Should oral foci of infection be removed before the onset of radiotherapy or chemotherapy?

Pretreatment dental screening aims to locate and eliminate oral foci of infection in order to eliminate local, loco-regional, or systemic complications during and after oncologic treatment. An oral focus of infection is a pathologic process in the oral cavity that does not cause major infectious problems in healthy individuals, but may lead to severe local or systemic inflammation in patients subjected to oncologic treatment. As head and neck radiotherapy patients bear a lifelong risk on oral sequelae resulting from this therapy, the effects of chemotherapy on healthy oral tissues are essentially temporary and reversible. This has a large impact on what to consider as an oral focus of infection when patients are subjected to, for example, head and neck radiotherapy for cancer or intensive chemotherapy for hematological disorders. While in patients subjected to head and neck radiotherapy oral foci of infection have to be removed before therapy that may cause problems ultimately, in patients that will receive chemotherapy such, so-called chronic, foci of infection are not in need of removal of teeth but can be treated during a remission phase. Acute foci of infection always have to be removed before or early after the onset of any oncologic treatment

Effects of on-farm hatching on short term stress indicators, weight gain, and cognitive ability in layer chicks

Layer chicks are usually transported early in life, experiencing immediate post-hatch food and water deprivation and various transport-related stressors with potentially negative long-term consequences for learning, cognition and welfare. In contrast, as chicks are only temporarily exposed to these stressors, the experienced stress could be sub-chronic which may improve cognitive flexibility. The aim of this exploratory study was therefore to investigate the acute and long-term effects of on-farm hatching (OFH) compared to conventional hatching. Dekalb White layer chicks were subjected to either OFH (n = 47) with ad libitum access to feed and water or temporary post-hatch resource deprivation and eight hour transport (RDT; n = 42). Physical and behavioural measures were collected to examine short-term effects of the treatment procedures. To determine longer term effects, treatment differences in learning and cognitive flexibility were assessed in a Y-maze using several paradigms (reversal, attentional-shift, extinction) between 4 and 12 weeks of age (WOA). Compared to OFH chicks, RDT had: greater corticosterone levels after transport (F1,19 =8.15, p = 0.01, RDT (16.24 ± 1.20 ng/mL) vs. OFH (8.13 ± 1.20 ng/mL) and post-recovery (F1,19 =4.93, p = 0.04; RDT (11.69 ± 1.35 ng/mL) vs. OFH (5.31 ± 1.37)), and lower body mass after resource deprivation and transport (F2258 =9.7, p < 0.001, RDT (33.14 ± 0.33 g) vs. OFH (37.62 ± 0.28 g)). Performance of activity behaviours (foraging, drinking, resting, wing-assisted running) after transport exhibited treatment by time interactions. Additionally, a tendency for OFH being heavier than RDT chicks was observed up to 11 WOA. The majority of birds learned the initial association in the Y-maze between a reward and location (77% of n = 19 RDT and n = 29 OFH chicks) or light stimulus (91% of n = 12 RDT and n = 11 OFH chicks). Subsequently, a number of chicks reached the learning criterion in the location reversal (24% of n = 13 RDT and n = 24 OFH chicks) and the light-to-location attentional-shift (47% of n = 11 RDT and n = 10 OFH chicks), and most of these chicks succeeded in the following extinction paradigm (80% of n = 3 RDT and n = 7 OFH chicks). No treatment effects were detected in any phase of cognitive testing. In conclusion, treatment affected behaviour and health parameters suggesting RDT animals were recovering from resource deprivation and transport. Continued treatment differences in body mass throughout rearing demonstrated long term effects as well although no effects on initial learning and cognitive flexibility were identified. Future work is needed to determine what mechanisms are responsible for the observed health and behavioural differences

What is the optimal timing for implant placement in oral cancer patients? A scoping literature review:A scoping literature review

Background Oral cancer patients can benefit from dental implant placement. Traditionally, implants are placed after completing oncologic treatment (secondary implant placement). Implant placement during ablative surgery (primary placement) in oral cancer patients seems beneficial in terms of early start of oral rehabilitation and limiting additional surgical interventions. Guidelines on the ideal timing of implant placement in oral cancer patients are missing. Objective To perform a scoping literature review on studies examining the timing of dental implant placement in oral cancer patients and propose a clinical practice recommendations guideline. Methods A literature search for studies dealing with primary and/or secondary implant placement in MEDLINE was conducted (last search December 27, 2019). The primary outcome was 5-year implant survival. Results Sixteen out of 808 studies were considered eligible. Both primary and secondary implant placement showed acceptable overall implant survival ratios with a higher pooled 5-year implant survival rate for primary implant placement 92.8% (95% CI: 87.1%-98.5%) than secondary placed implants (86.4%, 95% CI: 77.0%-95.8%). Primary implant placement is accompanied by earlier prosthetic rehabilitation after tumor surgery. Conclusion Patients with oral cancer greatly benefit from, preferably primary placed, dental implants in their prosthetic rehabilitation. The combination of tumor surgery with implant placement in native mandibular bone should be provided as standard care

