Pedro Infante-Cossio

Impact of treatment on quality of life for oral and oropharyngeal carcinoma.

This study evaluates the changes in quality of life (QoL) from pre-treatment to 3 years after commencement of treatment and its relation to therapeutic variables in patients with oral and oropharyngeal carcinoma. QoL was assessed using the EORTC QLQ-C30 questionnaires and the EORTC head and neck cancer specific module QLQ-H&N35. QoL data were obtained prior to treatment and 1 and 3 years after treatment began. Of 128 patients, 69 completed all the questionnaires over the course of 3 years. Variable deterioration of QoL scores was detected before treatment. Most of the parameters worsened significantly after treatment and during the first year, and improved by the third year. Patients who underwent surgical treatment combined with adjuvant radiotherapy and chemotherapy generally showed worse scores and needed a long time to recover from the disease and the treatment adverse effects. This long-term prospective study performed using the EORCT questionnaires in a homogeneous group of patients with oral and oropharyngeal carcinoma may allow better understanding of the impact of treatment and the changes in QoL that occur.

Reconstruction of a Severe Facial Defect by Allotransplantation in Neurofibromatosis Type 1: A Case Report

BACKGROUND On January 26, 2010, our team performed a facial transplant for a patient with neurofibromatosis type 1. We detail the perioperative surgical strategies for the composite tissue allograft (CTA) of the lower parts of the face to restore a severe defect after excision of bilateral massive plexiform neurofibromas. The main distinctive feature included an innovative provisional heterotopic transplantation (PHT) technique of the facial allograft to the femoral vessels before its final orthotopic transplantation. CASE REPORT A 35-year-old Caucasian man received a CTA of the lower two-thirds of the face, including a chin osseous segment. The face was obtained from a non-heart-beating donor. The sequence of microsurgical procedures began by performing a PHT of the CTA to the recipients femoral vessels in the right thigh. Intraoperatively, he experienced considerable blood loss that required transfusion of 24 units of packed cells. Surgical revision was required at day 7 to remove an extensive hematoma in the right side of the CTA. The maintenance immunosuppressive regimen included steroids, mycophenolate mofetil, and tacrolimus. CONCLUSION We have reported a case of successful provisional transplantation of a human facial allograft onto the thigh as an alternative technique in human face transplantation. PHT was a reliable alternative procedure to obtain the facial allograft from a cadaveric donor.

Quality of life in patients with oral and oropharyngeal cancer.

Quality of life (QoL) is an important aspect in the clinical assessment and management of patients with cancer. The aim of the present study was to evaluate QoL at the time of diagnosis in patients with oral and oropharyngeal cancer and to establish the influence of variables such as gender, age, tumor location and tumor staging. The authors studied 149 patients with oral and oropharyngeal cancer for 2 years. QoL was measured using the EORTC QLQ-C30 and its specific modules for head and neck cancer QLQ-H&N 35. Variable deterioration of QoL was observed before therapy. The emotional domain showed the greatest alterations, while pain was the most remarkable symptom variable. QoL seems to be associated with gender (female patients obtained worse scores in most of the functional scales), age (patients < 65 years scored better), tumor location (orpharyngeal tumors showed worse prognosis) and tumor staging (early stages obtained better scores than advances ones). Many patients with oral and oropharyngeal cancer show poor QoL before initiating treatment. The present study of a homogeneous group of patients is the first carried out in Spain following the EORTC QLQ-C30 questionnaire and its results may serve for future reference. These results are similar to those obtained in populations from the north and centre of Europe.

Efficacy and Safety of Sodium Hyaluronate in the Treatment of Wilkes Stage II Disease

