibulectomy... (Comparative Study)
Comparative Study
This is the first study to investigate the impact of a second fibula flap or a soft tissue flap combined with bridging plate for a repeated segmental mandibulectomy reconstruction on flap outcomes in head and neck cancer patients. A retrospective comparative analysis (2007-2016) of 61 patients who underwent a second segmental mandibulectomy was performed. 20 patients underwent a fibula flap reconstruction whereas 41 had a soft tissue flap and plate reconstruction. No significant difference was seen in the operative time, total hospital stay, flap loss, re-exploration rates, plate exposure rate, or recipient site infection rate. On multivariate analysis, patients reconstructed with a soft tissue flap and bridging plate (odds ratio (OR) 3.997; 95% confidence interval (CI), 1.046-15.280, p = 0.043) and complications developed in previous surgery (OR 4.792; 95% CI, 1.120-20.493, p = 0.035) were shown to be independent predictors of a prolonged nasogastric tube dependence. The utilization of a soft tissue flap with plate is associated with comparative results of acute complication rate within 1 week, recipient site infection rate, and plate exposure rate to free fibula flaps alone. Free fibula flaps may result in a decreased risk for prolonged tube dependence compared to free soft tissue flap reconstructions.
Topics: Aged; Bone Plates; Female; Fibula; Free Tissue Flaps; Head and Neck Neoplasms; Humans; Intubation, Gastrointestinal; Length of Stay; Male; Mandible; Mandibular Neoplasms; Mandibular Osteotomy; Mandibular Reconstruction; Middle Aged; Operative Time; Postoperative Complications; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome
PubMed: 31138880
DOI: 10.1038/s41598-019-44467-x -
Cureus Oct 2018Introduction Ameloblastoma is a locally destructive tumor with a propensity for recurrence if not entirely excised. Management of ameloblastoma poses a challenge for all...
Introduction Ameloblastoma is a locally destructive tumor with a propensity for recurrence if not entirely excised. Management of ameloblastoma poses a challenge for all involved in the field of head and neck surgery because successful treatment requires not only adequate resection but also a functional and aesthetically acceptable reconstruction of the residual defect. Methods Patients who had histologically proven ameloblastoma between 1991 and 2009 were identified from the database of Aga Khan University Hospital. A review of all medical records, radiological images, operative reports and pathology reports was undertaken. Results A total of 15 patients with histologically confirmed ameloblastoma were identified. Out of 15 patients nine were males and six were females with age range from 20 to 60 years (mean age 43 years). The most common symptom found in our patient group was painless facial swelling. In 13 patients the origin of tumor was mandible and in the remaining two the tumor originated from maxilla. Eleven out of 15 patients underwent segmental mandibulectomy, two had maxillectomy and two had enucleation. All patients who underwent segmental mandibulectomy required reconstruction. Reconstruction was done with microsurgical free tissue transfer in eight patients, non-vascularized iliac crest bone graft was used in one patient and two had plating only. All free flaps survived with no evidence of flap loss. The mean follow-up was eight years. There was no evidence of graft failure which was used in one patient. Complication was seen in only one of our patients in the form of plate exposure. Recurrence was seen in two of our cases who primarily underwent enucleation. All patients had satisfactory speech, cosmesis and mastication. Conclusion The management of ameloblastoma still poses a big challenge in spite of being the most common odontogenic tumor. In our study we have found that segmental mandibulectomy with disease-free margin of around 1 cm and immediate reconstruction with free tissue transfer have shown good results.
PubMed: 30546984
DOI: 10.7759/cureus.3437 -
L' Orthodontie Francaise Jun 2016
Topics: Dental Research; Esthetics; Face; Genioplasty; Humans; Malocclusion; Mandible; Mandibular Advancement; Mandibular Osteotomy; Orthodontics, Corrective; Orthognathic Surgical Procedures; Osteogenesis, Distraction; Patient Care Planning
PubMed: 27358002
DOI: 10.1051/orthodfr/2016021 -
Australian Dental Journal Mar 2018Facial Osteotomy techniques have evolved enormously over the past 20 years providing significant and often life-changing benefits to our dental patients with skeletal...
Facial Osteotomy techniques have evolved enormously over the past 20 years providing significant and often life-changing benefits to our dental patients with skeletal malocclusions. Advancements in technology and refined surgical techniques have resulted in improvements in surgical outcomes, a reduction in post-operative complications and a quicker recovery for today's patients undergoing orthognathic surgery. This paper aims to an update on the contemporary approach to the correction of skeletal malocclusions with facial osteotomies.
Topics: Adolescent; Adult; Dentistry; Face; Facial Bones; Female; Humans; Male; Malocclusion; Mandible; Maxilla; Orthognathic Surgical Procedures; Osteotomy; Osteotomy, Le Fort; Postoperative Period; Plastic Surgery Procedures; Young Adult
PubMed: 29574821
DOI: 10.1111/adj.12590