Lajos Olasz

A combined treatment for advanced oral cavity cancers

Effects of preoperative chemotherapy with three courses of a combination of bleomycin, vincristine, mitolactol, prednisone, and methotrexate, with a leucovorin rescue, followed by surgery were studied in 43 patients with advanced squamous cell carcinoma of the oral region. Before chemotherapy 34 patients (79%) had Stage III or IV carcinomas whereas nine patients had Stage II lesions. The clinical response was very encouraging: 20 patients (46%) achieved a clinical complete response and 23 patients (54%) were judged as partial responders. Side effects of this chemotherapy were minimal and reversible. Between 15 and 22 days after the last course of chemotherapy patients went to surgery. Wound healing complications did not occur. The surgical specimens were tested microscopically. The microphotographs showed small tumor rests with giant cells bordered by fibrous scar tissue and separated from the healthy tissues. With a median follow‐up of 36 months (range, 21–58 months) 74% of patients are alive and 70% remain disease‐free. Eleven patients died but only five (11%) because of the failure of the therapy. This combined therapy appears both safe and promising treatment for advanced squamous cell carcinomas of the oral cavity. A further follow‐up study needed to confirm the promising 5‐year results.

Digital versus conventional panoramic radiography in predicting inferior alveolar nerve injury after mandibular third molar removal.

AbstractThe aim of the study was to compare the accuracy of conventional and digital panoramic radiography (OPG) in relation to 4 specific high-risk signs (interruption of the superior cortical line, diversion, narrowing of the canal, and dark band of the root), which would indicate a close anatomic relationship between third molar roots and the inferior alveolar canal.Four hundred mandibular third molar surgical removals after conventional and 272 after digital radiographs were evaluated in the study. The association between postoperative inferior alveolar nerve (IAN) paresthesia and the presence of any preoperative high-risk signs in the OPG was investigated. Bivariate and multivariate logistic regression analyses were completed to compare the accuracy of conventional and digital radiographic techniques detecting high-risk signs predicting possible IAN paresthesia.Digital OPG results showed significantly higher sensitivity in diversion (P = 0.014) and narrowing (P < 0.002) of the canal, whereas the specificity of these signs was significantly lower (P < 0.001 and P = 0.035). The likelihood ratio analysis and multivariate logistic regression analysis did not prove the significant difference between digital and conventional imaging according to the examined high-risk signs. Positive predictive values of the signs were found in conventional radiography between 3.6% and 10.9%, whereas in the digital images, it ranged from 2.9% to 7.9%.The results of this study failed to prove significant difference between the accuracy of digital and conventional OPG for predicting IAN paresthesia, whereas low positive predictive values indicate both imaging techniques as inadequate screening methods for predicting IAN paresthesia after mandibular third molar removal.

Surgical closures of oropharyngocutaneous fistulas.

Of the 146 patients undergoing surgery for oropharyngeal cancer in our institution, 12 (8.2 percent) developed fistulas. As a first line of therapy, conservative measures were used, which consisted of debridement, Xeroform gauze packing, and nasogastric feeding. Seven fistulas closed after conservative treatment. Of the five patients who required surgery for fistula closure, three had large (more than 20 mm) and two had mid-size (5- to 20-mm) fistulas. In all cases, internal flaps were prepared from the healthy viable tissues surrounding the fistula, and sternocleidomastoid-trapezius-platysma myocutaneous flaps were used for external closure. None of the closures failed, and we obtained good functional and aesthetic results.

Application of Platysma-Based Transpositional Flap for Through-and-Through Facial Defect When the Facial Artery Circulation Is Blocked or Compromised

PURPOSE A novel use of site-limited platysma-based transpositional flap is demonstrated and discussed for the reconstruction of facial defects. MATERIALS AND METHODS Between January 1985 and January 2001, 342 patients were operated on for advanced oral-oropharyngeal and orofacial cancers. In 6 cases, a platysma-based transpositional flap was used for external closure of facial through-and-through defects. Internally, the saved oral mucosa was used in 4 patients and fasciocutaneous forearm free flaps in 2 patients. The facial artery was blocked in all cases. RESULTS The postoperative course was uneventful except in 1 case, when partial loss of the flap was observed intraorally. The externally used transpositional platysma-based flap showed cosmetic and functional advantages: its consistency, color, and texture were similar to those of the original facial tissues, the area of operation was the same, and the donor site was closed primarily. CONCLUSION The site-limited platysma-based myocutaneous transpositional flap is usable and safe even in those cases in which circulation of the facial artery is damaged or local vascular compromise has occurred and the facial through-and-through defect is extended. The facial reconstruction described is one of several applicable reconstructive methods that may be chosen for special facial defects. The method is not applicable when the neck is radically operated on (radical neck dissection) and/or irradiated. No similar use of platysma-based transpositional flaps has been reported thus far.

Transgingival lag-screw osteosynthesis of alveolar process fracture

Fracture of the alveolar process is a common injury. In some cases, traditional fixation may not be possible. The teeth needed for splinting or mandibulo-maxillary fixation may be missing. The fracture line and soft tissue injury may jeopardize the blood supply of the broken bone. In these extreme and rare situations, the best rehabilitation is needed to avoid the loss of hard and soft tissues, and a secondary reconstruction is required. Between January 2003 and December 2006, of 468 cranio-facial trauma patients studied, alveolar process fracture was reported in 28 (6%) cases. In six (1%) cases, the anatomy of the fracture lines, and the position and number of the remaining teeth made splinting and mandibulo-maxillary fixation impossible. Patients were treated with a transgingival lag-screw (TLS) osteosynthesis. All patients healed well with no complications. There was no bone or tooth loss in the surgical area, and broken fragments were not absorbed. The TLS technique is recommended for alveolar fractures when the blood supply is jeopardized and dental splinting or mandibulo-maxillary fixation is not possible. There is no need for flap reflection.

