Joseba Santamaría

Sentinel Node Biopsy in Head and Neck Cancer: Preliminary Results of a Multicenter Trial

Background: The aim was to determine the reliability and reproducibility of sentinel node biopsy (SNB) as a staging tool in head and neck squamous cell carcinoma (HNSCC) for T1/2 clinically N0 patients by means of a standardized technique.Methods: Between June 1998 and June 2002, 227 SNB procedures have been performed in HNSCC cases at six centers. One hundred thirty-four T1/2 tumors of the oral cavity/oropharynx in clinically N0 patients were investigated with preoperative lymphoscintigraphy (LSG), intraoperative use of blue dye/gamma probe, and pathological evaluation with step serial sectioning and immunohistochemistry, with a follow-up of at least 12 months. In 79 cases SNB alone was used to stage the neck carcinoma, and in 55 cases SNB was used in combination with an elective neck dissection (END).Results: In 125/134 cases (93%) a sentinel node was identified. Of 59 positive nodes, 57 were identified with the intraoperative gamma probe and 44 with blue dye. Upstaging of disease occurred in 42/125 cases (34%): with hematoxylin-eosin in 32/125 (26%) and with additional pathological staging in 10/93 (11%). The sensitivity of the technique with a mean follow-up of 24 months was 42/45 (93%). The identification of SNB for floor of mouth (FOM) tumors was 37/43 (86%), compared with 88/91 (97%) for other tumors. The sensitivity for FOM tumors was 12/15 (80%), compared with 30/30 (100%) for other tumor groups.Conclusion: SNB can be successfully applied to early T1/2 tumors of the oral cavity/oropharynx in a standardized fashion by centers worldwide. For the majority of these tumors the SNB technique can be used alone as a staging tool.

Does Tumor Depth Affect Nodal Upstaging in Squamous Cell Carcinoma of the Head and Neck

Purpose: The aim of this study was to determine whether tumor depth affects upstaging of the clinically node‐negative neck, as determined by sentinel lymph node biopsy with full pathologic evaluation of harvested nodes including step‐serial sectioning (SSS) and immunohistochemistry (IHC).

Radiologic variables of clinical significance in the extraction of impacted mandibular third molars

OBJECTIVE To determine which radiologic variables have a clinical significance in the extraction of impacted mandibular third molars. STUDY DESIGN A prospective study was carried out on 100 consecutive extractions of unilateral impacted mandibular third molars (60 women and 40 men, mean age: 26.27 +/- 10.63 years). Fourteen radiologic variables were ordinally evaluated, establishing their relation to the surgical intervention time. The Kruskal-Wallis test, a multivariant analysis of the principal components, the Pearson correlation coefficient, and logistical regression tests were carried out. RESULTS Seven variables (occlusal plane, relation to the second molar, depth, follicle, periodontal ligament width, ramus of the mandible, and angulation) demonstrated a statistically significant relation to the surgical intervention time (Kruskal-Wallis tests, p < 0.007). Two associated variables, depth and periodontal ligament width, showed the most powerful and simple relation to the surgical intervention time (r2 multiple = 0.307, p < 0.001). CONCLUSION The model we propose is a tool that may help the general practitioner to establish competence in an extraction of the impacted mandibular third molar by measuring the association of two radiologic variables: depth and periodontal ligament width.

Efficacy of Amoxicillin Treatment in Preventing Postoperative Complications in Patients Undergoing Third Molar Surgery: A Prospective, Randomized, Double-Blind Controlled Study

PURPOSE The aim of the present study was to evaluate and compare the occurrence of postoperative complications in patients receiving either pre- or postoperative amoxicillin versus placebo after third molar surgery. PATIENTS AND METHODS A randomized, double-blind, placebo-controlled clinical trial was performed in 123 patients undergoing third molar surgery. The patients were randomized to 3 groups, according to the treatment regimen: preoperative amoxicillin, postoperative amoxicillin, and placebo. Both surgeon and patients were unaware of the treatment assignment. The clinical outcomes, including pain, wound infection, trismus, temperature, intra- and extraoral swelling, dysphagia, side effects, and postoperative complications, were assessed. RESULTS Statistically significant differences were found in the incidence of pain, wound infection, temperature, trismus, and dysphagia between the groups receiving amoxicillin versus placebo. Suture dehiscence and infection of 5 sockets were only found in the placebo group. No cases of alveolitis were observed in the 3 groups studied. No significant differences in swelling were found among the different groups. No statistically significant differences in side effects were found between the groups. The efficacy was greatest in the group receiving postoperative amoxicillin compared with the group receiving a prophylactic preoperative dose. CONCLUSION Amoxicillin administered pre- or postoperatively demonstrated greater efficacy than placebo in preventing postoperative complications in patients undergoing third molar surgery. The best results were obtained using the postoperative protocol.

Bone regeneration after radicular cyst removal with and without guided bone regeneration.