PURPOSE To show whether an intra-articular (IA) infiltration of 1 mL sodium hyaluronate (SH) into the temporomandibular joint (TMJ) would significantly reduce pain and improve joint function in Wilkes stage II disease, compared with the oral administration of a combination of methocarbamol and paracetamol. PATIENTS AND METHODS Forty-one patients with Wilkes stage II disease were selected and randomly assigned to 2 groups. The experimental group received 1 IA infiltration of SH with assessments at days 14, 28, 56, and 84. The control group was given 2 tablets of a combination of methocarbamol 380 mg and paracetamol 300 mg every 6 hours for 4 weeks, with assessments at days 14 and 28. RESULTS Forty-one patients were randomized into the study (SH: 20 patients, control drug: 21 patients). A statistically significant difference (P < . 05) was detected in favor of the SH group from day 56 onward for TMJ pain at rest, from day 14 onward for pain on jaw opening, and at days 28 and 56 for pain on mastication. The TMJ function was statistically significantly (P < .05) better in the test group at all follow-up visits. The global evaluation of efficacy by both, the patients and investigators, was better for the test group. No adverse reactions were detected with SH. CONCLUSIONS An IA infiltration of SH showed better efficacy in reducing pain and improving joint function in Wilkes stage II disease, compared with the oral administration of methocarbamol-paracetamol tablets.

Use of a three-dimensional virtual reality model for preoperative imaging in DIEP flap breast reconstruction.

BACKGROUND The significant variation in the vascular anatomy of the abdominal wall makes preoperative imaging essential when raising a deep inferior epigastric artery perforator (DIEP) flap due to the potential for maximizing operative success, reducing intraoperative error and minimizing operative complications. Computerized models and virtual reality applications are being used to facilitate teaching and preoperative evaluation in a number of other complex anatomical regions. The variability in perforator anatomy makes DIEP flap surgery a suitable candidate for application of such technology. In this context, a study was undertaken to determine the feasibility of computed tomography angiography (CTA)-guided VirSSPA three-dimensional (3D) software for virtual reality navigation in DIEP flap surgery and to compare findings with operative measurements. MATERIALS AND METHODS We recruited 12 consecutive patients planned for an elective DIEP flap for breast reconstruction. Each patient underwent preoperative imaging of the anterior abdominal wall vasculature with both conventional CTA and VirSSPA 3D reconstruction. Imaging findings were compared with operative findings. RESULTS In all cases, the major perforators were accurately localized using both methods. 3D reconstruction of the abdominal wall with VirSSPA demonstrated a significant good correlation with perforator location compared with operative findings, showing an average error rate of 0.23cm (95% CI, 0.17-0.30). CONCLUSION In short, the main advantage of VirSSPA, when used in conjunction with an image assessment such as CTA, is to provide additional and potentially more accurate data over conventional CTA with regard to the site of the best perforators and its course through the muscle.

Ectopic third molar in the mandibular condyle: a review of the literature.

Objectives: To evaluate the etiopathogenesis, clinical features, therapeutic options, and surgical approaches for removal of ectopic third molars in the mandibular condyle. Study design: MEDLINE search of articles published on ectopic third molars in the mandibular condyle from 1980 to 2011. 14 well-documented clinical cases from the literature were evaluated together with a new clinical case provided by the authors, representing a sample of 15 patients. Results: We found a mean age at diagnosis of 48.6 years and a higher prevalence in women. In 14 patients, associated radiolucent lesions were diagnosed on radiographic studies and confirmed histopathologically as odontogenic cysts. Clinical symptoms were pain and swelling in the jaw or preauricular region, trismus, difficulty chewing, cutaneous fistula and temporomandibular joint dysfunction. Treatment included conservative management in one case and in the other cases, surgical removal by intra- or extraoral approaches, the latter being the most common approach carried out. In most reported cases, serious complications were not outlined. Conclusions: The etiopathogenic theory involving odontogenic cysts in the displacement of third molars to the mandibular condyle seems to be the most relevant. They must be removed if they cause symptoms or are associated with cystic pathology. The surgical route must be planned according to the location and position of the ectopic third molar, and the possible morbidity associated with surgery. Key words:Third molar, ectopic tooth, condyle, mandible.

Treatment of temporomandibular myofascial pain with deep dry needling

Objectives: The present study was designed to evaluate the usefulness of deep dry needling in the treatment of temporomandibular myofascial pain. Study Design: We selected 36 patients with myofascial pain located in the external pterygoid muscle (30 women/6 men, mean age=27 years with SD±6,5). We studied differences in pain with a visual analog scale and range of mandibular movements before and after intervention. Results: We found a statistically significant relationship (p<0,01) between therapeutic intervention and the improvement of pain and jaw movements, which continued up to 6 months after treatment. Pain reduction was greater the higher was the intensity of pain at baseline. Conclusions: Although further studies are needed, our findings suggest that deep dry needling in the trigger point in the external pterygoid muscle can be effective in the management of patients with myofascial pain located in that muscle. Key words:Temporomandibular joint, myofascial pain, external pterygoid muscle, trigger point, deep dry needling.

