Oral leukoplakia treatment with the carbon dioxide laser: A systematic review of the literature

We conducted a systematic review of the literature to evaluate treatment of oral leukoplakia with the carbon dioxide (CO2) laser. A comprehensive search of studies published between 1981 and 2015 and listed in the PubMed (National Library of Medicine, NCBI) database yielded 378 articles which were screened in detail. Rele- vant studies were selected according to predetermined inclusion and exclusion criteria. A total of 33 articles met the final inclusion criteria and were analysed in detail in accordance with the PRISMA-P statement. These full-text papers were classified as synopses (n 1⁄4 7), recurrence and malignant trans- formation studies (n 1⁄4 17), comparative studies between CO2 laser and cold knife surgery (n 1⁄4 3) and studies evaluating the efficacy of CO2, Nd:YAG and KTP lasers. According to the literature the CO2 laser is the workhorse of oral leukoplakia treatment due to its effectiveness and low associated morbidity. However, randomized clinical trials are needed to compare CO2 laser with other lasers. The results of our systematic review showed that there is no consensus regarding the factors involved in higher recurrence and malignization rates, so further studies are needed

The treatment of oral leukoplakia with the CO2 laser: A retrospective study of 65 patients

The use of CO2 laser has become a routine procedure for the treatment of oral leukoplakia. In this retrospective study, we evaluated 65 patients with oral leukoplakia treated with CO2 laser vaporization. The main location was the tongue (n ¼ 21/65, 32.3%). The initial biopsy showed mild/moderate dysplasia in almost half the patients (n ¼ 29, 44.6%) and hyperplasia without dysplasia in around a third of the patients (n ¼ 21, 32.3%). The recurrence and malignant transformation rates were 33.8% (n ¼ 22) and 15.4% (n ¼ 10), respectively. The follow-up mean (standard deviation) was 15.0 (10.6) months. The procedure-related complications rate was 7.7% (n ¼ 5). The KaplaneMeier curves for time to recurrence showed differences only for gingiva lesions compared to tongue lesions (log rank, p ¼ 0.032). Malignant leukoplakia transformation is independent of treatment, although it seems advisable to treat leukoplakia with or without dysplasia

Co-crystal of Tramadol-Celecoxib Versus Tramadol or Placebo for Acute Moderate-to-Severe Pain After Oral Surgery: Randomized, Double-Blind, Phase 3 Trial (STARDOM1)

Acute pain; Efficacy; Co-crystalDolor agut; Eficàcia; CocristallDolor agudo; Eficacia; CocristalIntroduction Co-crystal of tramadol-celecoxib (CTC) is the first analgesic co-crystal for acute pain. This completed phase 3 multicenter, double-blind trial assessed the efficacy and safety/tolerability of CTC in comparison with that of tramadol in the setting of moderate-to-severe pain up to 72 h after elective third molar extraction requiring bone removal. Methods Adults (n = 726) were assigned randomly to five groups (2:2:2:2:1): orally administered twice-daily CTC 100 mg (44 mg rac-tramadol hydrochloride/56 mg celecoxib; n = 164), 150 mg (66/84 mg; n = 160) or 200 mg (88/112 mg; n = 160); tramadol 100 mg four times daily (n = 159); or placebo four times daily (n = 83). Participants in CTC groups also received twice-daily placebo. The full analysis set included all participants who underwent randomization. The primary endpoint was the sum of pain intensity differences over 0 to 4 h (SPID0–4; visual analog scale). Key secondary endpoints included 4-h 50% responder and rescue medication use rates. Safety endpoints included adverse events (AEs), laboratory measures, and Opioid-Related Symptom Distress Scale (OR-SDS) score. Results All CTC doses were superior to placebo (P < 0.001) for primary and key secondary endpoints. All were superior to tramadol for SPID0–4 (analysis of covariance least squares mean differences [95% confidence interval]: − 37.1 [− 56.5, − 17.6], − 40.2 [− 59.7, − 20.6], and − 41.7 [− 61.2, − 22.2] for 100, 150, and 200 mg CTC, respectively; P < 0.001) and 4-h 50% responder rate. Four-hour 50% responder rates were 32.9% (CTC 100 mg), 33.8% (CTC 150 mg), 40.6% (CTC 200 mg), 20.1% (tramadol), and 7.2% (placebo). Rescue medication use was lower in the 100-mg (P = 0.013) and 200-mg (P = 0.003) CTC groups versus tramadol group. AE incidence and OR-SDS scores were highest for tramadol alone. Conclusions CTC demonstrated superior pain relief compared with tramadol or placebo, as well as an improved benefit/risk profile versus tramadol. Trial registration ClinicalTrials.gov identifier, NCT02982161; EudraCT number, 2016-000592-24.The study was sponsored by Mundipharma Research GmbH & Co. KG (Limburg, Germany) and bioanalytical analysis was performed by ESTEVE Pharmaceuticals S.A. (Barcelona, Spain), who invented and codeveloped CTC. CTC is now under development by ESTEVE Pharmaceuticals S.A. Scientists employed by the funder and ESTEVE Pharmaceuticals S.A. participated in the design and conduct of the study, data review and interpretation, and drafting of the article. Funding for the journal’s Rapid Service and Open Access Fees was provided by ESTEVE Pharmaceuticals S.A