In order to determine the degree of bone regeneration after removal of radicular cysts using guided bone regeneration (GBR), a prospective, controlled and randomized clinical study was performed. Thirty patients with radicular cysts were divided into three groups. One group, the control group (n=10 patients), was treated by enucleation and primary closure. The other two groups were treated by enucleation and primary closure but GBR was used in addition, using a resorbable membrane (n=10) and a nonresorbable membrane (n=10). The membranes were fixed with nonresorbable Memfix System screws. The residual volume and the density of the newly formed tissue was measured by computer-assisted tomography and computer-assisted digital image analysis before enucleation and three and six months postoperatively. No statistical significance was found in density and residual volume between the three treatment groups after six months. These results suggest that GBR using membranes does not contribute to increased bone regeneration.

Immunohistochemical localization of neurotrophins and neurotrophin receptors in human and mouse salivary glands

This study was undertaken to analyze the occurrence of low- (p75) and high-affinity (TrkA, TrkB and TrkC) neurotrophin receptor proteins in human and mouse salivary glands using immunohistochemistry. Furthermore, the presence of neurotrophins was also investigated. The study was carried out on 14 human (4 parotid, 6 submandibular and 4 sublingual glands) and 5 mouse salivary glands, using polyclonal antibodies against Trk proteins. The intensity of immunostaining was calculated automatically and evaluated in arbitrary units of grey levels. In human tissues no immunoreactivity (IR) for the assessed antigens was observed in the serous or mucous acinar cells, although TrkA IR was found in the acini of the submandibular gland. The cells of the intercalated ducts showed p75 IR (sublingual) and TrkA IR (parotid gland). The striated and excretory ducts displayed p75 IR, TrkA IR and TrkC IR in all glands, but TrkB IR was never detected. No neurotrophins were detected. In the mouse glands the ductal cells display IR for p75 (submandibular) and Trks A and C (parotid and submandibular) but not the sublingual gland. Acinar cells of the submandibular gland also show p75 IR. The only neurotrophin found in the mouse salivary glands was NGF (submandibular gland). These results suggest that neurotrophins may be involved in controlling the physiology of epithelial salivary cells.

Sentinel node biopsy in relation to survival in floor of the mouth carcinoma

Promising results have been obtained with sentinel node biopsy (SNB) in early oral carcinoma, but the floor of the mouth remains a site at risk of misdiagnosis. A retrospective and prospective study was designed to test the safety of SNB by comparing survival among patients with early stage carcinoma of the floor of the mouth (FOM) undergoing SNB, to a control group managed traditionally by a combination of clinical observation and elective neck dissection (END). A total of 63 patients with early stage carcinoma of the FOM were treated between 1991 and 2005. In the control group, 26 patients were managed with END and nine by close observation. In the test group, 28 patients were managed prospectively with SNB. Regional recurrence occurred in 23% (8/35) of control patients and 25% (7/28) of test patients. Approximately 25% of patients were successfully treated by salvage surgery. Disease-specific survival was 65.5% for control patients and 85% for SNB patients; the difference was not statistically significant. The use of SNB in the management of cancers of the FOM did not adversely affect survival and prevented 69.5% of patients undergoing unnecessary neck dissections, while clinical progress was better in the SNB group than in controls.

Metastasis of a malignant melanoma to the region of an impacted mandibular third molar: A case report☆

6. Eversole LR, Sabes WR: Minor salivary gland duct changes due to obstruction. Arch Otolaryngol 94:19, 1971 7. Nasu M, Takagi M, Ishikawa G: Sialadenoma papilliferum: Report of case. J Oral Surg 39:367, 1981 8. Shirasuna K, Watatani K, Miyazaki T: Ultrastructure of a sialadenoma papilliferum. Cancer 53:468, 1984 9. Fantasia JE, Nocco CE, Lally ET: Ultrastructure of sialadenoma papilliferum. Arch Path01 Lab Med 110:523, 1986 10. Nakahata A, Deguch H, Yanagawa T, et al: Coexpression of intermediatesized filaments in sialadenoma papilliferum and other salivary gland neoplasms. J Oral Path01 Med 19:313, 1990 Il. Cracker DJ, Christ TF, Cavalaris CJ: Sialadenoma papilliferum: Report of case. J Oral Surg 30:520, 1972 12. Jensen JL, Reingold IM: Sialadenoma papilliferum of the oral cavity: Report of a case. Oral Surg 35:521, 1973 13. Whittaker JS, Turner EP: Papillary tumors of the minor salivary glands. J Clin Path01 29:795, 1976 14. Drummond JF, Giansanti JS, Sabes WR, et al: Sialadenoma papilliferum of the oral cavity. Oral Surg 45:72, 1978 15. Freedman PD, Lumerman H: Sialadenoma papilliferum. Oral Surg 45:88, 1978 16. McCoy JM, Eckert EF: Sialadenoma papilliferum. J Oral Surg 38:691, 1980 17. Wertheimer FW, Burk K, Ruskin WJ: Sialadenoma papilliferum. Int J Oral Surg 12:190, 1983 18. Grushka M, Podoshin L, Boss JH: et al: Sialadenoma papilliferum of the parotid gland. Laryngoscope 94:231, 1984 19. Puts JJG, Voorsmit RACA, van Haelst UJGM: Sialadenoma papilliferum of the palate. J Maxillofac Surg 12:90, 1984 20. Regezi JA. Lloyd RV, Zarbo RJ, et al: Minor salivary gland tumors: A histologic and immunohistochemical study. Cancer 55:108, 1985 21. Bass KD, Cosentino BJ: Sialadenoma papilliferum. J Oral Maxillofac Surg 43:302, 1985 22. Chan KW, Ng WL, Lau WF: Sialadenoma papilliferum. Pathology 17:119, 1985 23. Papanicolaou SJ, Triantafyllou AG: Sialadenoma papilliferum of the oral cavity: A case report and review of the literature. J Oral Med 42:57, 1987 24. Kronenberg J, Horowitz A, Leventon G: Sialadenoma papilliferum of the parotid gland. J Laryngol Otol 103:1089, 1989 25. van der Wal JE, van der Waal I: The rare sialadenoma papilliferum: Report of a case and review of the literature. Int J Oral Maxillofac Surg 21:104, 1992