Deep dry needling of trigger points located in the lateral pterygoid muscle: Efficacy and safety of treatment for management of myofascial pain and temporomandibular dysfunction

Background To determine whether deep dry needling (DDN) of trigger points (TPs) in the lateral pterygoid muscle (LPM) would significantly reduce pain and improve function, compared with methocarbamol/paracetamol medication. Material and Methods Forty-eight patients with chronic myofascial pain located in the LPM were selected and randomly assigned to one of two groups (DDN test group, n=24; drug-treated control group, n=24). The test group received three applications of needling of the LPM once per week for three weeks, while control group patients were given two tablets of a methocarbamol/paracetamol combination every six hours for three weeks. Assessments were carried out pretreatment, 2 and 8 weeks after finishing the treatment. Results A statistically significant difference (p<0.05) was detected for both groups with respect to pain reduction at rest and with mastication, but the DDN test group had significantly better levels of pain reduction. Moreover, statistically significant differences (p<0.05) up to day 70 in the test group were seen with respect to maximum mouth opening, laterality and protrusion movements compared with pretreatment values. Pain reduction in the test group was greater as a function of pain intensity at baseline. The evaluation of efficacy as assessed both by patients/investigators was better for the test group. 41% of the patients receiving the combination drug treatment described unpleasant side effects (mostly drowsiness). Conclusions DDN of TPs in the LPM showed better efficacy in reducing pain and improving maximum mouth opening, laterality, and protrusion movements compared with methocarbamol/paracetamol treatment. No adverse events were observed with respect to DDN. Key words: Myofascial pain syndrome, myofascial trigger points, deep dry needling, lateral pterygoid muscle, randomized controlled trial, temporomandibular disorders.

First Face Composite-Tissue Transplant Recipient Successfully Treated for Cytomegalovirus Infection with Preemptive Valganciclovir Treatment

ABSTRACT Little is known about cytomegalovirus (CMV) infection after face transplantation, since only two of the 11 cases of face transplantation reported worldwide have documented a CMV infection after transplantation. Herein, we present the first report of a composite-tissue face allotransplant recipient at high risk for CMV infection (D+/R− [CMV serpositive donor positive/CMV seronegative receptor]) undergoing preemptive treatment. Preemptive treatment was safe and effective for controlling CMV infection and thus promoting early acquisition of a CMV-specific immune response that protected the patient from late-onset CMV disease.

Facial transplantation: A concise update

Objectives: Update on clinical results obtained by the first worldwide facial transplantation teams as well as review of the literature concerning the main surgical, immunological, ethical, and follow-up aspects described on facial transplanted patients. Study design: MEDLINE search of articles published on “face transplantation” until March 2012. Results: Eighteen clinical cases were studied. The mean patient age was 37.5 years, with a higher prevalence of men. Main surgical indication was gunshot injuries (6 patients). All patients had previously undergone multiple conventional surgical reconstructive procedures which had failed. Altogether 8 transplant teams belonging to 4 countries participated. Thirteen partial face transplantations and 5 full face transplantations have been performed. Allografts are varied according to face anatomical components and the amount of skin, muscle, bone, and other tissues included, though all were grafted successfully and remained viable without significant postoperative surgical complications. The patient with the longest follow-up was 5 years. Two patients died 2 and 27 months after transplantation. Conclusions: Clinical experience has demonstrated the feasibility of facial transplantation as a valuable reconstructive option, but it still remains considered as an experimental procedure with unresolved issues to settle down. Results show that from a clinical, technical, and immunological standpoint, facial transplantation has achieved functional, aesthetic, and social rehabilitation in severely facial disfigured patients. Key words:Face transplantation, composite tissue transplantation, face allograft, facial reconstruction, outcomes and complications of face transplantation.