Manejo de la vía aérea en oncología de cabeza y cuello

ResumenIntroducciónEl manejo de la vía aérea en cirugía de cabeza y cuello presenta varios retos tanto para el cirujano como para el anestesista. El empleo de la traqueostomía electiva es ampliamente usado pero continúan existiendo algunas controversias en la literatura al respecto.Material y métodosSe ha realizado un estudio prospectivo analizando aspectos clínicos, indicaciones y complicaciones en 57 pacientes afectados de enfermedad oncológica de cabeza y cuello que requirieron la realización de una traqueostomía durante el período comprendido entre enero de 2011 y junio de 2012 en el servicio de cirugía oral y maxilofacial del Hospital Universitario Vall d́Hebron de Barcelona.ResultadosEl grupo de pacientes que recibieron una reconstrucción microquirúgica fue el mayoritario que requirió una traqueostomía (40,35%). La tasa de complicaciones asociada con la técnica fue del 22,8%, de las cuales el 7% fueron consideradas mayores y 5,8% menores. La tasa de complicaciones asociadas con los cuidados de la cánula fue del 15,8%.ConclusionesLa traqueostomía es un método simple y efectivo para el manejo de la vía aérea difícil en pacientes oncológicos de cabeza y cuello asociada a una baja tasa de complicaciones.AbstractBackgroundAirway management in head and neck surgery presents several challenges to the surgeon and the anaesthesist. The use of elective tracheostomy is widely used, but there is still some controversy in the literature.MethodsA prospective study analyzing clinical aspects, indications and complications of 57 head and neck patients who underwent tracheostomy was performed from January 2011 to June 2012 in the Oral and Maxillofacial Surgery Department of Vall D́Hebron Hospital, Barcelona, Spain.ResultsMicrovascular reconstruction patients were the most frequent group in which tracheostomy was performed (40.35%). The complications rate associated with the technique was of 22.8%, of which only 7% were considered major, and 5.8% minor.The complication rate in relation to cannula care was 15.8%.ConclusionsWe conclude that tracheostomy is a simple and effective method for airway management in head and neck patients, with a low complication rate

Outcomes Following Autologous Fat Grafting in Patients with Sequelae of Head and Neck Cancer Treatment

Autologous fat grafting; Quality of life; ReconstructionInjerto autólogo de grasa; Calidad de vida; ReconstrucciónEmpelt autòleg de greix; Qualitat de vida; ReconstruccióA single-center retrospective study was designed to assess the outcomes of autologous fat grafting for improving surgery- and radiotherapy-related sequelae in 40 patients with head and neck cancer. All patients underwent surgical resection of primary tumors and radiotherapy (50–70 Gy) and were followed over 12 months after fat grafting. Eligibility for fat grafting procedures included complete remission after at least 3 years of oncological treatment. The cervical and paramandibular regions were the most frequently treated areas. Injected fat volumes ranged between 7.5 and 120 mL (mean: 23 mL). Esthetic improvement was obtained in 77.5% of patients, being significant in 17.5%, and functional improvement in 89.2%, being significant in 29.7% of patients. Minor complications occurred in three patients. There was a high degree of satisfaction regarding esthetic improvement, global satisfaction, and 92.5% of patients would recommend the procedure. This study confirms the benefits of fat grafting as a volumetric correction reconstructive strategy with successful cosmetic and functional outcomes in patients suffering from sequelae after head and neck cancer treatment

Characteristics and age-related injury patterns of maxillofacial fractures in children and adolescents: A multicentric and prospective study