Intraosseous Heat Production and Preparation Efficiency of Surgical Tungsten Carbide Round Drills: The Effect of Coronectomy on Drill Wear

PURPOSE The aim of this in vitro study was to examine the effects of surgical drill wear after coronectomy on bone temperature changes and preparation times for bone cavity drilling. MATERIALS AND METHODS Tungsten carbide round drills were used to perform 10 (D_10), 20 (D_20), or 30 (D_30) coronectomies on extracted lower third molars to elicit drill wear, and then 5-mm-deep cavities were drilled in pig ribs with a testing apparatus-controlled surgical unit. Temperature changes and preparation times were measured. Differences in mean values were examined with analyses of variance and the Tukey honest significant difference post hoc test. RESULTS The unused drills prepared the holes significantly faster (2.52 ± 1.6 seconds) than the D_20 (13.29 ± 5.76 seconds) and D_30 (31.48 ± 12.93 seconds) drills (P = .01 and P < .001, respectively). The D_10 (change, 2.33 ± 0.77°C), D_20 (change, 2.57 ± 0.57°C), and D_30 (change, 3.94 ± 0.62°C) drills produced significantly more heat than the D_0 drills (change, 1.18 ± 0.28°C; P < .001). At higher axial pressures of 25 N (to provoke ≤ 3-second preparation times in line with new drills), the D_30 drills produced a temperature change of 6.31 ± 1.23°C with 60 mL/minute and significantly more heat (change, 20.48 ± 8.84°C; P < .001) with 20 mL/minute of irrigation. CONCLUSIONS Intraosseous heat produced by surgical tungsten carbide round drills remains under the threshold temperature of bone necrosis for up to 30 coronectomies; however, the use of increased axial pressure (∼ 25 N), especially with the combination of decreased irrigation (∼ 33%), can cause unacceptable temperatures during bone removal. Professionals should select drills and drilling parameters that generate an acceptable amount of heat during surgical tooth removal.

Proteomic and scanning electron microscopic analysis of submandibular sialoliths

ObjectivesSeveral theories have been proposed regarding the genesis of sialoliths, including the organic core theory, which suggests epithelial or bacterial etiology originating in the central core. Our aim was to use novel methodologies to analyze central areas (the core) of calculi from sialolithiasis patients.Materials and methodsThe structures of the halves of six submandibular salivary stones were analyzed by scanning electron microscopy (SEM). After structural analysis, from the other six halves, samples from the central parts of the core and peripheral parts of the core were digested with trypsin and analyzed by matrix-assisted laser desorption ionization–time of flight mass spectrometry. The peptide mass fingerprints were compared with the results of in silico digestion.ResultsSEM analysis of the sialoliths showed that organic structures (collagen/fibrous-like structures, bacterial fragments) were visible only outside of the core in the concentric layers of external areas, but not in the core area. The mass spectrometry (MS)/MS post-source decay experiments were completed from the four, most intense signals observed in the MS spectrum and human defensin was proven to be present in three of the examined samples, originated from the peripheral region of three cores.ConclusionsAlthough proteomic analysis demonstrated defensin protein in the peripheral region of the core in three sialoliths, SEM failed to prove organic structures in the core.Clinical relevanceNew investigation modalities still cannot prove organic structures in the core, henceforward challenging the organic core theory.

Closure of an oropharyngocutaneous fistula in an irradiated patient: A case report

A case of oropharyngocutaneous fistula is presented in a preoperatively irradiated patient. A double-layer closure, using a modified Owens flap, was used to obtain a satisfactory result.

A gyógyszer indukálta vérzékeny betegek fogorvosi, szájsebészeti ellátása: a 2015-ös hazai szakmai ajánlás alkalmazása és értékelése

Absztrakt Bevezetes: A Magyar Arc-, Allcsont- es Szajsebeszeti Tarsasag es a Magyar Fogorvosok Implantologiai Tarsasaga altal 2015-ben elfogadasra kerult „A gyogyszer indukalta verzekeny betegek fogorvosi ellatasa” szakmai ajanlas. Celkitűzes: A szerzők celja volt az ajanlasban leirt lokalis verzescsillapitasi modszerek hatekonysaganak, megbizhatosaganak ellenőrzese. Modszer: Az oralis antithromboticus kezelesben reszesulő betegeiknel vizsgaltak a fogorvosi, szajsebeszeti ellatasukat kovető utoverzesek előfordulasat, retrospektiv modon. Eredmenyek: 263, verzessel jaro beavatkozas tortent (186 betegnel), amelyből 138 K-vitamin-antagonista, 97 thrombocytaaggregacio-gatlo es 6, ugynevezett uj tipusu oralis antikoagulans kezelesben reszesulő betegeknel. Osszesen 6 (2,3%) esetben tapasztaltak utoverzest az egyoras kontrollnal, mig ugyeletbe 1 beteg jott vissza utoverzes miatt (0,5%). Ezzel szemben 86-an jelentkeztek ugyeletukon, akiknel az ajanlast nem vettek figyelembe, kozuluk K-vitamin-antagonista gyogyszer...