Mandibular dental implant placement immediately after teeth removal in head and neck cancer patients

BACKGROUND: Little is known about immediate implant placement in head and neck cancer patients. We studied implant survival and functional outcomes of overdentures fabricated on implants placed immediately after removal of the lower dentition during ablative surgery or preceding primary radiotherapy (RT). METHODS: Inclusion criteria were primary head and neck cancer, dentate lower jaw, and indication for removal of remaining teeth. Two implants to support a mandibular overdenture were placed immediately after extraction of the dentition during ablative surgery, or prior to starting primary radiotherapy. Standardized questionnaires and clinical assessments were conducted (median follow-up 18.5 months, IQR 13.3). RESULTS: Fifty-eight implants were placed in 29 patients. Four implants were lost (implant survival rate 93.1%). In 9 patients, no functional overdenture could be made. All patients were satisfied with their dentures. CONCLUSIONS: Combining dental implant placement with removal of remaining teeth preceding head neck oncology treatment results in a favorable treatment outcome

Management strategy after diagnosis of Abernethy malformation: a case report

<p>Abstract</p> <p>Introduction</p> <p>The Abernethy malformation is a rare anomaly with a widely variable clinical presentation. Many diagnostic dilemmas have been reported. Nowadays, with the evolution of medical imaging, diagnosis can be made more easily, but management of patients with an Abernethy malformation is still open for discussion.</p> <p>Case presentation</p> <p>In this case study, we describe a 34-year-old Caucasian man who presented with a large hepatocellular carcinoma in the presence of an Abernethy malformation, which was complicated by the development of pulmonary arterial hypertension.</p> <p>Conclusion</p> <p>This case underlines the importance of regular examination of patients with an Abernethy malformation, even in older patients, to prevent complications and to detect liver lesions at an early stage.</p

Patient-specific finite element models of the human mandible:Lack of consensus on current set-ups

The use of finite element analysis (FEA) has increased rapidly over the last decennia and has become a popular tool to design implants, osteosynthesis plates and prostheses. With increasing computer capacity and the availability of software applications, it has become easier to employ the FEA. However, there seems to be no consensus on the input variables that should be applied to representative FEA models of the human mandible. This review aims to find a consensus on how to define the representative input factors for a FEA model of the human mandible. A literature search carried out in the PubMed and Embase database resulted in 137 matches. Seven papers were included in this current study. Within the search results, only a few FEA models had been validated. The material properties and FEA approaches varied considerably, and the available validations are not strong enough for a general consensus. Further validations are required, preferably using the same measuring workflow to obtain insight into the broad array of mandibular variations. A lot of work is still required to establish validated FEA settings and to prevent assumptions when it comes to FEA applications

Secondary surgical management of osteoradionecrosis using three-dimensional isodose curve visualization:a report of three cases

Osteoradionecrosis is defined as bone death secondary to radiotherapy. There is a relationship between the radiation dose received and the occurrence of osteoradionecrosis of the jaws, with the risk increasing above a dose of 60Gy. In cases of class III mandibular osteoradionecrosis, a segmental resection can be indicated. Current practice is to completely remove the affected bone up to the point where the bone looks healthy and is bleeding. Exact resection planning and the use of guided surgery based on imaging of the bone changes have not been reported so far. This article describes a method whereby the radiotherapy dose information is incorporated into the imaging of the affected bone in order to plan a three-dimensional (3D) virtual guided resection and reconstruction of the mandible in osteoradionecrosis. The method enables 3D visualization of each desired dose field in relation to the 3D model of the affected bone. Two types of application - for resection and reconstruction - are described.</p

The Impact of the Extent of Lymphadenectomy on Oncologic Outcomes in Patients Undergoing Radical Cystectomy for Bladder Cancer : A Systematic Review

Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.Peer reviewedPostprin

Prosthodontic rehabilitation of head and neck cancer patients-Challenges and new developments

Head and neck cancer treatment can severely alter oral function and aesthetics, and reduce quality of life. The role of maxillofacial prosthodontists in multidisciplinary treatment of head and neck cancer patients is essential when it comes to oral rehabilitation and its planning. This role should preferably start on the day of first intake. Maxillofacial prosthodontists should be involved in the care pathway to shape and outline the prosthetic and dental rehabilitation in line with the reconstructive surgical options. With the progress of three-dimensional technology, the pretreatment insight in overall prognosis and possibilities of surgical and/or prosthetic rehabilitation has tremendously increased. This increased insight has helped to improve quality of cancer care. This expert review addresses the involvement of maxillofacial prosthodontists in treatment planning, highlighting prosthodontic rehabilitation of head and neck cancer patients from start to finish