Children; Epidemiology; Maxillofacial fracturesNiños; Epidemiología; Fracturas maxilofacialesNens; Epidemiologia; Fractures maxil·lofacialsBackground/Aims Paediatric maxillofacial trauma accounts for 15% of all maxillofacial trauma but remains a leading cause of mortality. The aim of this prospective, multicentric epidemiological study was to analyse the characteristics of maxillofacial fractures in paediatric patients managed in 14 maxillofacial surgery departments on five continents over a 1-year period. Methods The following data were collected: age (preschool [0–6 years], school age [7–12 years], and adolescent [13–18 years]), cause and mechanism of the maxillofacial fracture, alcohol and/or drug abuse at the time of trauma, fracture site, Facial Injury Severity Scale score, associated injuries, day of the maxillofacial trauma, timing and type of treatment, and length of hospitalization. Statistical analyses were performed using SPSS software. Results Between 30 September 2019 and 4 October 2020, 322 patients (male:female ratio, 2.3:1) aged 0–18 years (median age, 15 years) were hospitalized with maxillofacial trauma. The most frequent causes of the trauma were road traffic accidents (36%; median age, 15 years), followed by falls (24%; median age, 8 years) and sports (21%; median age, 14 years). Alcohol and/or drug abuse was significantly associated with males (p < .001) and older age (p < .001). Overall, 474 fractures were observed (1.47 per capita). The most affected site was the mandibular condyle in children <13 years old and the nose in adolescents. The proportion of patients who underwent open reduction and internal fixation increased with age (p < .001). Conclusion The main cause of paediatric maxillofacial fractures was road traffic accidents, with the highest rates seen in African and Asian centres, and the frequency of such fractures increased with age. Falls showed an inverse association with age and were the leading cause of trauma in children 0–6 years of age. The choice of treatment varies with age, reflecting anatomical and etiological changes towards patterns more similar to those seen in adulthood.Open Access funding provided by Universita degli Studi di Torino within the CRUI-CARE Agreement

Osteomas de los senos paranasales

Se revisaron 21 pacientes con osteomas de los senos paranasales de un total de 86 pacientes estudiados, afectos de osteomas de la región craneofacial, con una media de edad de cincuenta años y predominio masculino (211). La localización más frecuente de los osteomas paranasales fue el seno frontal (57 por 100), seguido de los senos maxilar, etmoidal y esfenoidal. Se destaca la gran proporción de casos que fueron diagnosticados fortuitamente (45 por 100). La cefalea fue el síntoma más precoz y frecuentemente encontrado (57 por 100). Del total de los 21 pacientes, 18 fueron intervenidos quirúrgicamente, realizándose exéresis simple del osteoma paranasal. Se realiza un estudio de los datos obtenidos, así como una revisión de la literatura en cuanto a la incidencia, localización, diagnóstico, indicaciones y técnicas quirúrgicas empleadas en este tipo de osteoma

Osteoma periférico gigante del maxilar superior

Entre los osteomas de la región cráneofacial, la localización en el maxilar superior es relativamente rara. Presentamos el caso de un gran osteoma periférico del maxilar superior que, debido a su exhuberante crecimiento, impedía la deglución y causaba dificultad respiratoria severa. El interés de este caso residió en la localización infrecuente, el crecimiento exagerado, y la sintomatología atípica acompañante. Basándonos en esta observación, hacemos una revisión de la literatura, comentando la etiopato­genia, frecuencia, localización, diagnóstico e indicaciones del tratamiento quirúrgico de estos tumores

Osteoma periférico gigante del maxilar superior

Entre los osteomas de la región cráneofacial, la localización en el maxilar superior es relativamente rara. Presentamos el caso de un gran osteoma periférico del maxilar superior que, debido a su exhuberante crecimiento, impedía la deglución y causaba dificultad respiratoria severa. El interés de este caso residió en la localización infrecuente, el crecimiento exagerado, y la sintomatología atípica acompañante. Basándonos en esta observación, hacemos una revisión de la literatura, comentando la etiopato­genia, frecuencia, localización, diagnóstico e indicaciones del tratamiento quirúrgico de estos tumores

Osteomas de los senos paranasales

Se revisaron 21 pacientes con osteomas de los senos paranasales de un total de 86 pacientes estudiados, afectos de osteomas de la región craneofacial, con una media de edad de cincuenta años y predominio masculino (211). La localización más frecuente de los osteomas paranasales fue el seno frontal (57 por 100), seguido de los senos maxilar, etmoidal y esfenoidal. Se destaca la gran proporción de casos que fueron diagnosticados fortuitamente (45 por 100). La cefalea fue el síntoma más precoz y frecuentemente encontrado (57 por 100). Del total de los 21 pacientes, 18 fueron intervenidos quirúrgicamente, realizándose exéresis simple del osteoma paranasal. Se realiza un estudio de los datos obtenidos, así como una revisión de la literatura en cuanto a la incidencia, localización, diagnóstico, indicaciones y técnicas quirúrgicas empleadas en este tipo de osteoma