Survey of Spanish dentists on the prescription of antibiotics and antiseptics in surgery for impacted lower third molars

Background This study explored the attitude of registered dentists in Biscay towards prescribing antibiotics and/or antiseptics to prevent potential infections after surgical extraction of completely bone-impacted third molars in otherwise healthy individuals, with no history of infection. Material and Methods We sent letters to 931 registered dentists in Biscay, with an explanation of the study objectives, description of a case of lower third molar impaction, including a panoramic radiograph, and a questionnaire. The questionnaire asked whether they would prescribe antibiotics and/or antiseptics, in the hypothetical case of lower third molar extraction surgery presented, and if so, when, what type, at what dose and how long for. Results The questionnaire was completed by 261 dentists (28%), with a mean age of 44.3 years old (SD 11.05) and mean of 18.7 years working as a dentist (SD 9). A total of 216 dentists (82.7%) considered it necessary to prescribe antibiotics. Of these, 126 (58.3%) would prescribe amoxicillin and 74 (34.5%) amoxicillin/clavulanic acid, while 129 dentists (59%) would prescribe antibiotics both before and after surgery and 10 (4.6%) only after surgery. The most common doses were amoxicillin 500 mg or 750 mg every 8 hours, and amoxicillin/clavulanic acid 875/125 mg every 8 hours, in both cases for a mean of 7 days. Further, 74 dentists (28%) said they would use immediate post-extraction socket irrigation with chlorhexidine, while 211 (81%) would prescribe antiseptics in the postoperative period, of whom 97% recommended chlorhexidine. We did not find significant differences in the use of antibiotics or antiseptics by dentist age (ANOVA p=0.22 and p=0.53, respectively), or professional experience (ANOVA p=0.45 and p=0.62). Conclusions In our sample, the prophylactic prescription of antibiotics and/or chlorhexidine is widespread in clinical practice, in most cases amoxicillin and amoxicillin/clavulanic acid for a week, starting the treatment before surgery. Key words:Extraction, lower third molar, survey, antibiotics, antiseptics.

Efficacy of amoxicillin and amoxicillin/clavulanic acid in the prevention of infection and dry socket after third molar extraction. A systematic review and meta-analysis

Background Prophylactic use of amoxicillin and amoxicillin/clavulanic acid, although controversial, is common in routine clinical practice in third molar surgery. Material and Methods Our objective was to assess the efficacy of prophylactic amoxicillin with or without clavulanic acid in reducing the incidence of dry socket and/or infection after third molar extraction. We conducted a systematic review and meta-analysis consulting electronic databases and references in retrieved articles. We included double-blind placebo-controlled randomized clinical trials published up to June 2015 investigating the efficacy of amoxicillin with or without clavulanic acid on the incidence of the aforementioned conditions after third molar extraction. Relative risks (RRs) were estimated with a generic inverse-variance approach and a random effect model using Stata/IC 13 and Review Manager Version 5.2. Stratified analysis was performed by antibiotic type. Results We included 10 papers in the qualitative review and in the quantitative synthesis (1997 extractions: 1072 in experimental groups and 925 in controls, with 27 and 74 events of dry socket and/or infection, respectively). The overall RR was 0.350 (p< 0.001; 95% CI 0.214 to 0.574). We found no evidence of heterogeneity (I2=0%, p=0.470). The number needed to treat was 18 (95% CI 13 to 29). Five studies reported adverse reactions (RR=1.188, 95% CI 0.658 to 2.146, p =0.567). The RRs were 0.563 for amoxicillin (95% CI 0.295 to 1.08, p=0.082) and 0.215 for amoxicillin/clavulanic acid (95% CI 0.117 to 0.395, p<0.001). Conclusions Prophylactic use of amoxicillin does not significantly reduce the risk of infection and/or dry socket after third molar extraction. With amoxicillin/clavulanic acid, the risk decreases significantly. Nevertheless, considering the number needed to treat, low prevalence of infection, potential adverse reactions to antibiotics and lack of serious complications in placebo groups, the routine prescription of amoxicillin with or without clavulanic acid is not justified. Key words:Meta-analysis, amoxicillin, infection, removal, dry socket, third molar.